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Cerebrovascular disease.ppt

Cerebrovascular disease.ppt






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  • tPA - tissue plasminogen activator

Cerebrovascular disease.ppt Cerebrovascular disease.ppt Presentation Transcript

    • Name of the disease & terminologies
    • Etiology
    • Physical examination, signs and symptoms
    • Investigations
    • Modern medical treatment
    • Alternative therapies – Yoga management
    • Diet
    • Books and journals for reference
    • General term for a brain dysfunction caused by an abnormality of the cerebral blood supply.
    • A stroke is an interruption of the blood supply to any part of the brain. A stroke is sometimes called a "brain attack.“
    • Alternative names: Stroke CVA, Cerebral infarction, Cerebral hemorrhage.
    • A stroke can happen when:
    • A blood vessel carrying blood to the brain is blocked by a blood clot. This is called an ischemic stroke .
    • A blood vessel breaks open, causing blood to leak into the brain. This is a hemorrhagic stroke .
    • If blood flow is stopped for longer than a few seconds, the brain cannot get blood and oxygen. Brain cells can die, causing permanent damage.
    • This is the most common type of stroke.
    • Usually this type of stroke results from clogged arteries, a condition called atherosclerosis.
    • Fatty deposits and blood platelets collect on the wall of the arteries, forming a sticky substance called plaque.
    • Over time, the plaque builds up. Often, the plaque causes the blood to flow abnormally, which can cause the blood to clot. There are two types of clots:
    • A clot that stays in place in the brain is called a cerebral thrombus.
    • A clot that breaks loose and moves through the bloodstream to the brain is called an cerebral embolism.
    • Another important cause of cerebral embolisms is a type of arrhythmia called atrial fibrillation.
    • Other causes of ischemic stroke include endocarditis and the use of a mechanical heart valve.
    • A clot can form on the artificial valve, break off, and travel to the brain.
    • For this reason, those with mechanical heart valves must take blood thinners.
    • A second major cause of stroke is bleeding in the brain hemorrhagic stroke.
    • This can occur when small blood vessels in the brain become weak and burst.
    • Some people have defects in the blood vessels of the brain that make this more likely.
    • The flow of blood after the blood vessel ruptures damages brain cells.
  • Sites of Brain Hemorrhage
    • High blood pressure is the number one reason.
    • The risk of stroke is also increased by age, family history of stroke, smoking, diabetes, high cholesterol, and heart disease.
    • Certain medications increase the chances of clot formation.
    • Birth control pills can cause blood clots, especially in women who smoke and who are older than 35.
    • Men are prone to more strokes than women.
    • But, women have a risk of stroke during pregnancy and the weeks immediately after pregnancy.
    • Cocaine use, alcohol abuse, head injury, and bleeding disorders increase the risk of bleeding into the brain.
    • The symptoms of stroke depend on what part of the brain is damaged.
    • In some cases, a person may not even be aware that he or she has had a stroke.
    SYMPTOMS Usually, a SUDDEN development of one or more of the following indicates a stroke:
    • Weakness or paralysis of an arm, leg, side of the face, or any part of the body
    • Numbness, tingling, decreased sensation
    • Vision changes
    • Slurred speech, inability to speak or understand speech, difficulty reading or writing
    • Swallowing difficulties or drooling
    • Loss of memory
    • Vertigo (spinning sensation)
    • Loss of balance or coordination
    • Personality changes
    • Mood changes (depression, apathy)
    • Drowsiness, lethargy, or loss of consciousness
    • Uncontrollable eye movements or eyelid drooping
    If one or more of these symptoms is present for less than 24 hours, it may be a transient ischemic attack (TIA). A TIA is a temporary loss of brain function and a warning sign for a possible future stroke.
    • In diagnosing a stroke, knowing how the symptoms developed is important.
    • The symptoms may be severe at the beginning of the stroke, or they may progress or fluctuate for the first day or two (stroke in evolution).
    • Once there is no further deterioration, the stroke is considered completed.
    • During the exam, doctor will look for specific neurologic, motor, and sensory deficits.
    • These often correspond closely to the location of the injury in the brain.
    • An examination may show changes in vision or visual fields, abnormal reflexes, abnormal eye movements, muscle weakness, decreased sensation, and other changes.
    • A "bruit" (an abnormal sound heard with the stethoscope) may be heard over the carotid arteries of the neck.
    • There may be signs of atrial fibrillation.
    • Tests are performed to determine the type, location, and cause of the stroke and to rule out other disorders that may be responsible for the symptoms.
    • Head CT or head MRI -- used to determine if the stroke was caused by bleeding (hemorrhage) or other lesions and to define the location and extent of the stroke.
    • ECG (electrocardiogram) -- used to diagnose underlying heart disorders.
    • Echocardiogram -- used if the cause may be an embolus (blood clot) from the heart.
    • Carotid duplex (a type of ultrasound) -- used if the cause may be carotid artery stenosis (narrowing of the major blood vessels supplying blood to the brain).
    • Heart monitor -- worn while in the hospital or as an outpatient to determine if a heart arrhythmia (like atrial fibrillation) may be responsible for stroke.
    • Cerebral (head) angiography -- may be done so that the doctor can identify the blood vessel responsible for the stroke. Mainly used if surgery is being considered.
    • Blood work may be done to exclude immune conditions or abnormal clotting of the blood that can lead to clot formation.
    • A stroke is a medical emergency.
    • Physicians have begun to call it a "brain attack" to stress that getting treatment immediately can save lives and reduce disability.
    • Treatment varies, depending on the severity and cause of the stroke.
    • For virtually all strokes, hospitalization is required, possibly including intensive care and life support.
    • The goal is to get the person to the emergency room immediately, determine if he or she is having a bleeding stroke or a stroke from a blood clot, and start therapy -- all within 3 hours of when the stroke began.
    • Thrombolytic medicine, like tPA, breaks up blood clots and can restore blood flow to the damaged area.
    • Blood thinners such as heparin and Coumadin are used to treat strokes. Aspirin and other anti-platelet agents may be used as well.
    • Other medications may be needed to control associated symptoms. Analgesics (pain killers) may be needed to control severe headache. Anti-hypertensive medication may be needed to control high blood pressure.
    • Nutrients and fluids may be necessary, especially if the person has swallowing difficulties. The nutrients and fluids may be given through an intravenous tube (IV) or a feeding tube in the stomach (gastrostomy tube). Swallowing difficulties may be temporary or permanent.
    • For hemorrhagic stroke, surgery is often required to remove pooled blood from the brain and to repair damaged blood vessels.
    • Life support and coma treatment are performed as needed.
    • The goal of long-term treatment is to recover as much function as possible and prevent future strokes.
    • Depending on the symptoms, rehabilitation includes speech therapy, occupational therapy, and physical therapy.
    • The recovery time differs from person to person.
    • Certain therapies, such as repositioning and range-of-motion exercises, are intended to prevent complications related to stroke, like infections and bed sores.
    • People should stay active within their physical limitations.
    • Sometimes, urinary catheterization or bladder/bowel control programs may be necessary to control incontinence.
    • The person's safety must be considered.
    • Some people with stroke appear to have no awareness of their surroundings on the affected side.
    • Others show indifference or lack of judgment, which increases the need for safety precautions.
    • For these people, friends and family members should repeatedly reinforce important information, like name, age, date, time, and where they live, to help the person stay oriented.
    • Behavior modification may be helpful in controlling unacceptable or dangerous behaviors.
    • Caregivers may need to show the person pictures, repeatedly demonstrate how to perform tasks, or use other communication strategies, depending on the type and extent of the language problems.
    • In-home care, boarding homes, adult day care, or convalescent homes may be required to provide a safe environment, control aggressive or agitated behavior, and meet medical needs.
    • Family counseling may help in coping with the changes required for home care.
    • Carotid endarterectomy (removal of plaque from the carotid arteries) may help prevent new strokes from occurring in people with large blockage in these important blood vessels.
    • The long-term outcome from a stroke depends on the extent of damage to the brain, the presence of any associated medical problems, and the likelihood of recurring strokes.
    • Of those who survive a stroke, many have long-term disabilities, but about 10% of those who have had a stroke recover most or all function.
    • Fifty percent are able to be at home with medical assistance while 40% become residents of a long-term care facility like a nursing home.
    • Problems due to loss of mobility (joint contractures, pressure sores)
    • Permanent loss of movement or sensation of a part of the body
    • Bone fractures
    • Muscle spasticity
    • Permanent loss of brain functions
    • Reduced communication or social interaction
    • Reduced ability to function or care for self
    • Decreased life span
    • Side effects of medications
    • Aspiration
    • Malnutrition
    • To help prevent a stroke:
    • Get screened for high blood pressure at least every two years, especially if family history of high blood pressure.
    • Cholesterol check.
    • Treat high blood pressure, diabetes, high cholesterol, and heart disease if present.
    • Follow a low-fat diet.
    • Quit smoking.
    • Exercise regularly.
    • Lose weight if overweight.
    • Avoid excessive alcohol use (no more than 1 to 2 drinks per day).
    • Intravenous tPA (tissue Plasminogen Activator)
    • Calcium channel blocker
    • Anticoagulants
    • Antithrombotics (anti-platelet agents and anticoagulants)
    • Thrombolytics
    • Neuroprotective agents
    • Nutrition and Diet
    • Vitamin and Nutritional Supplements
    • Exercise and Bodywork, including Massage, Hydrotherapy, Tai Chi, Qigong, and Feldenkrais
    • Herbal Medicine
    • Homeopathy
    • Traditional Chinese Medicine like Chelation Therapy
    • Snake Venom Remedy for Stroke
    • Spider-Venom Remedy for Stroke
    • Aromatherapy
    • Bach Flower Remedies
    • Vision therapy
    • Mind Body Medicine including Hypnotherapy, Biofeedback, Guided Imagery, Meditation, Stress Management, Relaxation and Social Support
    • Others: Light Therapy, Magnetic Field Therapy, Naturopathic Medicine, Osteopathy, Sound Therapy, Chiropracty, Reflexology and Folk Remedies
    • AIMS :
    • Breathing practices
    • Hands in and out breathing
    • Ankle stretch breathing
    • Tiger breathing
    • Rabbit breathing
    • Sasankasana breathing
    • Straight leg raise breathing
    • Sithilikarana vyayama (loosening exercise)
    • Jogging
    • Forward and Backward bending
    • Side bending
    • Twisting
    • Pavanamuktasana kriya
    • Suryanamaskar
    • Yogasanas
    • Standing
    • Ardhakati cakrasana
    • Ardha cakrasana
    • Padahastasana
    • Prone
    • Bhujangasana
    • Salabhasana
    • Dhanurasana
    • Supine
    • Sarvangasana
    • Matsyasana
    • Cakrasana
    • Sitting
    • Pascimottanasana
    • Vakrasana/Ardha Matsyendrasana
    • Sasankasana/ Yogamudra
    • Ustrasana
    • Deep relaxation technique (DRT)
    • Pranayama
    • Kapalabhati
    • Vibhaga pranayama (Sectional breathing)
    • Nadi suddhi
    • Meditation (Dhyana Dharana)
    • Nadanusandhana
    • OM meditation
    • Kriyas
    • Jala Neti
    • Sutra Neti
    • Vaman Dhouti
    • Stroke (brain hemorrhage or acute brain ischaemia)
    • General considerations : Proper medical treatment is necessary, yoga can be used within the framework of long-term rehabilitation.
    • Contraindications : No inverted asanas, the limitations of trainees should be strictly respected.
    • Recommendations : In the beginning relaxation, full yoga breath, Ujjayi, gentle mobilisation of the affected parts of the body.
    • Suryanamaskara
    • Natarajasana
    • Santulanasana
    • Shirshasana
    • Sarvangasana
    • Matsyasana
    • Dhanurasana
    • Pachhimottanasana
    • Shavasana
    • Pranayama
    Heat exhaustion and heat stroke
  • T H A N K Y O U