CVA

CEREBROVASCULAR
ACCIDENT OR STROKE

BY: THALIA NICOLE SANCHEZ

DEFINITION:
Cerebrovascular Accident (CVA)/Stroke
- is an interruption of the blood supply to any part of the brain,
resulting in damaged brain tissue.
- A sudden neurological deficits char by loss of motor control, altered
sensation, cognitive or language impairment & disequilibrium or
coma.
.
ETIOLOGY & EPIDEMIOLOGY:

- 4th leading cause of death and the leading cause of disability

of adults.
- Women < Men if Less than 85 y/o
- Atherosclerosis – the major contributory factor in CVD. A
plaque formation with an accumulation of lipids, fibrin,
complex carbohydrates and calcium deposits in arterial walls.
Most common sites for lesions:
- origin of the common carotid artery
- middle cerebral artery
- main bifurcation of the middle cerebral artery
- junction of the vertebral arteries w/ the basilar artery
ANATOMY & PHYSIOLOGY:
BRAIN

1. Cerebrum- It performs higher functions like

interpreting touch, vision and hearing, as well as
speech, reasoning, emotions, learning, and fine
control of movement.

2. Cerebellum- Its function is to coordinate muscle

movements, maintain posture, and balance.

3. Brainstem- acts as a relay center connecting the

cerebrum and cerebellum to the spinal cord.
 RIGHT & LEFT
HEMISPHERE
RIGHT HEMISPHERE
➢ mnemonics: MICA LEFT HEMISPHERE
• Memory & Music ➢ mnemonics: MALL
• Insight Mathematical
• Creativity Analytical
• Arts Logical
Language
 4 LOBES OF THE BRAIN:
1. FRONTAL LOBE: Complex Functioning- personality,
judgement, insight, reasoning, problem solving, abstract
thinking and working memory

2. PARIETAL LOBE: Spatial orientation, perception and

comprehension of language function recognizing object by
touch. Links visual and somatosensory information together

3. TEMPORAL LOBE: Involved in receiving and processing

auditory information, higher order visual information,
complex aspects of memory and language.

4. OCCIPITAL lOBE: Visual processing area

CIRCLE OF
WILLIS
ANTERIOR CIRCULATION:

- Internal Carotid Artery: main branch/root of ant. circulation.

1. Ophthalmic Artery: responsible for the blood supply in

the orbitals of the eyes.

2. Anterior Cerebral Artery: supplies the frontal & medial

parietal lobe

3. Middle Cerebral Artery: supplies the cerebellum

4. Anterior Communicating Artery: it connects the right

& left ACA.
POSTERIOR CIRCULATION:
- Vertebral Artery: main branch/root of post. circulation
BASILAR ARTERY
4 Branches:
1. Posterior Inferior Cerebellar Artery (PICA):
Supplies the medulla oblongata & cerebellum
2. Anterior Inferior Cerebellar Artery (AICA): First
branch of vertebral artery. Supplies the PONS &
Cerebellum.
3. Superior Cerebellar Artery: Supplies the Midbrain
& Cerebellum
4. Posterior Cerebral Artery: supplies the cerebrum
- Post. Communicating Artery: connects the ant & post
circulation to form circle of willis.
TEMPORAL ETIOLOGIC
CLASSICIFICATIONS: CLASSIFICATIONS:
1.) Ischemic stroke
- is caused by a blockage in an artery that
a. Transient Ischemic Attack (TIA) – supplies blood to the brain.
deficits disappear within 24 hours   a. Thrombotic – Assoc. with atherosclerotic
plaque formation occurring frequently at major
b. Reversible Ischemic Neurologic Disease
branching sites
(RIND) – Deficits resolve within a week  
b. Embolic - Travelling bits of matter
c. Stroke in evolution –progressing stroke   c. Lacunar - Small vessels affected
2.) Hemorrhagic stroke
d. Crescendo TIA –deficits over several - happens when a blood vessel bursts, causing
hours or days (on/off)   bleeding in the brain.
e. Completed stroke – neurologic deficits a. Intracerebral hemorrhage - site of rupture:
stabilize deep perforating cerebral arteries  
b. Subarachnoid hemorrhage (aneurysms) -
bleeding that occurs within the dural space
around the brain
RISK
FACTORS:
Modifiable: Non-Modifiable:
• Cigarette smoking • Age
• Hypercholesterolemia • Sex
• Obesity • Race
• heart disease • history of stroke
 TYPES OF STROKE SYNDROMES:

MIDDLE CEREBRAL ARTERY ANTERIOR CEREBRAL

SYNDROME ARTERY SYNDROME
 C/L hemiplegia/hemianesthesia UE>LE
 contralateral hemiplegia;
 upper division: Broca aphasia

LE>UE
lower division: Wernicke’s aphasia
 Global aphasia  contralateral hemianesthesia
 Limb kinetic apraxia  Urinary incontinence
 Loss of conjugate gaze to the opposite side  Problems w/ imitation &
 Ataxia of C/L limb(s) bimanual tasks, apraxia
   akinetic mutism (abulia)
 C/L grasp reflex & sucking
reflex
 VERTEBROBASILAR
POSTERIOR CEREBRAL ARTERY SYNDROME
ARTERY SYNDROME
 Problems with vital functions (eg,
 C/L homonymous hemianopsia breathing)
 visual impairment  Difficulty with chewing, swallowing, and
 visual agnosia speaking
 prosopagnosia  Weakness or paralysis in the arms, legs,
 dyslexia without agraphia and/or face
 Problems with sensation
 memory deficits
 Hearing loss
 hemisensory deficit
 Vision problems
 Involuntary movements  Vertigo (feeling of spinning or whirling
 C/L hemiplegia when you are not moving)
 Weber’s syndrome  “Locked-in syndrome” (only the eyes are
  able to move)
 Coma
HOW TO ASSESS & DIAGNOSE:
CT scan of head:

- to detect a stroke from a blood clot or bleeding within the brain.

DIFFIRENTIAL
DIAGNOSIS
ASSESSMENT TOOLS:
1. Functional Independence Measure
(FIM) ASSESSMENT:

- grade the functional status of a person based

on the level of assistance he or she requires.
ASSESSMENT TOOLS:
2. Deep Tendon Reflex:

-testing primarily assesses the

integrity of the motor system

3. Modified Ashworth Scale:

- used to measure the increase of

muscle tone.
ASSESSMENT TOOLS:
4. Fugl-Meyer :

- is a stroke-specific, performance-based
impairment index. It is designed to assess
motor functioning, balance, sensation and
joint functioning in patients with post-
stroke hemiplegia

5. Brunnstrom Stage of Recovery (BSOR):

- describes the sequence of motor

development and reorganization of the brain
after stroke.
ASSESSMENT TOOLS:
6. Pathological Reflex - are reversions to primitive responses and indicate loss of cortical
inhibition.

7. RLA Gait Analysis- is a standardized approach utilized to assess gait impairment for
various diagnoses
PT MANAGEMENTS:
• Bobath: Focuses to control responses from damaged postural reflex mechanism. Emphasis
is placed on affected inputs facilitation and normal movement patterns.
• Brunnstrom: is one form of neurological exercise therapy in the rehabilitation of stroke
patients.
• Rood: Emphasize the use of activities in developmental sequences, sensation stimulation
and muscle work classification. Cutaneous stimuli such as icing, tapping and brushing are
employed to facilitate activities.
• Proprioceptive neuromuscular facilitation (PNF) Pattern
• Sensory re-education
• Balance retraining
• Fall prevention
• Gait re-education
• Upper limb training