Title : Stroke type and post-stroke spasticity: A comparative analysis of ischemic and hemorrhagic basal ganglia lesions

Background: Stroke remains a major global health problem. It can be classified into ischemic and hemorrhagic types, both of which may lead to clinical manifestations such as spasticity. Although both types can produce similar clinical manifestations, their underlying pathophysiological mechanisms differ and may consequently influence the pattern and severity of cerebral injury. Cerebral injury resulting from ischemic stroke occurs through excitotoxicity, oxidative stress, neuroinflammation, and neuronal death signaling. In contrast, injury in hemorrhagic stroke occurs through two mechanisms: primary injury, including hematoma formation, mass effect, volume expansion, and hydrocephalus; and secondary injury resulting from inflammation, blood brain barrier dysfunction, edema, reactive oxygen species production, and excessive excitotoxicity. Given the differences in the pathophysiological mechanisms of ischemic and hemorrhagic stroke, these two stroke types may have different effects on descending motor pathways and subsequently on the development and severity of spasticity. However, whether ischemic and hemorrhagic stroke involving the basal ganglia differ in their association with post-stroke spasticity remains unclear. Identifying this association may improve early recognition of patients at risk for significant spasticity and facilitate timely rehabilitation and individualized management. Therefore, this study aims to investigate the association between ischemic and hemorrhagic stroke and the severity of post-stroke spasticity.

Method: This analytical observational study employed a cross-sectional design with an unpaired categorical comparative approach. Secondary data were obtained from the medical records of stroke patients with basal ganglia lesions treated between 2023 and 2024, using purposive sampling. Data analysis was performed using bivariate analysis with the chi-square test.

Results: A total of 51 subjects met the inclusion and exclusion criteria. Based on stroke type, the majority of subjects had ischemic stroke (35 patients; 68.6%), while 16 patients (31.4%) had hemorrhagic stroke. Statistical analysis using the chi-square test showed a p-value of 0.043 (<0.05), with an Odds Ratio (OR) of 4.339 and a 95% Confidence Interval (CI) of 1.226–15.361, indicating a statistically significant association between stroke type and spasticity.

Conclusion: Stroke type involving the basal ganglia is significantly associated with spasticity. Among patients with basal ganglia stroke, hemorrhagic stroke was significantly associated with higher odds of spasticity compared with ischemic stroke. These findings may serve as a basis for improving the management and rehabilitation of stroke patients, with the aim of reducing the long-term impact of spasticity on patients’ quality of life.

Vyenna Cheryll Winata is a medical student at the Faculty of Medicine, Universitas Pelita Harapan, with a particular interest in neurology. She is passionate about exploring neurological disorders and promoting greater awareness of stroke and its prevention. Beyond her academic pursuits, she actively participates in community outreach and social initiatives focused on health education and public awareness. She previously served as an Executive Board of Community Outreach at the Asian Medical Students’ Association – Universitas Pelita Harapan 2024/2025 (AMSA-UPH), where she was involved in organizing and supporting various community-based health initiatives. Through these experiences, she continues to develop her interest in medicine, neurology, and community health.