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Cerebrovascular disease.ppt


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Cerebrovascular disease.ppt

  2. 2. <ul><li>MÜKAM KARÔTI VACÁLAM </li></ul><ul><li>PANGUM LANGHAYATÄ GIRIM </li></ul><ul><li>YATKRIPÁ TAMAHAM VANDÄ </li></ul><ul><li>PARAMÁNANDA SÁGARAM </li></ul>PRAYER
  3. 3. <ul><li>Name of the disease & terminologies </li></ul><ul><li>Etiology </li></ul><ul><li>Physical examination, signs and symptoms </li></ul><ul><li>Investigations </li></ul><ul><li>Modern medical treatment </li></ul><ul><li>Alternative therapies – Yoga management </li></ul><ul><li>Diet </li></ul><ul><li>Books and journals for reference </li></ul>
  4. 4. <ul><li>General term for a brain dysfunction caused by an abnormality of the cerebral blood supply. </li></ul><ul><li>A stroke is an interruption of the blood supply to any part of the brain. A stroke is sometimes called a &quot;brain attack.“ </li></ul><ul><li>Alternative names: Stroke CVA, Cerebral infarction, Cerebral hemorrhage. </li></ul>CEREBROVASCULAR DISEASE
  5. 5. <ul><li>A stroke can happen when: </li></ul><ul><li>A blood vessel carrying blood to the brain is blocked by a blood clot. This is called an ischemic stroke . </li></ul><ul><li>A blood vessel breaks open, causing blood to leak into the brain. This is a hemorrhagic stroke . </li></ul><ul><li>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. </li></ul>CAUSES, INCIDENCE, & RISK FACTORS
  6. 6. <ul><li>This is the most common type of stroke. </li></ul><ul><li>Usually this type of stroke results from clogged arteries, a condition called atherosclerosis. </li></ul><ul><li>Fatty deposits and blood platelets collect on the wall of the arteries, forming a sticky substance called plaque. </li></ul><ul><li>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: </li></ul><ul><li>A clot that stays in place in the brain is called a cerebral thrombus. </li></ul>ISCHEMIC STROKE
  7. 8. <ul><li>A clot that breaks loose and moves through the bloodstream to the brain is called an cerebral embolism. </li></ul><ul><li>Another important cause of cerebral embolisms is a type of arrhythmia called atrial fibrillation. </li></ul><ul><li>Other causes of ischemic stroke include endocarditis and the use of a mechanical heart valve. </li></ul><ul><li>A clot can form on the artificial valve, break off, and travel to the brain. </li></ul><ul><li>For this reason, those with mechanical heart valves must take blood thinners. </li></ul>
  8. 9. <ul><li>A second major cause of stroke is bleeding in the brain hemorrhagic stroke. </li></ul><ul><li>This can occur when small blood vessels in the brain become weak and burst. </li></ul><ul><li>Some people have defects in the blood vessels of the brain that make this more likely. </li></ul><ul><li>The flow of blood after the blood vessel ruptures damages brain cells. </li></ul>HEMORRHAGIC STROKE
  9. 10. Sites of Brain Hemorrhage
  10. 12. <ul><li>High blood pressure is the number one reason. </li></ul><ul><li>The risk of stroke is also increased by age, family history of stroke, smoking, diabetes, high cholesterol, and heart disease. </li></ul><ul><li>Certain medications increase the chances of clot formation. </li></ul><ul><li>Birth control pills can cause blood clots, especially in women who smoke and who are older than 35. </li></ul>STROKE RISKS
  11. 13. <ul><li>Men are prone to more strokes than women. </li></ul><ul><li>But, women have a risk of stroke during pregnancy and the weeks immediately after pregnancy. </li></ul><ul><li>Cocaine use, alcohol abuse, head injury, and bleeding disorders increase the risk of bleeding into the brain. </li></ul>
  12. 14. <ul><li>The symptoms of stroke depend on what part of the brain is damaged. </li></ul><ul><li>In some cases, a person may not even be aware that he or she has had a stroke. </li></ul>SYMPTOMS Usually, a SUDDEN development of one or more of the following indicates a stroke: <ul><li>Weakness or paralysis of an arm, leg, side of the face, or any part of the body </li></ul><ul><li>Numbness, tingling, decreased sensation </li></ul><ul><li>Vision changes </li></ul><ul><li>Slurred speech, inability to speak or understand speech, difficulty reading or writing </li></ul>
  13. 15. <ul><li>Swallowing difficulties or drooling </li></ul><ul><li>Loss of memory </li></ul><ul><li>Vertigo (spinning sensation) </li></ul><ul><li>Loss of balance or coordination </li></ul><ul><li>Personality changes </li></ul><ul><li>Mood changes (depression, apathy) </li></ul><ul><li>Drowsiness, lethargy, or loss of consciousness </li></ul><ul><li>Uncontrollable eye movements or eyelid drooping </li></ul>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.
  14. 16. <ul><li>In diagnosing a stroke, knowing how the symptoms developed is important. </li></ul><ul><li>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). </li></ul><ul><li>Once there is no further deterioration, the stroke is considered completed. </li></ul><ul><li>During the exam, doctor will look for specific neurologic, motor, and sensory deficits. </li></ul><ul><li>These often correspond closely to the location of the injury in the brain. </li></ul>SIGNS AND TESTS
  15. 17. <ul><li>An examination may show changes in vision or visual fields, abnormal reflexes, abnormal eye movements, muscle weakness, decreased sensation, and other changes. </li></ul><ul><li>A &quot;bruit&quot; (an abnormal sound heard with the stethoscope) may be heard over the carotid arteries of the neck. </li></ul><ul><li>There may be signs of atrial fibrillation. </li></ul><ul><li>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. </li></ul>
  16. 18. <ul><li>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. </li></ul><ul><li>ECG (electrocardiogram) -- used to diagnose underlying heart disorders. </li></ul><ul><li>Echocardiogram -- used if the cause may be an embolus (blood clot) from the heart. </li></ul><ul><li>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). </li></ul>INVESTIGATIONS
  17. 19. <ul><li>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. </li></ul><ul><li>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. </li></ul><ul><li>Blood work may be done to exclude immune conditions or abnormal clotting of the blood that can lead to clot formation. </li></ul>
  18. 20. <ul><li>A stroke is a medical emergency. </li></ul><ul><li>Physicians have begun to call it a &quot;brain attack&quot; to stress that getting treatment immediately can save lives and reduce disability. </li></ul><ul><li>Treatment varies, depending on the severity and cause of the stroke. </li></ul><ul><li>For virtually all strokes, hospitalization is required, possibly including intensive care and life support. </li></ul><ul><li>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. </li></ul>TREATMENT
  19. 21. <ul><li>Thrombolytic medicine, like tPA, breaks up blood clots and can restore blood flow to the damaged area. </li></ul><ul><li>Blood thinners such as heparin and Coumadin are used to treat strokes. Aspirin and other anti-platelet agents may be used as well. </li></ul><ul><li>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. </li></ul>IMMEDIATE TREATMENT
  20. 22. <ul><li>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. </li></ul><ul><li>For hemorrhagic stroke, surgery is often required to remove pooled blood from the brain and to repair damaged blood vessels. </li></ul><ul><li>Life support and coma treatment are performed as needed. </li></ul>
  21. 23. <ul><li>The goal of long-term treatment is to recover as much function as possible and prevent future strokes. </li></ul><ul><li>Depending on the symptoms, rehabilitation includes speech therapy, occupational therapy, and physical therapy. </li></ul><ul><li>The recovery time differs from person to person. </li></ul><ul><li>Certain therapies, such as repositioning and range-of-motion exercises, are intended to prevent complications related to stroke, like infections and bed sores. </li></ul>LONG-TERM TREATMENT
  22. 24. <ul><li>People should stay active within their physical limitations. </li></ul><ul><li>Sometimes, urinary catheterization or bladder/bowel control programs may be necessary to control incontinence. </li></ul><ul><li>The person's safety must be considered. </li></ul><ul><li>Some people with stroke appear to have no awareness of their surroundings on the affected side. </li></ul><ul><li>Others show indifference or lack of judgment, which increases the need for safety precautions. </li></ul>
  23. 25. <ul><li>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. </li></ul><ul><li>Behavior modification may be helpful in controlling unacceptable or dangerous behaviors. </li></ul><ul><li>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. </li></ul>
  24. 26. <ul><li>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. </li></ul><ul><li>Family counseling may help in coping with the changes required for home care. </li></ul><ul><li>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. </li></ul>
  25. 27. <ul><li>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. </li></ul><ul><li>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. </li></ul><ul><li>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. </li></ul>EXPECTATIONS (PROGNOSIS)
  26. 28. <ul><li>Problems due to loss of mobility (joint contractures, pressure sores) </li></ul><ul><li>Permanent loss of movement or sensation of a part of the body </li></ul><ul><li>Bone fractures </li></ul><ul><li>Muscle spasticity </li></ul><ul><li>Permanent loss of brain functions </li></ul><ul><li>Reduced communication or social interaction </li></ul><ul><li>Reduced ability to function or care for self </li></ul><ul><li>Decreased life span </li></ul><ul><li>Side effects of medications </li></ul><ul><li>Aspiration </li></ul><ul><li>Malnutrition </li></ul>COMPLICATIONS
  27. 29. <ul><li>To help prevent a stroke: </li></ul><ul><li>Get screened for high blood pressure at least every two years, especially if family history of high blood pressure. </li></ul><ul><li>Cholesterol check. </li></ul><ul><li>Treat high blood pressure, diabetes, high cholesterol, and heart disease if present. </li></ul><ul><li>Follow a low-fat diet. </li></ul><ul><li>Quit smoking. </li></ul><ul><li>Exercise regularly. </li></ul><ul><li>Lose weight if overweight. </li></ul><ul><li>Avoid excessive alcohol use (no more than 1 to 2 drinks per day). </li></ul>PREVENTION
  28. 30. <ul><li>Intravenous tPA (tissue Plasminogen Activator) </li></ul><ul><li>Calcium channel blocker </li></ul><ul><li>Anticoagulants </li></ul><ul><li>Antithrombotics (anti-platelet agents and anticoagulants) </li></ul><ul><li>Thrombolytics </li></ul><ul><li>Neuroprotective agents </li></ul>ALLOPATHIC THERAPY
  29. 31. <ul><li>Nutrition and Diet </li></ul><ul><li>Vitamin and Nutritional Supplements </li></ul><ul><li>Exercise and Bodywork, including Massage, Hydrotherapy, Tai Chi, Qigong, and Feldenkrais </li></ul><ul><li>Herbal Medicine </li></ul><ul><li>Homeopathy </li></ul><ul><li>Traditional Chinese Medicine like Chelation Therapy </li></ul><ul><li>Snake Venom Remedy for Stroke </li></ul>ALTERNATIVE THERAPIES
  30. 32. <ul><li>Spider-Venom Remedy for Stroke </li></ul><ul><li>Aromatherapy </li></ul><ul><li>Bach Flower Remedies </li></ul><ul><li>Vision therapy </li></ul><ul><li>Mind Body Medicine including Hypnotherapy, Biofeedback, Guided Imagery, Meditation, Stress Management, Relaxation and Social Support </li></ul><ul><li>Others: Light Therapy, Magnetic Field Therapy, Naturopathic Medicine, Osteopathy, Sound Therapy, Chiropracty, Reflexology and Folk Remedies </li></ul>
  31. 33. YOGA PRACTICES <ul><li>YOGA IS BALANCE (SAMATVAM) </li></ul><ul><li>I A Y T CORRECTS IMBALANCES </li></ul><ul><li>AIMS : </li></ul><ul><li>STRESS REDUCTION </li></ul><ul><li>RELIEF OF PAIN </li></ul><ul><li>MEDICATION REDUCTION </li></ul>
  32. 34. PROMOTION OF POSITIVE HEALTH <ul><li>Breathing practices </li></ul><ul><li>Hands in and out breathing </li></ul><ul><li>Ankle stretch breathing </li></ul><ul><li>Tiger breathing </li></ul><ul><li>Rabbit breathing </li></ul><ul><li>Sasankasana breathing </li></ul><ul><li>Straight leg raise breathing </li></ul><ul><li>Sithilikarana vyayama (loosening exercise) </li></ul><ul><li>Jogging </li></ul><ul><li>Forward and Backward bending </li></ul><ul><li>Side bending </li></ul><ul><li>Twisting </li></ul><ul><li>Pavanamuktasana kriya </li></ul><ul><li>Suryanamaskar </li></ul>
  33. 35. <ul><li>Yogasanas </li></ul><ul><li>Standing </li></ul><ul><li>Ardhakati cakrasana </li></ul><ul><li>Ardha cakrasana </li></ul><ul><li>Padahastasana </li></ul><ul><li>Prone </li></ul><ul><li>Bhujangasana </li></ul><ul><li>Salabhasana </li></ul><ul><li>Dhanurasana </li></ul><ul><li>Supine </li></ul><ul><li>Sarvangasana </li></ul><ul><li>Matsyasana </li></ul><ul><li>Cakrasana </li></ul><ul><li>Sitting </li></ul><ul><li>Pascimottanasana </li></ul><ul><li>Vakrasana/Ardha Matsyendrasana </li></ul><ul><li>Sasankasana/ Yogamudra </li></ul><ul><li>Ustrasana </li></ul><ul><li>Deep relaxation technique (DRT) </li></ul>
  34. 36. <ul><li>Pranayama </li></ul><ul><li>Kapalabhati </li></ul><ul><li>Vibhaga pranayama (Sectional breathing) </li></ul><ul><li>Nadi suddhi </li></ul><ul><li>Meditation (Dhyana Dharana) </li></ul><ul><li>Nadanusandhana </li></ul><ul><li>OM meditation </li></ul><ul><li>Kriyas </li></ul><ul><li>Jala Neti </li></ul><ul><li>Sutra Neti </li></ul><ul><li>Vaman Dhouti </li></ul>
  35. 37. <ul><li>Stroke (brain hemorrhage or acute brain ischaemia) </li></ul><ul><li>General considerations : Proper medical treatment is necessary, yoga can be used within the framework of long-term rehabilitation. </li></ul><ul><li>Contraindications : No inverted asanas, the limitations of trainees should be strictly respected. </li></ul><ul><li>Recommendations : In the beginning relaxation, full yoga breath, Ujjayi, gentle mobilisation of the affected parts of the body. </li></ul>SPECIFIC PRACTICE
  36. 38. <ul><li>Suryanamaskara </li></ul><ul><li>Natarajasana </li></ul><ul><li>Santulanasana </li></ul><ul><li>Shirshasana </li></ul><ul><li>Sarvangasana </li></ul><ul><li>Matsyasana </li></ul><ul><li>Dhanurasana </li></ul><ul><li>Pachhimottanasana </li></ul><ul><li>Shavasana </li></ul><ul><li>Pranayama </li></ul>Heat exhaustion and heat stroke
  37. 40. T H A N K Y O U