BIEN

2. Etiology and Pathophysiology
• Brain requires continuous supply of O2 and glucose for neurons to
function
• If blood flow is interrupted
• Neurologic metabolism is altered in 30 seconds
• Metabolism stops in 2 minutes
• Cell death occurs in 5 minutes

3. Etiology and Pathophysiology
• Atherosclerosis is a major cause of stroke
• Can lead to thrombus formation and contribute to emboli

4. Cerebrovascular Accident
Anatomy of Cerebral Circulation
Blood Supply
Anterior: Carotid Arteries – middle & anterior cerebral arteries
frontal, parietal, temporal lobes; basal ganglion; part of the diencephalon
(thalamus & hypothalamus)
Posterior: Vertebral Arteries – basilar artery
Mid and lower temporary & occipital lobes, cerebellum, brainstem, & part
of the diencephalon
Circle of Willis – connects the anterior & posterior cerebral
circulation

5. Cerebrovascular Accident
Anatomy of Cerebral Circulation
Blood Supply
20% of cardiac output—750-1000ml/min
>30 second interruption– neurologic metabolism is altered;
metabolism stops in 2 minutes; brain cell death < 5 mins.

7. Cerebrovascular Accident
Pathophysiology
Atherosclerosis: major cause of CVA
Thrombus formation & emboli development
Abnormal filtration of lipids in the intimal layer of the arterial wall
Plaque develops & locations of increased turbulence of blood - bifurcations
Increased turbulence of blood or a tortuous area
Calcified plaques rupture or fissure
Platelets & fibrin adhere to the plaque
Narrowing or blockage of an artery by thrombus or emboli
Cerebral Infarction: blocked artery with blood supply cut off beyond the
blockage

8. Cerebrovascular Accident
Pathophysiology
Ischemic Cascade
Series of metabolic events
Inadequate ATP adenosine triphosphate production
Loss of ion homeostasis
Release of excitatory amino acids – glutamate
Free radical formation
Cell death
Border Zone: reversible area that surrounds the core ischemic
area in which there is reduced blood flow but which can be
restored (3 hours +/-)

9. • Cognitive and emotional activities might include:
• Therapy for cognitive disorders. Occupational therapy and speech therapy
can help you with lost cognitive abilities, such as memory, processing,
problem-solving, social skills, judgment and safety awareness.
• Therapy for communication disorders. Speech therapy can help you regain
lost abilities in speaking, listening, writing and comprehension.
• Psychological evaluation and treatment. Your emotional adjustment might
be tested. You might also have counseling or participate in a support group.
• Medication. Your doctor might recommend an antidepressant or a
medication that affects alertness, agitation or movement

10. Re-education
to empower the patient more possible
Kinesitherapy
stimulate sensory functions
walking rehabilitation

11. Ergotherapy
Assessment of the person's limitations, abilities,
interests and level of autonomy in everyday life.

12. Speech Therapy
At home more than in a
hospital setting
Assessment and treatment
of aphasic disorders,
communication, swallowing
Neuropsychologist
Management of anxiety
and depression
Assessment and treatment
of neuropsychological
disorders

13. Rehabilitation
Prepare the patient, in connection with his family and
the multidisciplinary team, to return to live in his
environment, and resuming his daily activities.

14. Neuroplasticity

15. • SECONDARY PREVENTION <ul><li>Blood pressure control
</li></ul><ul><li>Diabetes Management </li></ul><ul><li>Lipid
Management </li></ul><ul><li>Smoking Cessation
</li></ul><ul><li>Alcohol Moderation </li></ul><ul><li>Weight
Reduction/Physical Activity </li></ul><ul><li>Carotid Artery
Interventions </li></ul><ul><li>Anti platelet agents / Anti coagulants
</li></ul><ul><li>Statins </li></ul><ul><li>Diuretics +/- ACE inhibitors
</li></ul>

16. Thank you for your attention!

17. Multidisciplinary Team
• Rehabilitation specialist
• Physical, occupational and speech therapist
• Social worker
• Dietician
• Recreational therapist
• Psychologist
• Vocational rehabilitation counsellor
• Nurses
• Orthotist
• Patient, caregiver