Stroke (cerebrovascular accident [CVA]) is the sudden loss of neurological function caused by an interruption of the blood flow to the brain.
Impairments may resolve spontaneously as brain swelling subsides (reversible ischemic neurological deficit), generally within 3 weeks.
Residual neurological impairments are those that persist
longer than 3 weeks and may lead to lasting disability
3. Objectives
• After end of this lecture students
should be able to know–
• Brain circulation, types of stroke &
physiotherapy management for the
same.
11-04-2018stroke
3
4. Def’n
• Stroke (cerebrovascular accident
[CVA]) is the sudden loss of
neurological function caused by an
interruption of the blood flow to the
brain.
• Impairments may resolve
spontaneously as brain swelling
subsides (reversible ischemic
neurological deficit), generally within 3
weeks.
. 11-04-2018
4
5. • Residual neurological impairments are
those that persist
longer than 3 weeks and may lead to
lasting disability
11-04-2018stroke
5
6. Types
• Ischemic
• stroke is the most common type,
affecting about 80% of
individuals with stroke, and results when
a clot blocks or
impairs blood flow, depriving the brain of
essential oxygen
and nutrients.
11-04-2018stroke
6
7. • Hemorrhagic stroke occurs when
blood vessels rupture, causing leakage
of blood in or around the brain.
11-04-2018stroke
7
8. Risk factors
• Major risk factors for stroke are -
• Hypertension, heart disease (HD)
• Diabetes mellitus (DM).
• In patients with ABI, approximately
70% have hypertension, 30% HD, 15%
congestive heart failure (CHF), 30%
peripheral arterial disease (PAD) and
15% DM.
11-04-2018stroke
9
9. • Warning signs –
1. Sudden numbness or weakness of
face, arm, leg specially one side of
body.
2. Sudden confusion, trouble in speaking
or understanding
3. Sudden trouble in seeing in one or
both eyes.
4. Sudden trouble in walking, dizziness,
loss of balance or coordination.
5. Sudden severe headache with
unknown cause.
11-04-2018stroke
10
22. ACA
Sign & symptoms Structure involved
Contralat hemiparesis
involving mainly LL (UL is
spared)
Primary motor area, medial
aspect of cortex, internal
capsule
Contralat hemisensory loss Primary sensory area,
medial aspect of cortex
Urinary incontinence Posteromed aspect of sup.
Frontal gyrus
Problems with imitation &
bimanual tasks, apraxia
Corpus callosum
Abulia (lack of will power 0r
inability to take decision)
Uncertain localization
11-04-2018stroke
23
24. Sign & Symptoms Structure involved
Contralat hemiparesis
involve UL &face
Primary motor cortex & int
capsule
Contralat hemisensory loss Primary sensory cortex & int
capsule
Motor speech impairment –
Broca’s Aphasia
Broca’s cortical area
Wernicke’s aphasia Wernicke’s cortical area
Global Aphasia Post portion of sup.
Temporal gyrus
Perceptual deficit – unilat
neglect, agnosia (inability to
process sensory information)
Parietal sensory asso cortex
Contralat homonymous
hemianopsia
Optic radiation in int capsule
11-04-2018stroke
25
29. Lacunar Syndrome
• Caused by small vessel disease deep
in the cerebral white matter.
• Pure motor lacunar stroke –
involvement of – post limb of Int cap,
pons & pyramids
• Pure sensory lacunar stroke - –
involvement of – ventrolat thalamus.
11-04-2018stroke
30
32. Stages
Stage 1 (Acute):-
- contra. Hemiparesis / paralysis
- Hypotonicity
- Reflexes – Sup- diminished or may be
absent
- Deep – absent
- Loss of vol movt
- Loss of bowel / bladder function
11-04-2018stroke
33
33. Stage 2 –
- Hypertonicity
- Reflexes – Sup – diminished
Deep – Hyperreflexia
Babinski sign +ve
- Loss of vol control- UL & LL synergy pattern
• In both synergic pattern – Wrist & finger
flexors & Ankle invertors are involved
• In both synergic pattern – Latissimus dorsi,
wrist & finger extensors, ankle evertors &
teres major are not involved. 11-04-2018stroke
34
34. Stage 3
• No recovery
• Abnormal tone with multiple
contracture & deformity
11-04-2018stroke
35