hope it will usefull

1. STROKE
PREPARED BY:
NOOR HAZILAH BT OMAR

2. Anatomy

4. Definition
• Also known as cerebrovascular accident (CVA).
• A stroke is the sudden death of brain cells in a
localized area due to inadequate blood flow.
• Sudden onset of neurological sign and
symptoms, usually focal and acute.
• It involve blood vessels which can cause
temporary or permanent loss of function.
(World Health Organization, 1989)

5. Risk Factors
• Hypertension
• Diabetes Mellitus
• Heart disease
• Cigarette or other tobacco use. Cigarettes
cause the carotid arteries to develop severe
atherosclerosis or to close. Atherosclerosis is
accelerated by smoking.
• Head injury
• Obesity

6. Etiology
CEREBRAL 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

7. Types of stroke
Ischemic Hemorrhagic
-Interruption of blood supply
depress oxygen and nutrient to
brain cell and make severity
brain death/ damage depending
on 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

8. Classification of Stroke
• 1) Transient Ischemic Attack
– Acute of focal cerebral or monocular function with
symptoms lasting <24 hr.
– The patient may not loss consciousness and there may
be 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 surrounding
brain tissue
– Rapidly developing clinical symptoms lasting > 24hr

9. • 3) Arteriosclerotic dementia
- Deterioration in previously normal
memory/intellect d/t repeated episode of
cerebral ischemic infarction or hemorrhage
( Ann thompson,1994)

10. 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)

11. PATHOPHYSIOLOGY
Atheroma cause the narrowing of arteries
Cause increase in blood pressure
Rupture of the vessel.
Internal bleeding – blood clot or hematoma
Cause ischemia-necrosis
Brain cell damage

15. 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)

16. Physiotherapy Management
Acute Care
Aims :
1)Prevent recurrent stroke
2)Monitor vital signs, dysphasia adequate nutrition, bladder &
bowel function.
3)Prevent complications
4)Mobilize the patient
5)Encourage resumption of self-care activities
6)Provide emotional support & education for patient & family
7)Screen for rehabilitation and choice of settings

17. Rehabilitation care
Aims :
1)Set rehabilitation goals; develop rehabilitation plan and
monitor progress
2)Manage sensory-motor deficits
3)Improve functional mobility & independence
4)Prevent & treat complications
5)Monitor functional health conditions
6)Discharge planning (safe residence recommendation,
patient & caregivers education & continuity of care)
7)Community – reintegration
(Physiotherapy Practice Guidelines for Stroke Rehabilitation,
May 2000)