It is a simple made PPT of stroke which make easy to learn more about stroke a cardiovascular accident (CVA).

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STROKE is defined as :
“Clinical syndrome consisting of rapidly
developing clinical signs of focal (or global
in case of coma) disturbance of cerebral
function lasting for 24 hours or longer, or
Leading to death, with no apparent cause
other than a vascular lesion.”

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It is the brief
interruption of blood
flow to part of the
brain that causes
TEMPORARY
STROKE or MINI
STROKE like
symptoms.

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• Stenosis of the major
intracranial arteries (middle
cerebral artery, internal carotid
artery and intracranial
vertebral arteries).
• They are caused by blockage of one
of the small arteries that branch off
of the larger arteries. These small
arteries penetrate deep into the
brain, and can cause any of the
symptoms of ischemic stroke.

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 Most common type of stroke
 Affecting about 80% of individuals
 Results when a clot blocks or impairs blood flow,
depriving the brain of essential oxygen and
nutrients.
1) Cerebral Thrombus
2) Cerebral Embolus
3) Low systemic Perfusion

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 CEREBRAL THROMBOSIS :- Due to the development
of a blood clot within the arteries or their branches.
 CEREBRAL EMBOLUS :- Blood clot or Plaque formed
elsewhere & released into the bloodstream, traveling to
cerebral arteries.
 LOW SYSTEMIC PERFUSION :-Due to Cardiac
Failure or Significant Blood Loss.

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 Occurs when blood vessel rupture, causing leakage of blood in or around the
brain
 It results in increased intracranial pressure with injury to brain tissue and
restricted distal blood flow.
1) Trauma
2) Cerebral Vascular Lesions

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Skin
Skull
Dura Mater
Arachnoid Mater
Pia Mater
Brain Tissue
Epi Dural SpaceSub dural SpaceSub Arachnoid Space

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1) Epidural Hemorrhage
2) Subdural Hemorrhage
3) Subarachnoid Hemorrhage
4) Cerebral Hemorrhage

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Acute occlusion of an intracranial vessel
Reduction in blood flow to the brain region it supplies
Decrease in cerebral blood flow to zero
Death of Brain tissue within 4-10 minutes
If blood flow is restored the patient may experience only transient
symptoms. Tissue surrounding the core region of infarction is ischemic but
reversibly dysfunctional and is referred to as the ISCHEMIC PENUMBRA

17. Cells become
programmed to die
Rapid breakdown of
cellular cytoskeleton
due to energy failure of
cell
Apoptotic PathwayNecrotic Pathway
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Focal cerebral Infarction occurs by two distinct pathways

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Middle Cerebral Artery:
Brain infarction or ischemia in the territory supplied by
the MCA. The MCA is by far the largest cerebral
artery and is the vessel most commonly affected by
Cerebrovascular accident.
SYMPTOMS:-

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Anterior Cerebral Artery:
Stroke occurring in the area normally
supplied by ACA.
SYMPTOMS:-

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Posterior Cerebral Artery:
Branches of the PCA that supply the thalamus can
result in central post-stroke pain
SYMPTOMS:-

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Vertebrobasilar Artery:
The basilary artery supplies the pons, inner ear and cerebellum. Complete
occlusion is often fatal.
SYMPTOMS:-
Ventral Brain
Stem Damage
-
-
-
-
-

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Medullary
Pyramids

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1. SENSORY:
a) Touch, Pain, temperature, proprioceptive sensation may be involved to a variable degree.
b) Involvement of thalamus can result in Contralateral Hemianasthesia.
c) Loss of cortical sensation i.e. tactile localization, tactile discrimination,
stereognosis and tactile extinction.
d) Common visual disturbances seen in which there is loss of vision in the nasal
half of the opposite eye and the temporal half of the eye on the hemiplegic side.
e) Crossed anesthesia – anesthesia on the same side of the face and on the
opposite side of the trunk.
2. MOTOR:
a) Immidiately after the onset of stroke, Flaccidity & Areflexia .
b) Gradually, Spasticity & Hyperreflexia.

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3. SPASTICITY:
a) Severe degree of spasticity makes movements impossible; Moderate
Spasticity will allow for some slow movements but will be performed with
much efforts; Mild Spasticity will allow gross movements but fine
movements of limbs specially distal portion will be difficult.
b) In hemiparesis there are some muscles always involved which consequently
give rise to peculiar abnormal mass movement that is characteristic of many
hemiparesis patient.
4. SYNERGY:
UPPER LIMBS LOWER LIMBS
Flexion
Synergies
Shoulder girdle retraction & elevation,
shoulder abduction, external rotation,
supination, flexion of elbow, wrist &
finger flexion
Hip flexion, abduction & lateral
rotation, knee flexion,
dorsiflexion & inversion.
Extension
Synergies
Shoulder girdle protraction &
depression, shoulder adduction, internal
rotation, elbow extension, pronation,
wrist & finger flexion.
Hip extension, adduction,
internal rotation, knee
extension, ankle plantar
flexion, inversion and toe
plantar flexion.

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5. REFLEXES:
a) In stage of flaccidity all the reflexes are suppressed or absent. As the patient
enters into the stage of spasticity, the reflexes reoccur.
b) Superficial reflexes are lost but plantar responses show BABINSKI SIGN
positive.
6. IMPAIRMENT of HIGHER LEVEL REACTIONS:
a) Righting Reactions
b) Equilibrium Reactions
7. SPEECH & LANGUAGE DISORDERS:
a) Broca’s/Motor/Expressive/Non-fluent aphasia
(BMEN)
b) Wernicke’s/Sensory/Receptive/Fluent aphasia
(WSRF)
c) Global/Conductive or Total aphasia
8. APRAXIA:
a) Inability to carry out purposeful movement despite the presence of a good
motor, sensory or coordination function. It is caused by the lesion of
dominent parietal lobe.

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9. AGNOSIA:
Its is failure to recognize objects despite having an intact visual, auditory and tactile
sensation, due to the lack of association pathways to arrange sensory images,
memory and disposition towards the action.
10. PERCEPTION AND COGNITIVE DYSFUNCTION:
a) Visuospatial relation disorder: It is difficulty in determining the distance, size,
position and relationship of various parts to the whole.
b) Unilateral body neglect : The individual does not use the involved limb, i.e. non-
dominant limb.
11. DYSPHAGIA
12. BLADDER & BOWEL IMPAIRMENT:
In flaccid stage there is overflow incontinence Hence continuous catheterization is
advisable.
13. SEXUAL DYSFUNCTION

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Psychological Dysfunction:
Psychological Functions are very common after an attack of stroke & are:
Depression
Social withdrawal
Anxiety
Sleep Disorder (insomnia)
Emotional Lability (i.e. crying & laughing)
Behavior Problem (aggressiveness, over dependency, Abusive)
Even Personality Changes…….Like an introvert become extrovert or may appear
very happy.
Musculoskeletal Complications:
Musculoskeletal complications set in 95% of stroke patients if proper
Physiotherapy treatment is not given.
Pain & Stiffness is common in various joints.

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Decreased tone in flaccid stage commonly causes subluxation of glenohumeral
joint on affected side.
Deep Vein Thrombosis:
It occurs due to accumulation of the clot in the distal blood vessels.
It is manifested as pain or tenderness in the calf muscle, swelling &
discoloration of the leg.
It occur in Hemiplegia mainly if the patient remains in Comatose state for a
long time.
Cardiac & respiratory Diseases:
Although the cardiac & respiratory systems are not directly affected, Decreases
physical activity has been found out to be the main cause of deconditioning of
these systems.
Gastro Intestinal Renal System:
Although these systems may not directly involved, rarely, some patients with
stroke do exhibit constipation and urinary tract infections. How ever the
frequency of involvement is very low.

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Pain:
 Pain is very common only in
stroke affecting the thalamus
and is termed as Thalamic
syndrome, which is
characterized by very intense
pain on the opposite side of
the body.
 Pain can also occur as a
result of various
musculoskeletal
complications as discussed
above.

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History and Examination
An accurate profiling the timing of
neurological events is obtained from the patient
or from family members in the case of the
unconscious or non-communicative patient.
Cerebrovascular Imaging
 Computed Tomography (CT): It is the most
commonly used and readily available
neuroimaging technique. CT resolution allows
identification of large arteries and veins and
venous sinuses.

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Magnetic Resonance Angiography(MRA): It is
a type of magnetic resonance image that uses
special software to create an image of the
arteries in the brain.
Doppler Ultrasound: It is a non invasive
technique that sends sound waves into the body.
Echoes bounce of the moving blood and artery
and are formed into an image.
Arteriography & Digital Subtraction
Angiography: It is an X-Ray of the carotid artery
with a special dye injected into an artery in the
leg or arm. DSA is also an X-Ray of the carotid
artery with less dye used.

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a) Improve cerebral perfusion by reestablishing circulation and oxygenetion.
Oxygenation is delivered via mask or nasal cannula. Patients in a coma may
require intubation or assisted ventilation and suctioning.
b) Maintain adequate blood pressure. Hypotension or extreme hypertension is
treated.
c) Restore/maintain fluid and electrolyte balance.
d) Maintain blood glucose levels within the normal range.
e) Control seizures and infections.
f) Control edema, intracranial pressure.
g) Maintain bowel and bladder function, which may include urinary catheter.

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: plasminogen activator, dissolves clots & reestablishes
blood flow.
: to reduce the risk of blood clots.
: Decrease the risk of thrombosis.
to control hypertension.
: Enlarges blood vessels
and reduces blood pressure.
: Lower cholesterol that produces
in the liver.

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: relax skeletal muscle & decrease
muscle spasm.
: relax skeletal muscle & decrease muscle spasm.
: control seizures.

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1. In hemorrhagic stroke, surgery may be indicated to repair a superficial
ruptured aneurysm, prevent rebleeding, and evacuate a clot.

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2. The Penumbra System uses a catheter and separator that is threaded to
the site of the clot. It suctions and grabs the clot and aspirates the site.

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3. Carotid endarterectomy is a surgical procedure used to remove fatty
deposits from the carotid artery. It is a useful procedure to prevent recurrent
stroked or the development of stroke in individuals with TIAs.

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