BASAL GANGLIA STROKE: TYPES, SIGNS, TREATMENT, AND RECOVERY

Medically Reviewed by Dr. Rae Osborn, Ph.D. 

The basal ganglia refers to a cluster of deep brain structures vital for coordinating movement, regulating behavior, and processing emotions^[1]. A basal ganglia stroke occurs when the blood supply to this region is disrupted, either due to a blockage (ischemic stroke) or a bleed (hemorrhagic stroke).

Basal ganglia strokes differ from those affecting other brain regions because they often lead to distinct symptoms. These symptoms can include movement disorders, changes in personality or mood, and cognitive difficulties. These differences are due to the unique functions of the basal ganglia within the brain.

As with any stroke, timely medical attention is critical for patients with suspected basal ganglia strokes. Speedy intervention can effectively minimize brain damage and improve the chances of survival and recovery. Understanding the potential signs and symptoms of a basal ganglia stroke is important so anyone can recognize them and seek help immediately.

What are the Basal Ganglia?

The basal ganglia are a cluster of interconnected nuclei (groups of nerve cells) situated deep within the brain.

The main components include^[2]:

• Striatum: The basal ganglia's input center, comprising the caudate nucleus and putamen.
• Globus Pallidus (Internal and External): Involved in motor regulation^[3].
• Substantia Nigra: Plays a role in movement and reward processes^[4].
• Subthalamic Nucleus: Involved in regulating movement^[5].

Roles of the Basal Ganglia

The basal ganglia play several vital roles in movement, cognition, mood, and behavior:

• Action Selection: The basal ganglia help select which movements to initiate and which to suppress. They act like a filter, allowing desired movements to proceed while preventing unnecessary or conflicting ones^[6].
• Smooth and Coordinated Movement: The basal ganglia help refine movements, ensuring they are executed smoothly, with proper timing and force.
• Reward and Motivation: The basal ganglia process rewards, influencing motivation and goal-directed behavior.
• Habit Formation: These structures play a role in learning and automating habitual behaviors^[7].
• Decision-Making and Executive Function: The basal ganglia contribute to complex cognitive processes such as decision-making, planning, and problem-solving^[8].

Types of Strokes Affecting the Basal Ganglia

Several types of stroke can affect the basal ganglia, each with its respective causes^[9].

Regardless of the type, a stroke impacting the basal ganglia can lead to movement, behavioral, and cognitive difficulties, which are characteristic of basal ganglia damage.

Hemorrhagic Stroke

This occurs when a weakened blood vessel within the brain ruptures or leaks. The leaked blood pools, compressing surrounding brain tissue and disrupting normal function. Up to 13% of strokes are hemorrhagic.

The small size of the blood vessels in the basal ganglia can predispose this deep brain region to hemorrhagic strokes, especially in older people where cerebral small vessel disease is more likely^[10]. Blood vessel abnormalities like arteriovenous malformations may predispose a person to this type of stroke^[11]. The cause of an AVM is not known for sure but seems related, in some cases, to gene mutations^[12]. The presence of an aneurysm also increases the odds of a hemorrhagic stroke since these are weakened areas of blood vessels, causing blood flow disruptions that lead to a hemorrhage.^[13]

Chronic high blood pressure (hypertension) is the most significant risk factor that leads to weakened blood vessel walls^[14].

Other risk factors include:

• Using blood thinners and blood clotting disorders like hemophilia or sickle-cell anemia. These can lead, in general, to an increased risk of hemorrhagic stroke anywhere in the brain.
• Cerebral small vessel disease (CSVD): This is when small vessels are damaged in the brain^[15]. This can sometimes lead to hemorrhagic stroke.

Ischemic Stroke

This type of stroke manifests with a blockage (usually a blood clot) that cuts off the blood supply to a brain region. Brain cells starved of oxygen and nutrients begin to die, resulting in brain damage. Ischemic strokes comprise the bulk of strokes, an average of 87% of all cases.^[16]

Basal ganglia ischemic strokes are often lacunar strokes. These involve the blockage of tiny, deeply penetrating arteries supplying the basal ganglia and other deep brain structures^[17]. This is caused by:

• Cerebral small vessel disease: This is associated with large artery atherosclerosis^[18]. i
• Embolism: Ischemic strokes may also result when embolisms - blood clots that form outside the brain or its major arteries - break off from where they initially developed and travel through the blood toward the brain, blocking off the blood supply and leading to a stroke.^[19]

Risk factors for basal ganglia strokes include^[20]:

• High blood pressure
• Diabetes and blood vessel abnormalities
• The presence of calcifications in the basal ganglia^[21]

General risk factors for strokes

• High cholesterol
• Dyslipidemia
• Smoking
• Heart disease
• Atrial fibrillation (irregular heartbeat)

Transient Ischemic Attack (TIA)

A TIA is comparable to an ischemic stroke. However, the blockage is not as severe. Symptoms usually resolve within minutes to a few hours. These strokes are sometimes called “mini-strokes.”

Despite being less severe, they can still result in stroke-related complications and often require immediate medical attention. Individuals suffering from TIA episodes are also at a higher risk of contracting a full-blown stroke and need close monitoring.^[22]

Risk factors are similar to those of Ischemic strokes.

Childhood Basal Ganglia Stroke

Strokes are not restricted to adults and can occur in children, too. Causes in children may differ from those in adults, with the leading risk factor pertaining to head trauma or injury.^[23]

Other risk factors for a basal ganglia stroke include^{[24] [25] [26]}:

• Blood clotting disorders
• Heart problems and congenital defects
• Increased homocysteine
• Infections like chicken pox
• Moya moya disease
• Head trauma
• Blood vessel abnormalities
• Premature birth (in newborns and infants)

The specific symptoms of a basal ganglia stroke depend on the precise area affected within the basal ganglia. This is because different parts of the basal ganglia are involved in distinct movement, behavioral, and cognitive functions.

Other risk factors that increase the chances of a stroke in general include^{[27] [28]}:

• Dehydration
• Gestational diabetes, pre-eclampsia, maternal hypertension, or other pregnancy complications

While some of these risk factors may persist into adulthood, such as infection^[29] or dehydration^[30], and affect an adult's chances of stroke, the likelihood is rare.

Basal Ganglia Stroke Symptoms

The signs and symptoms of a basal ganglia stroke are the same as for any stroke and can include difficulties with speech or using one side of the face or body.^[31]

Unlike other strokes, there are a few extra symptoms that may differentiate a basal ganglia stroke from other kinds. Signs of basal ganglia dysfunction include^[32]:

• Movement Disorders:
  • Tremors or stiffness (rigidity) of limbs are typical.
  • The slowness of movement (bradykinesia) is prominent.
  • Involuntary or unusual movements (dyskinesias) may arise.
• Difficulty Walking and Balance: Gait problems or unsteadiness are frequent.
• Speech Problems: Difficulty speaking may be present but is often less severe than the type of speech difficulty (aphasia) seen in strokes affecting the brain's language centers.
• Mood and Behavior Changes:
  • Flattened emotions (loss of typical emotional expression).
  • Apathy (loss of motivation).
  • Personality changes are possible.
• Cognitive Difficulties: Issues with memory, attention, and problem-solving can occur, but these may be less prominent than the movement-related symptoms.

While symptoms can be subtle compared to classic "stroke warning signs”, it is vital to seek medical attention as soon as possible if you or someone you know experiences any of the symptoms described above. A basal ganglia stroke is still a stroke, and timely treatment can improve outcomes.

When to See a Doctor?

Signs of a stroke are easy to identify using the FAST acronym^[33]:

• F - Face drooping: Does the person's smile look uneven? Is one side of their face drooping?
• A - Arm weakness: Can the person lift both arms and hold them up? Does one arm drift downwards?
• S - Speech difficulty: Is their speech slurred, garbled, or difficult to understand?
• T - Time to call your local emergency services: If you notice any of these signs, don't hesitate. Call your local emergency services or an ambulance immediately.

Diagnosing Basal Ganglia Stroke

Timely identification of a stroke is crucial to prevent life-threatening complications.

A doctor or neurologist will ask about the symptoms (when they started, how severe they are, etc.) and medical history to understand which part of the brain might be affected. They will also assess the patient’s reflexes, strength, sensation, coordination, and other neurological functions to evaluate how the brain and nervous system are working.

An MRI or CT scan enables identification of the affected brain region. Often, an MRI is best for detecting a basal ganglia stroke, as it can image finer blood vessels in the brain with a higher accuracy.

Depending on the presumed cause, other tests can assist with confirming the diagnosis, such as:

• Blood tests (to look for clotting problems, blood sugar levels, etc.)
• Echocardiogram (ultrasound of the heart to check for potential sources of blood clots)
• Carotid ultrasound (to look for narrowing of the carotid arteries in the neck)

How do you Recover from Basal Ganglia Stroke?

The step to treatment is acute stabilization. Medical professionals will attempt to limit bleeding in a hemorrhagic stroke or address the blockage in an ischemic stroke.

Blood thinners or blood clotting drugs are administered depending on the cause. These can provide immediate relief and minimize further complications.

The patient’s condition requires continuous monitoring until they are stable again. Rarely, surgery is necessary for treating severe strokes to address bleeding or extensive clots or to relieve pressure on the brain.

How do you Repair Basal Ganglia?

Once the patient is stable again, they need to actively work with a healthcare provider to re-establish brain connectivity and promote the repair of any damaged areas. Recovery is a long-term process that can span over years, although most patients can make major progress within a few months.

In recent years, research has proven that the brain is capable of regeneration. Patients and providers can facilitate the process by using a phenomenon known as neuroplasticity. Neuroplasticity is the ability of the brain’s circuits to reorganize and for neurons to form new neural connections^[34].

During a stroke, some of the neurons become damaged. Practicing various skills encourages the brain to be neuroplastic, allowing for new neural connections to form that can replace or enhance the damaged ones.

Most patients benefit from tailored therapy that can help them restore specific functions they lost due to stroke, such as:

• Physical Therapy: Works on strength, coordination, balance, gait training, and regaining overall movement function^[35].
• Occupational Therapy: Focuses on improving independence with everyday tasks like dressing, eating, and self-care.
• Speech Therapy: Addresses any speech or language difficulties that may have arisen after the stroke.
• Cognitive Therapy: It may help with memory, attention, and problem-solving issues if they are affected^[36].

These therapies can help the patient re-strengthen weakened neural connections by working with specific brain regions. A therapist will work with a stroke patient and fine-tune their therapy following their needs.

What Vitamins Help Basal Ganglia?

Many nutrients can aid with brain repair after a stroke, either by limiting inflammation, thinning or clotting blood, or indirectly affecting the ability of neurons to regenerate or form stronger connections, enhancing neuroplasticity.

Examples of antioxidant vitamins and nutrients known to help stroke recovery include^[37]:

• B Vitamins (B6, B12, folate): Involved in blood vessel health and may help lower homocysteine levels^[38] (an amino acid linked to stroke risk).
• Vitamin C: As an antioxidant, vitamin C might help protect against cellular damage and facilitate optimal recovery in some stroke patients^[39].
• Omega-3 Fatty Acids^[40]: These fats are crucial for forming new neurons, enhancing recovery after stroke, and lowering the odds of one occurring.
• Vitamin D: Some studies suggest that very low vitamin D levels share a link with an elevated risk of stroke and worse outcomes among survivors^[41]. Supplementation may be beneficial for those who are deficient.

In addition to supplementation, the patient should implement beneficial lifestyle changes, including a nutritious diet and regular physical activity^[42].

Consult with your doctor before starting any new supplement during the recovery process.

Recovery Outcomes and Long-Term Effects

Recovery can be a lengthy process despite the brain’s impressive potential for regeneration. Not all basal ganglia stroke survivors make a full recovery, suffering from a variety of long-term complications that range from cognitive impairment^[43] to movement disorders like Parkinsonism or dystonia^[44].

Many factors influence recovery potential after a basal ganglia stroke, including:

• The location and severity of the stroke and the extent of brain damage
• A person's age and overall health before the stroke
• How quickly treatment is received
• Access and dedication to rehabilitation

If full recovery is not possible, the aim is to optimize the patient’s functionality, independence, and overall well-being.

A stroke may affect life expectancy similarly to a neurological condition. The immediate survival rates depend on the location of the stroke and the size of the region impacted. For instance, a hemorrhage inside the capsule of the basal ganglia has a higher survival rate of 86.7 % compared with a hemorrhagic stroke in the lobar region of the basal ganglia, where survival is at 67.1%.^[45] Ischemic strokes involving the basal ganglia carry about a 44% good outcome when treated by a thrombectomy (removal of blood clot).^[46]

A comprehensive treatment plan and regular follow-up with healthcare providers are crucial for managing long-term effects, monitoring potential complications, and adjusting therapy plans.

Latest Research and Potential Breakthroughs

Researchers are actively seeking ways to improve diagnostic tools, treatment options, and patient outcomes. Here are a few promising developments that may benefit stroke survivors in the future:

• Neuroprotective Drugs: Research aims to find medications that can shield brain cells from the immediate damage caused by stroke, preserving more brain tissue and potential for recovery.^[47]
• Drugs Enhancing Neuroplasticity: Scientists are investigating medications that might stimulate the brain's ability to rewire and form new connections, leading to better long-term recovery.
• Minimally Invasive Clot Removal: Less invasive procedures, such as robot-assisted surgeries, are being developed to remove blood clots (for ischemic stroke), reducing risk and potentially expanding the treatment window.^[48]
• Surgical Interventions for Hemorrhage: Researchers are exploring surgical techniques that may help stop bleeding, remove large blood clots, and relieve pressure on the brain following hemorrhagic stroke.^[49]
• Technology-Assisted Therapy: Robotics, virtual reality, and other technologies are integrated into rehabilitation to provide intensive, personalized, and engaging therapy sessions.
• Brain Stimulation Techniques: Brain stimulation techniques are promising in stroke recovery research. Transcranial Magnetic Stimulation (TMS) uses magnetic fields to stimulate the brain noninvasively, potentially aiding recovery from stroke when combined with rehabilitation^[50]. Deep Brain Stimulation (DBS), a more invasive method involving implanted electrodes, is currently used for movement disorders like Parkinson's disease and may hold future potential for certain stroke-related movement issues.^[51] TMS and DBS are active areas of investigation aimed at improving patient outcomes after a stroke.
• Stem Cell Therapy: Early-stage research explores the potential of stem cells to repair damaged brain tissue and promote recovery. While promising, significant hurdles remain.^[52]

Conclusion

While a basal ganglia stroke is a severe event, the journey toward recovery does not end with acute care. Ongoing rehabilitation, a focus on healthy living, and staying informed about emerging treatments offer hope for improved function and quality of life. Research is pushing the boundaries of stroke recovery with advancements in everything from medication to brain stimulation. Remember, recovery is a process, and support from loved ones and healthcare professionals is key.

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