STROKE

PREPARED BY:

NOOR HAZILAH BT OMAR

Anatomy

Definition

• Also known as cerebrovascular accident (CVA).

• A stroke is the sudden death of brain cells in alocalized area due to inadequate blood flow.

• Sudden onset of neurological sign andsymptoms, usually focal and acute.

• It involve blood vessels which can causetemporary or permanent loss of function.

(World Health Organization, 1989)

Risk Factors

• Hypertension

• Diabetes Mellitus

• Heart disease

• Cigarette or other tobacco use. Cigarettescause the carotid arteries to develop severeatherosclerosis or to close. Atherosclerosis isaccelerated by smoking.

• Head injury

• Obesity

EtiologyCEREBRAL HEMORRHAGE

- Often d/t HPT & combination of weakness of vessel wall & lead to hemorrhage

ISCHAEMIA

-gradual occlusion of blood vessel (slow onset of

symptoms)

SUBARACHNOID HEMORRHAGE

- d/t berry aneurysm with hemorrhage into subarachnoid

type

CEREBRAL EMBOLISM

Block of blood vessel to the brain

Types of stroke

Ischemic Hemorrhagic

-Interruption of blood supplydepress oxygen and nutrient tobrain cell and make severitybrain death/ damage dependingon total blood supply lack.

- Ischemic embolism

- Ischemic thrombotic

- lacunar syndrome

-d/t burst of blood vessel that supply brain

- commonly d/t aneurysm & TIA

- Intracerebral haemorrhage

-Subarachnoid heamorrhage

Classification of Stroke• 1) Transient Ischemic Attack

– Acute of focal cerebral or monocular function withsymptoms lasting <24 hr.

– The patient may not loss consciousness and there maybe an initial weakness of muscles.

• 2) Cerebral Hemorrhage /CVA– A cerebral hemorrhage occurs when a blood vessel in

the brain ruptures and bleeds into the surroundingbrain tissue

– Rapidly developing clinical symptoms lasting > 24hr

• 3) Arteriosclerotic dementia

- Deterioration in previously normal memory/intellect d/t repeated episode of cerebral ischemic infarction or hemorrhage

( Ann thompson,1994)

Symptoms

• Sudden numbness or weakness of face, arm or leg, especially on one side of the body

• Sudden confusion, trouble speaking or understanding• Sudden trouble seeing in one or both eyes• Sudden trouble walking, dizziness, loss of balance or coordination• Sudden severe headache with no known cause

Other important but less common symptoms include:• Sudden nausea, and vomiting - different from a viral illness because

of how fast it begins (minutes or hours vs. several days)• Brief loss of consciousness or a period of decreased consciousness

(fainting, confusion, convulsions or coma)

(National Stroke Association)

PATHOPHYSIOLOGY

Brain cell damage

Cause ischemia-necrosis

Internal bleeding – blood clot or hematoma

Rupture of the vessel.

Cause increase in blood pressure

Atheroma cause the narrowing of arteries

Dr’s Investigation

• CT Scan –Computed Tomography Scan

• MRI-Magnetic Resonance Imaging.

• MRA-Magnetic Resonance Angiography.

• Lumbar Puncture-CSF test.

Dr’s Management

• Medical –antibiotics ,IV Methanol .

• Surgical –Craniotomy, Vascular reconstructive

surgery, Clipping of rupture aneurysm.

(Tidy’s physiotherapy,1991)

Physiotherapy Management

Acute CareAims :

1)Prevent recurrent stroke2)Monitor vital signs, dysphasia adequate nutrition, bladder &

bowel function.3)Prevent complications4)Mobilize the patient5)Encourage resumption of self-care activities6)Provide emotional support & education for patient & family7)Screen for rehabilitation and choice of settings

Rehabilitation careAims :

1)Set rehabilitation goals; develop rehabilitation plan and monitor progress

2)Manage sensory-motor deficits3)Improve functional mobility & independence4)Prevent & treat complications5)Monitor functional health conditions6)Discharge planning (safe residence recommendation,

patient & caregivers education & continuity of care)7)Community – reintegration

(Physiotherapy Practice Guidelines for Stroke Rehabilitation, May 2000)