The brain is part of a complex system in the body that contains 100 billion nerves that transmit electrical impulses, known as the nervous system.(7) The nervous system is divided into two main parts, the central nervous system, and the peripheral nervous system, and its purpose is to regulate all sensory, motor, autonomic, cognitive, and x activities. The nervous system also maintains the body's external and internal environments. Additionally, the brain is split into two hemispheres, left and right(1) (8) (9). The frontal, parietal, temporal, and occipital lobes of the cerebrum are separated. The frontal lobe regulates inhibitions, judgment, personality, and the storage of abstract information as well as motor function and speech control. The vertebral arteries branch from the subclavian arteries to serve most of the brain stem, the basilar arteries choose from the two branches of the posterior cerebral arteries, and the common carotid arteries arise at the bifurcation of the common carotid arteries. The vertebral arteries unite the two branches of the brain stem to which the basilar artery is divided.(10) Aneurysms and haemorrhages are caused by any injury to the arteries. Any functional abnormalities of the central nervous system (CNS), peripheral nervous system (PNS), or both are referred to as cerebrovascular disorders.(11) In India, there are 145 cases of cerebrovascular disorders for every 100,000 individuals. There are two different forms of stroke. Ischemic stroke is one type, and A form of ischemic stroke that affects the central nervous system is a cerebral vascular accident. 145 cases in 100,000 patients make up the incidence rate. With a higher incidence rate for men (2.39% vs. 1.22%) than for women, Urban communities reported slightly more strokes than rural areas did (2.01% vs. 1.57%). However, early detection and treatment are lowering the death rate and lowering the chance of developing diseases (4) (12) (13). bleeding-related stroke Although there are some parallels between the two types of strokes, there are differences in the Etiology, pathophysiology, and medical therapy with nursing. An ischemic stroke sometimes referred to as a cerebrovascular accident (CVA) or a cerebrovascular event, is a clinical condition that results from an interruption in the blood flow to any area of the brain. And the central nervous system is affected by cerebrovascular accident, which results in bulbar palsy. It is a muscle immobility inverted by cranial nerves with their cell body and the lower part of the brain stem that is associated with bulbar palsy. The symptom of bulbar palsy is facial dropping with upper motor neuron damage caused by inoperative spell laugh/crying with jaw jerk with an increased gag reflex and atrophy of tongue the bulbar palsy happens when the Vth, VIIth, IXth, Xth, XIth, and XIIth cranial nerve these nerves situated at medulla oblongata when the motor fibber of nucleus ambiguous is the branchiomotor fibber the IXth, Xth, and XIth nerves are attach with larynx and pharynx and the XIIth nerve attach to the tongue is get affected upper motor palsy in 60%. The doctor's advice is for prompt admission and vigorous therapy.(14)
a comparable instance of pseudobulbar palsy A 61-year-old man with symptoms of dysphagia and difficulty speaking but no motor impairment presented to the emergency room. He was also a chronic alcoholic with a history of hypertension and diabetes mellitus. On neurological examination, the patient was agitated and showed signs of cognitive impairment, making it difficult for him to maintain time, place, and person orientation. The soft palate was dropped, and the tongue protruded gently and consistently without any aberrations. With the exception of proprioception and touch on the lower limb, a sensory function was also unaltered. Emergent enhanced computed tomography of the brain revealed possible bilateral thalamic infarction, mild atherosclerotic changes in the left and right cavernous and petrous internal carotid arteries (ICA), the origin of the left ICA, and the V4 segment of the left vertebral artery with no significant stenosis. The presence of limited diffusion was later confirmed by magnetic resonance imaging (MRI) of these findings. While there was no evidence of a brainstem lesion, MRI results showed symmetrical high signal intensity in both thalami on diffusion-weighted and rapid spin-echo T2-weighted images and low signal intensity on apparent diffusion coefficient maps at the same level. The patient had acute-stage management in the Department of Neurology before being moved to a rehabilitation facility. Nine days after the onset of symptoms, a speech evaluation indicated significant dysarthria with palilalia, hyper nasality, and erroneous consonants. Speech intelligibility dropped to between 50% and 55% as a result of decreasing alternating motion rates (AMRs) and sequential motion rates (SMRs). Treatments for dysphagia that the patient received included shaker exercises, Mendelsohn maneuvers, tongue retraction exercises, effortful swallowing exercises, oral motor exercises, and pharyngeal tactile stimulation. He also received treatment for his dysarthria and instruction in respiration-phonation. Tests using motor and sensory evoked potentials were also carried out. Motor-evoked potential stimulation of the bilateral abductor pollicis brevis and abductor hallucis muscles revealed no clearly aberrant findings and no malfunction of the cortical pathway.(11) (3) (1)
In this case, A 64-year-old man who was receiving ayurvedic treatment went to the hospital complaining of facial drooping, left-side weakness, speech problems, and breathing difficulties. Prior to the onset of the symptoms, the patient appeared well., having a history of an inguinal hernia from more than 20 years ago and being treated for hypertension (HTN) with tablets of amlodipine (5 mg) and Ecosprin (75 mg) orally daily, according to his son. there is no history of loss of consciousness or seizures episode at home early investigation was done and CT-Brain shows acute infract on left corona radiata and right corona radiata (fig no.1) with age-related atrophic changes with small vessel disease, ECG shows sinus tachycardia, Chest X-ray imagining revels that patient having consolidation of fibro-bronchiectasis changes in the right upper lobe. Right upper and subpleural blebs in apical regions: focal areas of Para septal and centrilobular emphysematous changes and MRI Brain reveal acute infarct in left and right corona radiata with age-related atrophic changes and admitted in Medical ICU. With final diagnosis sepsis with cerebrovascular event with pseudobulbar palsy. A type of ischemic stroke that affects the central nervous system is a cerebral vascular accident. Having an incidence rate of 145 patients in 100,000 patients. And men are more likely to get pregnant than women (2.39% vs. 1.22%) Urban communities reported slightly more strokes than rural areas did. (2.01% vs. 1.57%). (6) However, early detection and treatment are lowering the death rate and lowering the chance of developing diseases.