Deficits after a Stroke according to its location

There are various possible disabilities resulting from a stroke: hemiparesis (one-sided body weakness), paralysis of one side of the face, slurred speech, motor impairments, etc.

Although medical treatment and physical rehabilitation help in the recovery of stroke survivors, a stroke often leaves a lasting mark. Depending on the location and extent of the damage, it may cause moderate to severe disabilities.

The brain is a complex structure which can be divided into 3 sections: the forebrain, the midbrain and the hindbrain. Damage to each of these areas results in different types of disabilities.

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Stroke in the Forebrain

Some of the major functions of the forebrain are receiving and processing sensory information, thinking, creating and understanding language, perceiving, and controlling motor function.

The forebrain can be divided into two structures: the diencephalon and the telencephalon.

  • The diencephalon is composed of the thalamus and the hypothalamus which are responsible for functions such as motor control, autonomic functions and relaying sensory information.
  • The telencephalon is made up of the largest part of the brain, the cerebral cortex (or cerebrum). The cerebrum is divided in four lobes: the frontal, parietal, occipital and temporal lobe.

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The frontal lobe
is located at the front  of the brain.

It is associated with higher level cognitive functions like reasoning and judgment. This lobe also contains important cortical areas which are responsible for voluntary control of muscle movement including those responsible for the production of speech and swallowing. Broca’s area is a part of the frontal lobe which is necessary for the coordination or programming of motor movements for the production of speech sounds. It is also involved in syntax which involves morphology (the allomorphs at the ends of words) and the ordering of words. The frontal lobe is also a significant part of the brain dealing with emotions, problem solving, reasoning, and planning.

When a stroke affects the frontal lobe, the following deficits can be expected:

  • Broca’s aphasia or expressive aphasia (difficulty conveying thoughts through speech or writing)
  • Apraxia (altered voluntary movements)
  • Confusion, disorganized thinking
  • Altered reasoning and judgment
  • Hemiplegia (one-sided paralysis)
  • Dysphagia (difficulty in swallowing)
  • Clinical depression

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The parietal lobe
is located behind the frontal lobe.

It is primarily associated with sensation, including the sense of touch, kinesthesia, vibration and feeling of warmth and cold. This part of the brain is involved in controlling functions like recognition, orientation, movement, and perception of stimuli. It is also involved in reading and some aspects of writing.

When a stroke happens, the following conditions can be expected:

  • Hemineglect (one-sided inability to respond to objects or sensory stimuli)
  • Paresthesia (numbness, sensation of tingling in paralyzed or weakened limbs)
  • Anomia (difficulty with word-finding or naming)
  • Alexia with agraphia (difficulties with reading and writing)
  • Finger agnosia (lack of sensory ability to identify which finger is which)
  • Acalcula (difficulties with arithmetic)
  • Left-right disorientation (inability to distinguish right from left)

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The occipital lobe
is located at the most posterior portion of the brain and is mainly involved in vision. The primary visual area receives the input while the secondary visual area integrates the input and gives meaning to it.

When a stroke occurs, the following conditions can be expected:

  • Visual field deficit, or VFD
  • Blind spots in the visual field or total blindness
  • Visual agnosia (can see visual stimuli but cannot associate them with any meaning or identify their function)

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The temporal lobe
is located in front of the occipital lobe.

It is responsible for memory, auditory processing and olfaction and has also important functions in semantics or word meaning. Wernicke’s area is an important component of this lobe. Wernicke’s area is responsible for the ability to understand and produce meaningful speech.

When a stroke attacks the following conditions can be expected:

  • Hearing difficulties
  • Memory deficit
  • Anosognosia (inability to recognize physical impairments after a stroke attack)
  • Wernicke’s aphasia or receptive aphasia (language disorder that impacts language comprehension and the production of meaningful language)

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Stroke in the Midbrain

The midbrain, or mesencephalon, is situated behind the frontal lobe and in the middle of the entire brain. It is mainly involved in functions such as vision, hearing and body and eye movements. Portions of the midbrain which are called the red nucleus and the substantia nigra are involved in body movement control.

If a stroke strikes, the following symptoms are expected from the patient:

  • Visual field deficit, or VFD
  • Hearing impairment
  • Uncoordinated body movement
  • Involuntary eye movement

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Stroke in the Hindbrain

The hindbrain (rhombencephalon) is the posterior part of the brain and is composed of:
- The cerebellum
- The pons
- The medulla

The midbrain, pons and medullas are collectively referred to as the brain stem together with the 12 cranial nerves


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The cerebellum plays a very crucial part in maintaining balance and equilibrium, coordinating muscle movement and conduction of sensory information. It does not initiate movement but it contributes to movement precision and accurate timing.

Damage to the cerebellum during stroke attack includes:

  • Ataxia (inability to coordinate movement)
  • Difficulties in speed
  • Gait impairments and problems with leg coordination
  • Vertigo and disequilibrium

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The Pons
is located just above the medulla and below the midbrain.

It relays signals from the forebrain to the cerebellum and deals primarily with breathing, sleep, swallowing, bladder control, hearing, tastes, equilibrium, posture, eye movement, facial expressions and facial sensation. Inside it is the pneumotaxic center which regulates the change from inspiration to expiration.

The resulting damage to the pons during stroke attack includes:

  • Alteration of smell, taste, hearing, or vision (total or partial)
  • Urinary incontinence
  • Drooping of eyelid (ptosis) and weakness of ocular muscles
  • Decreased reflexes: swallow, gag and pupil reactivity to light
  • Decreased sensation and muscle weakness of the face
  • Weakness in tongue
  • Nystagmus (involuntary eye movement)
  • Alteration of breathing pattern

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The medulla rhythmically stimulates the intercostal muscles and diaphragm, regulates heartbeat and regulates the diameter of arterioles thus adjusting blood flow. It also includes autonomic function such as vomiting and digestion.

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Damage to the medulla during stroke attack includes:

  • Loss of bowel control and constipation
  • Alteration of heart rate
  • Alteration of breathing pattern
  • Blood pressure changes

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10 thoughts on “Deficits after a Stroke according to its location

  1. Why would blood not be absorbed when a stroke occurs in the mid brain? I have been told they cannot operate to remove it so what can they do?

  2. MRI show T2weighted images show low attenuating area in both occipital and posterior parietal lobes. corresponding area show low singnal in T1 and FLAIR images and perihemispheric CSPspaces are prominent

  3. Would other areas of the brain improve their function after surgery for a subdural hemorrhage in the right frontal lobe? After surgery, I experienced seizures(ongoing and medication controlled), but no other of the cited deficits. I seem to have advanced analytical skills, however, although I was always analytical, just not quite as skilled as I am today. I experienced this in rehab in June 2008. Could it be the perseverance that is indicated as a personality change or neuroplasticity in other parts of the brain? My neurologist indicated that the residual scar tissue from the craniotomy surgery may put subtle pressure on that part of the brain, which will perpetuate the seizure disorder for life. I was told that the cognition and executive function would likely prevent me from returning to my previous occupation as a CEO. Although, I have developed a startup company post-rehab and am prospecting for funding. Entrepreneurs have told me that I have the tools to obtain our required investment and that my approach will meet with success. I am wondering whether or not, I am being delusional as to my abilities to actually execute the business plan that I conceived, researched, developed and now am pitching to investors. Once funded, the CEO responsibilities will be intense and intellectually demanding. I am surrounded by hand picked, highly competent professional managers, but my vision will require me to champion the execution of the strategy. Am I expecting too much of myself?
    One comment I have on cognitive rehab, is that an institution has no baseline to compare your cognitive deficit to and they treat each patient with a vanilla approach, which may often be misleading. I was found to be lacking social skills while playing UNO, yet I always disliked simplistic card games and anything one dislikes, he/she is not necessarily interested in. Conversely, I was completing complex mathematical and reading comprehension tests which the neuropsychologists themselves reported having difficulty doing.
    Other then having a rude awakening as to how fortunate I was as compared to most patients, I believe that cardiac rehab would have been more appropriate(I had two heart valve surgeries within one month of my stroke). I might add that the cognitive rehab that I describe was the “activities of daily living portion”, whereas the initial rehab was in a controlled hospital setting, where I was being rehabbed many for physical deficits from 60 days of hospitalization. I was 113 days in hospitals and rehabilitation.
    Best, Dave

  4. my husband recently was in the hospital unable to talk, eyesight & hearing distorted & confused. The drs. @ this small town hosp. said it was due to a coumidan level that was too high & “out of whack” then (after 2 days) released him. Can coumidan cause these ‘stroke-like’ symptoms if the levels are off? A response ASAP would be greatly appreciated!

  5. My brother had a stroke affecting the thalamus and hypothalamus over 2 years ago. Is there anything that can help with the constant temperature change from within? Also his sleep/wake patterns have been affected as well as his slowness to communicate his thoughts with a lot of facial (licking /smacking lips and garbled gutteral sounds preceding his verbal attempt at talking. Is there any hope for improvement at all? Also, is it possible to get PBA from this type of stroke?

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