Agnosia ( a = not, gno = know) - inability recognising familiar objects or symbols by the senses : sight (visual agnosia, may fail to recognise colour, faces, may put inappropriate objects in mouth) or touch (tactile agnosia) or sound (auditory agnosia - e.g., can't recognise a sound such as doorbell). For tactile agnosia, the problem is present in both hands. Agnosias are due to disturbance of function in the cerebral cortex. Visual agnosia can occur with and without an hemianopia. In visuospatial agnosia the person has difficulty putting two objects together e.g., cup on saucer.

Agraphia ( a = not, graphia = write) - loss of ability to express thoughts in writing.

Ambulatory ECG - 24 hour monitor worn around the waist to check the pulse and electrical activity of the heart.

Aneurysm - weakness in a blood vessel wall, which bulges outwards and can burst.

Anosognosia - when the patient denies anything being wrong with the stroke side. The lack of awareness or denial of disease. May occur with damage to the parietal lobe in the region of the supramarginal gyrus.

Aphasia - inability to express thoughts by speech or writing and/or to understand the spoken or written word. This is a disorder of language. Dysphasia = difficulty with cf. aphasia which means complete loss. In testing for dysphasia the ability to understand spoken and written language is tested, the ability to express oneself in spoken and written language is tested and the ability to name objects is tested. The most important areas for speech are Broca's area (1) and Wernicke's area (2,3). Broca's dysphasia is a motor dysphasia characterised by halting speech with simpler grammatical relationships than usual. There may also be problems with understanding the spoken word, the written word (dyslexia) and writing difficulties (dysgraphia). Wernicke's dysphasia. Unlike Broca's, speech is fluent. Understanding of the spoken word is markedly impaired, the person is unaware of errors in speech, new 'rubbish' words and other extra sounds may be added. There are often reading and writing difficulties. There are other forms of dysphasia but classification is continually changing, speak to a speech and language therapist.

Apraxia - inability to perform a movement or action despite having normal power, co-ordination, sensation and understanding. It is a problem of motor planning. In movement apraxia the movement memory patterns for an action are lost, the person usually understands the purpose of the movement but can't execute it. In ideational apraxia the person cannot grasp the idea or purpose of the desired act, complicated acts can't be performed. It is usually a sign of diffuse cerebral ischaemia. In ideomotor apraxia old learned movements can be performed 'automatically' but the person cannot perform a given act. It is usually associated with a precentral gyrus lesion.

Arteriogram - injection of a radio-opaque dye (usually) into an artery to look for a blockage or site of bleeding. E.g., carotid arteriogram - of the carotid circulation.

Arteriovenous malformation - an abnormal collection of small blood vessels which can leak or burst.

Astereognosis - inability to identify an object by touch. Present in one hand only, on the side opposite to which the brain is damaged. Stereognosis is a higher mental function of the parietal lobe of the brain. It should only be tested for when the lower sensory tracts are undamaged as damage here also causes inability to recognise an object.

Atheroma - fat deposited in the wall of medium and larger sized arteries, Associated with the laying down of calcium and fibrous tissue, causing narrowing of the artery. Atherosclerosis and arteriosclerosis are often used interchangeably.

Autotopognosia, autopognosia (auto = self ), non-belonging - when the patient doesn't recognise the affected limb(s) as belonging to him/her. A perceptual problem. The impaired recognition of body parts, may occur with damage to the posteroinferior part of the parietal lobe.

Bulbar palsy - a lower motor neurone lesion of the lowermost cranial nerves (ix, x, xii).

Carotid endarterectomy - the operation to remove atheroma from a narrowed blood vessel in the neck (usually the internal carotid artery).

CAT scan, CT scan - computerised X-ray of the brain. Usually performed to exclude a cerebral haemorrhage. May show nothing in the early stages of a cerebral infarct. can show brain tumours.

Cerebrovascular accident, CVA (cerebro = brain) - a neurological deficit of vascular origin. Damage to the brain caused by a sudden reduction in blood supply.

Cerebral embolism - partial or total blockage of a blood vessel in the brain, caused by a clot breaking off and travelling up an artery.

Cerebral haemorrhage - bleeding into the brain tissue.

Cerebral infarction - death/damage of part of the brain caused by a sudden insufficiency of blood supply.

Cerebral thrombosis - narrowing, sometimes to the point of complete blockage, of a blood vessel in the brain, usually already damaged and narrowed by atheroma. A platelets collect and a clot forms on the damaged surface. If the blood supply is interrupted enough it causes an ischaemic ( = lack of blood) stroke.

Diplopia - double vision. Suggests a brainstem lesion, lesion of a nerve(s) to the eye, secondary pressure effect on the cranial nerves involved in eye movement (iii, iv, vi).

Disability - decreased ability to perform an activity normally e.g., walking, eating. Due to an impairment caused by the stroke.

Dressing apraxia - inability to dress despite no obvious weakness, loss of co-ordination, sensory loss, visual or neglect problems.

Duplex carotid scan - an 'ultrasound' scan of the blood vessels in the neck. Painless. Carried out to see if there is narrowing in an artery in the neck severe enough to require an operation.

Dysarthria - difficulty in articulation.

Dysgraphia - see aphasia.

Dyslexia - see aphasia.

Dysphasia - see aphasia.

Dysphonia - difficulty in phonation e.g., vocal cord damage.

ECG - electrocardiogram - shows the electrical activity and rhythm of the heart.

ECHO cardiogram, echo cardiography - 'ultrasound' of the heart. Used in stroke if an embolus is suspected of coming from the heart, if a heart valve needs investigating, or looking for an atrial septal defect (hole between the right and left sides of the heart, between the two atria) if a 'paradoxical' embolus is suspected as the cause of a stroke.

Epilepsy - a sudden transitory 'electrical' disturbance of brain function. it may be associated with a period of unconsciousness, disturbance of consciousness, twitching, sensory disturbance, urinary incontinence.

Handicap - the limitation, caused by disability or impairment, imposed on the person by the stroke, to perform or fulfil a previously normal role for them e.g., to continue in a particular employment.

Hemianaesthesia - loss of sensation down one side of the body.

Hemianopia - loss of vision in one half of the visual field of one or both eyes.

Hemiparesis, hemiplegia - paralysis, weakness on one side of the body.

Homonymous hemianopia - loss of vision in both the left halves or both right halves of the visual field. E.g., the person may bump into things on his/her right hand side.

Impairment - loss or abnormality of physiological, psychological or anatomical structure or function (e.g., muscle weakness, dysphasia, sensory loss) caused by the stroke.

Ischaemic infarct - cell death due to lack of blood supply caused by an embolus or thrombosis (clot blocking a blood vessel).

Lacunar infarct - a small area of brain damage caused by blockage of a small end artery.

Monoparesis, monoplegia - weakness, paralysis of one limb only.

MRI scan - magnetic resonance imaging. Very useful for bone, brain and spinal cord lesions. Uses a very strong fluctuating magnetic field so anyone with any metal in them can't have the test. CAT scan is the most commonly used in stroke.

NG tube - nasogastric tube, put down the nose into the stomach.

Paraparesis, paraplegia - weakness, paralysis of both legs. Can happen with bilateral strokes or spinal cord problems.

Papilloedema - swelling of the optic disc in the eye. Usually associated with raised intracranial (inside the skull) pressure.

PEG tube - (percutaneous - endoscopic - gastrostomy) feeding tube put through the abdominal wall into the stomach.

Perseveration - obeying one command and then performing the same action even when a different command is given. The same can happen with speech.

Pseudobulbar palsy - an upper motor neurone lesion affecting the lowermost cranial nerves (ix, x, xii). Both halves of the brain are affected.

Sensory inattention or extinction - failure to recognise a tactile stimulus to one side of the body when both sides of the body are touched simultaneously. When each side is touched separately there is no problem. This is a form of visuospatial disturbance.

Spasticity - increased muscle tone. It may be worsened by the wrong posture, squeezing a soft ball both of which should be avoided.

Spatial sense - awareness of where one is in space, where the different parts of the body are in relation to one another, where objects are sited e.g., in a room, and how they are related to each other in space (e.g., estimate of distance apart, shape).

Stroke - see cerebrovascular accident.

Subarachnoid haemorrhage - bleeding into the subarachnoid space outside of the brain, usually caused by a burst blood vessel, aneurysm or arteriovenous malformation.

24 hour ECG - see ambulatory ECG.

Venogram - injection of a radio-opaque dye into a vein in the back of the foot to see if there is a clot in a vein higher up.

Visual inattention or extinction - failure to register a visual stimulus in one homonymous visual field when the stimulus is presented to both fields at the same time and the person has no visual field loss.