Mahatma Gandhi

Physiotherapy College
STROKE
OR
Cerebo Vascular Accident (CVA)

Guided By- Dr. Anjali Jain Presented By –

(PT) 1.Shivanshi Choudhary
2.Abhinav Phophalia
STROKE
❖Stroke or Brain attack is the sudden loss
of neurological function caused by an
interruption of the blood flow to brain .
RISK FACTORS
Risk Factors
Nonmodifiable
❖Age
❖Gender (women more likely to die)
❖Race (African Americans)
❖Heredity
Risk Factors
Modifiable
❖Asymptomatic ❖Hypertension
carotid stenosis ❖Obesity
❖Diabetes mellitus ❖Oral
contraceptive
❖Heart disease, use
atrial fibrillation ❖Physical
❖Heavy alcohol inactivity
consumption ❖Sickle cell
disease
❖Hypercoagulabilit ❖Smoking
y
❖Hyperlipidemia
EPIDEMIOLOGY
❖Third leading cause of death.
❖The incidence of stroke is about 1.25
times greater for males than females.

❖Most common cause of disability

among adults.
 Transient Ischemic Attacks (TIA)

❖Temporary focal loss of neurologic

function caused by ischemia
(analogous to angina in CAD)
❖Most resolve within 3days.
❖May be due to micro-emboli that
temporarily block blood flow
❖A warning sign of progressive
cerebrovascular disease
Signs of a Stroke
Classification of Stroke
Major Types of Stroke

Fig. 56-3
 Ischemic Stroke
❖Result of inadequate blood flow to
brain due to partial or complete
occlusion of an artery
❖Constitute 85% of all strokes
❖Most patients with ischemic stroke do
not have a decreased level of
consciousness in the first 24 hours
❖Symptoms often worsen during first
72 hours d/t cerebral edema
 Ischemic Stroke

⚫ Thrombotic stroke
❖Thrombosis occurs in relation to injury to
a blood vessel wall → blood clot
❖Result of thrombosis or narrowing of the
blood vessel
❖Most common cause of stroke
 Ischemic Stroke

⚫ Thrombotic stroke
❖Two-thirds are associated with HTN and
diabetes
❖Often preceded by a TIA
 Ischemic Stroke

⚫ Embolic stroke
❖Embolus lodges in and occludes a
cerebral artery
❖Results in infarction and edema of the
area supplied by the vessel
❖Second most common cause of stroke
 Ischemic Stroke

⚫ Embolic stroke
❖Majority of emboli originate in heart, with
plaque breaking off from the endocardium
and entering circulation
❖Associated with sudden, rapid occurrence
of severe clinical symptoms
 Ischemic Stroke

⚫ Embolic stroke
❖Patient usually remains conscious
although may have a headache
❖Recurrence is common unless the
underlying cause is aggressively treated
 Hemorrhagic Stroke

❖Account for approximately 15% of all

strokes
❖Result from bleeding into the brain
tissue itself or into the subarachnoid
space or ventricles
 Hemorrhagic Stroke

⚫ Intracerebral hemorrhage
❖Bleeding within the brain caused by a
rupture of a vessel
❖Hypertension is the most important
cause
❖Commonly occurs during activity
 Hemorrhagic Stroke

⚫ Intracerebral hemorrhage
❖Often a sudden onset of symptoms
that progress over minutes to hours
b/c of ongoing bleeding
❖Manifestations include neurologic
deficits, headache, N & V, decreased
levels of consciousness, and HTN
 Hemorrhagic Stroke

⚫ Subarachnoid hemorrhage
❖Bleeding into cerebrospinal space
between the arachnoid and pia mater
❖Commonly caused by rupture of a
cerebral aneurysm (capalaries)
 Clinical Manifestations of Stroke

⚫ Affects many body

functions
❖Motor activity
❖Intellectual function
❖Spatial-perceptual
alterations
❖Sensation
❖Communication
 Clinical Manifestations
Motor Function
❖Most obvious effect of stroke
❖Can include impairment of
o Mobility
o Respiratory function
o Swallowing and speech
o Gag reflex
o Self-care abilities
 Clinical Manifestations
Motor Function
❖Characteristic motor deficits (contra-
lateral)
❖Loss of skilled voluntary movement
❖Impairment of integration of
movements
❖Alterations in muscle tone (flaccid →
spastic)
❖Alterations in reflexes (hypo → hyper)
 Clinical Manifestations
Communication
⚫ Patient may experience aphasia when
stroke damages the dominant
hemisphere of the brain
◦ Aphasia: total loss of comprehension and
use of language
◦ Dysphasia: difficulty with comprehension
and use of language
● Classified as nonfluent or fluent
 Clinical Manifestations
Communication
❖Dysarthria
❖Disturbance in the muscular control of
speech
❖Impairments in pronunciation, articulation,
and phonation; NOT meaning or
comprehension
 Clinical Manifestations
Affect
❖May have difficulty controlling their
emotions
❖Emotional responses may be
exaggerated or unpredictable
❖Depression , impaired body image
and loss of function can make this
worse
❖May be frustrated by mobility and
communication problems
 Clinical Manifestations
Intellectual Function
❖Memory and judgment may be
impaired
❖Left-brain stroke: more likely to result
in memory problems related to
language
Manifestations of Right-Brain and Left-Brain
Stroke

Fig. 56-6
 Clinical Manifestations
Spatial-Perceptual Alterations
❖Stroke on the right side of the brain is
more likely to cause problems in
spatial-perceptual orientation
❖However, this may occur with left-
brain stroke
 Clinical Manifestations
Spatial-Perceptual Alterations

❖Spatial-perceptual problems may be

divided into four categories
❖ Incorrect perception of self and illness
(may deny illness or body parts)
❖ Erroneous perception of self in space
(e.g., neglect all input from affected
side; distance judgement)
Clinical Manifestations
Spatial-Perceptual Alterations
❖ Inability to recognize an object by
sight, touch, or hearing
❖ Inability to carry out learned sequential
movements on command
 Clinical Manifestations
Elimination
❖Most problems with elimination occur
initially and are temporary
❖Prognosis for normal bladder function
is excellent when only one hemisphere
of brain is affected.
DIAGNOSIS
❖TEST AND MEASURES
❖ Blood cholesterol & lipid profile
❖ Cardiac Evaluation
❖ Lumbar puncture
IMAGING
❖CT SCAN
ACUTE PHASE – CT SCAN are used to
rule out brain lesions.
SUB-ACUTE PHASE – CT SCAN can
identify development of cerebral edema
( within 3 days ) & cerebral infarction
( within 3-4 days ).
❖ MRI
❖ CEREBRAL ANGIOGRAPHY
OBSERVATIONS
ObSERVATIONs
observations
POST ACUTE STAGE
❖5 Days a week for a minimum of
3 hours of active rehabilitation per
day.
❖Intensive rehabilitation if vitals
are stable.