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A patient suffers a cerebral vascular accident stroke which damages part of his primary motor cortex leaving his left leg paralysed A second patient suffers an automobile accident in which his left sciatic nerve is severed paralysing his leg Describe and contrast the effects on the leg muscles of these two injuries including a description of the pathways involved Patient A is suffering from an upper motor neuron lesion due to stroke also known as a cerebrovascular accident CVA a stroke is a life-threatening event in which part of the brain is deprived of adequate oxygen Strokes are extremely dangerous accounting for more than 160000 deaths in 2001 according to the American Heart Association Stroke is the third leading cause of death in the United States behind heart disease and cancer It is also a leading cause of adult disability and institutionalization Fig1 reference 5 There are two kinds of strokes An ischemic stroke which accounts for more than 88 of stroke occurs when the blood supply to the brain is interrupted usually by a blood clot thrombosis These clots may be caused by hardening of the arteries atherosclerosis in the carotid arteries which feed the head and brain with oxygen-rich blood The second kind of stroke is a hemorrhagic stroke which occurs when there is excessive bleeding haemorrhaging within or around the brain Bleeding within the brain is known as a cerebral haemorrhage which is often due to complication of high blood pressure Bleeding around the brain is known as subarachnoid haemorrhage which could be caused by ruptured cerebral aneurysm a head injury or other causesreference 5 After a stroke begins it is imperative that people seek treatment as soon as possible to re-establish the flow of oxygen-rich blood to the brain cells before permanent tissue damage or death occurs reference 6 Fig 2 Reference 7 The upper motor neurone system can be divided into pyramidal
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