neurological conditions

1. CVA (stroke)
BY
Y.ANITHA CHELLAMONI
M.O.T.-NEURO

2. Cerebrovascular Accidents
 A stroke occurs when the blood supply to part of
brain is interrupted or reduced, preventing brain
tissue from getting oxygen and nutrients. Brain cells
begin to die in minutes.
 According to W.H.O “ a neurological deficit of sudden
onset accompanied by focal dysfunction and
symptoms lasting more than 24 hrs that are
presumed to be of a non-traumatic vascular origin”

3. Cont…
 Early action can reduce the brain damage and other complications.
 The location and extent of lesion, amount of collateral blood flow
determine the severity of the neurological deficit in an individual.

5. Etiology:
 Atherosclerosis:
 Cerebral venous thrombosis (CVT)
 Atherothrombotic brain infraction( ABI)
 Cerebral embolism
 Intracerebral hemorrhage
 Sub arachnoid hemorrhage
 Arteriovenous malformation

6. Risk factors:
modifiable Non modifiable
Hypertension Age (50-75)
Cardiac disease Gender
Atrial fibrillation
Diabetes mellitus Heredity
Cigarette smoking
Alcohol abuse
Hyper lipidemia

7. Classification:
 Ischemic stroke
embolic
thrombotic
 Hemorrhagic stroke

9. Ischemic stroke: (clot)
 Ischemic stroke occurs when a vessels supplying blood to the brain is
obstructed.
 It is common form (87%)
 The main cause for the ischemic stroke is atherosclerosis. That means fatty
deposits lining the vessels value.
 Fatty deposits can cause the two type of obstructions:
o Thrombosis
o embolism

11. Thrombotic stroke:
 Cerebral thrombosis is a thrombus (blood clot) that develops
at the fatty plaque within the blood vessel.
 Its can be a result of many causes but most are related to the development of
abnormalities in the arterial vessel wall.
 Other causes are
-atherosclerosis
-arteritis
-dissection
-external compression
- Hematologic disorders

12. Transient ischemic attack (TIA)
A transient ischemic attack (TIA) is a temporary period of
symptoms similar to those of a stroke.
A TIA usually lasts only a few minutes and doesn't cause
permanent damage.
Often called a ministroke, a transient ischemic attack may be
a warning.
About 1 in 3 people who has a transient ischemic attack will
eventually have a stroke, with about half occurring within a
year after the transient ischemic attack.

14. Embolic stroke:
 Cerebral embolism is a blood clot that forms at
another location in the heart and large arteries of the
upper chest and neck.
 Part of the blood clot breaks loose, enters the
bloodstream and travels through the brain’s blood
vessels until it reaches vessels too small to let it pass.
 A main cause of embolism is an irregular heartbeat
called atrial fibrillation.

16. Hemorrhagic stroke
 Hemorrhagic strokes make up about 13 % of stroke
cases. They're caused by a weakened vessel that
ruptures and bleeds into the surrounding brain. The
blood accumulates and compresses the surrounding
brain tissue.
 The two types of hemorrhagic strokes are
 intracerebral (within the brain) hemorrhage (ICH)
 subarachnoid hemorrhage. (SAH)

17.  A hemorrhagic stroke occurs when a weakened
blood vessel ruptures. Two types of weakened blood
vessels usually cause hemorrhagic stroke:
 aneurysms and
 arteriovenous malformations (AVMs).

18. Signs and symptoms:
FAST
• Face:
• Ask the person to smile. Does one side of the face droop?
• Arms:
• Ask the person to raise both arms. Does one arm drift
downward? Or is one arm unable to rise?
• Speech:
• Ask the person to repeat a simple phrase. Is his or her speech
slurred or strange?
• Time:
• If you observe any of these signs, call emergency provide
medical help immediately.

20.  Plegia:
 Plegia, or paralysis, is a complete paralysis of skeletal muscles.
 Paresis:
 An incomplete paralysis is called a paresis.

21. • Monoplegia
The complete paralysis affects only one limb, e.g.
• Paraplegia
Both legs are completely paralysed; upper limbs (arms)
• Hemiplegia
Arm and leg of one side of the body are completely
• Quadriplegia (tetraplegia)
It involves a complete paralysis of all four limbs (arms and
over the torso and head is impaired.

23. MCA Rt hemisphere Lt hemisphere
Upper trunk:
• Contra lateral hemiplegia (
especially of face and arm)
• contra lateral hemi sensory
• apraxia
• depression,
• lack of intrest
• impaired organization of
behavior
•Lt unilateral body neglect
•Left unilateral visual neglect
•Visuo spatial impairment
•Left unilateral motor apraxia
•Bilateral motor apraxia
•Broca’s aphasia
•frustration
Lower trunk:
• contra lateral visual field
• behavior abnormalities
visuo spatial dysfunction wernicke’s aphasia

24. PCA Rt hemisphere Lt hemisphere
• the symptoms are
potentially varied
because it supplies the
upper brainstem ,
temporal and occipital
lobes.
• Partial blindness
• Difficulty to recognize
visually present objects.
• memory impairment
Occasional contra lateral
numbness
•Cortical blindness
•Visuo spatial impairment
•Impaired rt lft
discrimination
•Difficulty to identify the
objects/ people
•difficulty to retrieving
known objects
•inability to produce
written language
•inability to perform simple
maths.
•impaired balance and co-
ordination

25. ACA BASILAR ARTERY VERTEBRAL ARTERY
•Contra lateral hemiplegia
•Contra lateral sensory loss
•Unilateral apraxia
•Mutism
•Intellectual changes:
confusion, disorientation
•Behavior changes
• Quadriparesis
• Visual abnormalities
• Cranial nerve
abnormality
• Dizziness
• Head ache
• coma
• Dizziness
• Vomiting
• Numbness
• Tachycardia
• Gait ataxia

27. diagnosis:
 Computed tomography (CT)
 Magnetic resonance imaging (MRI)
 Positron emission tomography(PET)
 Single photon emission computerized tomography(SPECT)

28. Computerized tomography
 Readily available and standard technique used for a patient with acute
stroke.
 Important function of CT is to rule out other conditions such as tumor and
abscess and find if there is hemorrhagic conversion.
 In most acute cases CT scan is negative. If it’s associated with acute
neurological deficits it verifies stroke.
 Helps to find out hemorrhagic transformation.

30. MRI
 Not commonly used because of its cost and less availability.
 It is more sensitive in detecting cerebral infarctions in acute patients.

32. ELECTRO CARDIO GRAPHY
 It is used to evaluate patients stroke symptoms to detect arrhythmias or
myocardial infarction or other acute cardiac events .
ECHO CARDIO GRAPHY
 In patients with history of cardiac disease and stroke it is used.
 Congestive cardiac failure
 Valvular heart disease
 Arrhythmias
 Recent MI

33. BLOOD WORK
 Includes hematology, serum electrolyte level , renal and hepatic chemical
analyses .
 It helps to rule out other causes of stroke like symptoms, diagnose
complications, baseline analyses before initiation of therapies like anti
coagulations.

34. Medical management:
PRINCIPAL GOALS
 general patient care
 Airway protection
 Maintenance of adequate circulation
 Treatment of associated injuries or conditions
 Preventing medical complications
 Stop progression of lesion to limit deficits
 Reducing cerebral edema
 Decreasing risk of hydrocephalous
 Treating seizures
 Preventing DVTs, aspirations
rehabilitation

35.  Major goal will be achieving improvement in cerebral perfusion by
reestablishing blood flow, decreasing neuronal damage at the site of
ischemia by modifying the patho physiologic process and decreasing
edema( secondary damage to non ischemic area

36. Pharmacologic therapies
 It’s a divided into
 Anti thrombotic
 Thrombolytic
 Neuro protective
 anti edema

37. Anti thrombotic therapy
 IT IS USED for rapid recanalization and reperfusion of occluded vessels and
reduction of infarction area.
 Also prevents clot propagation and recurring vascular thrombosis.
 The risk associated are hemorrhagic conversion, hemorrhage and
increased cerebral edema.
 Aspirin
 heparin

38. Thrombolytic therapy
 IT IS most attractive therapy for acute stroke because it opens up occluded
cerebral vessel and immediately restores blood flow to ischemic areas.
 But the treatment must be in started in 6 hours from onset of symptoms.
 Urokinase
 Streptokinase
 Tissue plasminogen acivater

39. Neuroprotective agents
 They can alter the course of metabolic events after the onset of ischemia
and therefore have the potential to reduce stroke damage.
 Ca channel blockers
 Glutamate antagonist
 Naloxone

40. Anti-cerebral edema
 Cortico steroids
 Mannitol
 Glycerol
 Vinca alkaloids
CAROTID ENDARTERECTOMY
Surgical opening of carotid artery to remove plaque.

41. Rehabilitation:
 Occupational therapy
 Physio therapy
 Speech therapy

42. Complications:
 Contractures
 Osteoporosis
 Heterotropic ossification
 Falls
 Seizures
 Hydrocephalus
 Spasticity
 Depression
 Urinary Tract Infection
 Pressure sores
 Deep Vein Thrombosis