2. DEFINITION
• A stroke is the sudden death of brain cells in a localized area
due to inadequate blood flow.
3. • Description
• A stroke occurs when blood flow is interrupted to part of the
brain. Without blood to supply oxygen and nutrients and to
remove waste products, brain cells quickly begin to die.
Depending on the region of the brain affected, a stroke may
cause paralysis, speech impairment, loss of memory and
reasoning ability, coma, or death. A stroke also is sometimes
called a brain attack or a cerebrovascular accident (CVA).
• Some important stroke statistics include:
4. • more than one-half million people in the United States
experience a new or recurrent stroke each year
• stroke is the third leading cause of death in the United States
and the leading cause of disability
• stroke kills about 160,000 Americans each year, or almost one
out of three stroke victims
5. • three million Americans are currently permanently disabled
from stroke
• in the United States, stroke costs about $30 billion per year in
direct costs and loss of productivity
• two-thirds of strokes occur in people over age 65 but they can
occur at any age
• strokes affect men more often than women, although women
are more likely to die from a stroke
• strokes affect blacks more often than whites, and are more
likely to be fatal among blacks
6. • Stroke is a medical emergency requiring immediate treatment.
Prompt treatment improves the chances of survival and increases
the degree of recovery that may be expected. A person who may
have suffered a stroke should be seen in a hospital emergency
room without delay. Treatment to break up a blood clot, the
major cause of stroke, must begin within three hours of the
stroke to be effective. Improved medical treatment of all types of
stroke has resulted in a dramatic decline in death rates in recent
decades. In 1950, nine in ten died from stroke, compared to
slightly less than one in three in the twenty-first century.
However, about two-thirds of stroke survivors will have
disabilities ranging from moderate to severe.
14. causes
Cerebral thrombosis and
cerebral embolism are caused
by blood clots that block an
artery supplying the brain,
either in the brain itself or in
the neck. These account for
70-80% of all strokes.
15. • Subarachnoid hemorrhage and intracerebral hemorrhage
occur when a blood vessel bursts around or in the brain.
• Cerebral thrombosis occurs when a blood clot, or thrombus,
forms within the brain itself, blocking the flow of blood
through the affected vessel. Clots most often form due to
"hardening" (atherosclerosis) of brain arteries.
16. • a transient ischemic attack, or TIA, sometimes called a "mini-
stroke." In a TIA, blood flow is temporarily interrupted,
causing short-lived stroke-like symptoms. Recognizing the
occurrence of a TIA, and seeking immediate treatment, is an
important step in stroke prevention.
17.
18. Components
• The Circle of Willis is composed of the following arteries:[3]
• Anterior cerebral artery (left and right)
• Anterior communicating artery
• Internal carotid artery (left and right)
• Posterior cerebral artery (left and right)
• Posterior communicating artery (left and right)
19. Regulation of blood flow
• The brain requires a contious supply of blood to provide the
o2 &glucose that neuronsneed to function. Normal blood
flow : 750 - 1000 ml per mts.if blood flow to the brain totally
interruped , neurologic metabolism is altered in 30
seconds.metabolism stops in 2 mts ,& cellular death will occur
in 5 mts.
The brain normally well producted from changes in mean
systemic arteral pressure over a range from 50- 150 mmhg by
a mechanism of cerebral auto regulation .
20. Imparied auto regulation
• Changes in the diameter of cerebral blood flow (ischemia)
Systemic blood pressure ,cardiac output, blood viscosity.
ICP
22. Transient ischemic attack
• Is a temporary focal loss of neurologic
function caused by ischemia of the vascular
territories of the brain, lasting less than 24
hours & often 15 mts. Most TIAs may be
due to microembolie that temporarily block
the blood flow. It is warning signs of cva. Tia
depends on the blood vessel.
24. Clinical manifestation
Right brain damage
• Paralyzed left side
• left side neglect
• Spaital _ perceptual deficits
• Rapid performances, short
attention span
• Impulsive, safety problems
• Imparied judgment
• Impaired time concepts
Left brain damage
• Paralyzed right side
• Impaired speech language
aphasias
• Impaired RT & LT
discrimination
• Slow performances,
cautions
• Depression ,anxiety
• Impaired comprehension
rto language, math
25. Motor function
• Mobilty
• Respiratory function
• Swallowing & speech
• Gag reflex & self care abilities
Symptoms caused by the destruction of motor neurons
In the pyramidal path ways. akinesia ,impaired itergration of
movements ,alterations in reflexes (hypo ,hyper )
26. Communication
• Aphasia _total loss of voice
• Dysphasia _difficulty to the comprehension (or) use of
languag
I .non fluent
ii. Fluent
When affecting a stroke wernicke,s area receptive Aphasia
Brocas area brain cause expressive Aphasia
Global Aphasia
27. dysarthria
• Disturbance in the muscular control of speech (pronunciation
,articulation ,phonation)it affects the
mechanics of speech.
AFFECT _depression ,anxiety.
INTELLECTUAL FUNCTION _ MEMORY,judgement
28. Spatial_perceptual alterations
• i. incorrect perception of self & illness
• ii .the patient erroneous perception of self In
space,(homonymous hemianopsia in which blindness occurs in
the same half of the visual fields of both eyes.
• Iii . Agnosia _ inability to recognize an object by sight,touch ,
hearing.
• Iv. Apraxia _ inability to carry out learned sequential
movements on command.
30. Collaborative care
• Control HT
• Control DM
• Treatment of underlying cardiac problem
• Anticoagulation therapy
• No smoking
• Platelet inhibitors
• Limiting alcohol intake
• CEA _carotid endarterctomy
• Stenting
• Trans luminal angioplasty
• Extra intra cranial bypass
33. Warning signs of stroke
• Sudden dimness or loss vision in one or both eyes
• Sudden loss of speech , confusion, difficulty speaking,
understanding speech
• Unexplained sudden dizziness, unsteady ness, loss of balance
or coordination
• Sever headache
