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Stroke (cva)

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Stroke (cva)

  2. 2. Anatomy
  3. 3. Definition • Also known as cerebrovascular accident (CVA). • A stroke is the sudden death of brain cells in a localized area due to inadequate blood flow. • Sudden onset of neurological sign and symptoms, usually focal and acute. • It involve blood vessels which can cause temporary or permanent loss of function. (World Health Organization, 1989)
  4. 4. Risk Factors • Hypertension • Diabetes Mellitus • Heart disease • Cigarette or other tobacco use. Cigarettes cause the carotid arteries to develop severe atherosclerosis or to close. Atherosclerosis is accelerated by smoking. • Head injury • Obesity
  5. 5. Etiology CEREBRAL HEMORRHAGE - Often d/t HPT & combination of weakness of vessel wall & lead to hemorrhage ISCHAEMIA -gradual occlusion of blood vessel (slow onset of symptoms) SUBARACHNOID HEMORRHAGE - d/t berry aneurysm with hemorrhage into subarachnoid type CEREBRAL EMBOLISM Block of blood vessel to the brain
  6. 6. Types of stroke Ischemic Hemorrhagic -Interruption of blood supply depress oxygen and nutrient to brain cell and make severity brain death/ damage depending on total blood supply lack. - Ischemic embolism - Ischemic thrombotic - lacunar syndrome -d/t burst of blood vessel that supply brain - commonly d/t aneurysm & TIA - Intracerebral haemorrhage -Subarachnoid heamorrhage
  7. 7. Classification of Stroke • 1) Transient Ischemic Attack – Acute of focal cerebral or monocular function with symptoms lasting <24 hr. – The patient may not loss consciousness and there may be an initial weakness of muscles. • 2) Cerebral Hemorrhage /CVA – A cerebral hemorrhage occurs when a blood vessel in the brain ruptures and bleeds into the surrounding brain tissue – Rapidly developing clinical symptoms lasting > 24hr
  8. 8. • 3) Arteriosclerotic dementia - Deterioration in previously normal memory/intellect d/t repeated episode of cerebral ischemic infarction or hemorrhage ( Ann thompson,1994)
  9. 9. Symptoms • Sudden numbness or weakness of face, arm or leg, especially on one side of the body • Sudden confusion, trouble speaking or understanding • Sudden trouble seeing in one or both eyes • Sudden trouble walking, dizziness, loss of balance or coordination • Sudden severe headache with no known cause Other important but less common symptoms include: • Sudden nausea, and vomiting - different from a viral illness because of how fast it begins (minutes or hours vs. several days) • Brief loss of consciousness or a period of decreased consciousness (fainting, confusion, convulsions or coma) (National Stroke Association)
  10. 10. PATHOPHYSIOLOGY Atheroma cause the narrowing of arteries Cause increase in blood pressure Rupture of the vessel. Internal bleeding – blood clot or hematoma Cause ischemia-necrosis Brain cell damage
  11. 11. Dr’s Investigation • CT Scan –Computed Tomography Scan • MRI-Magnetic Resonance Imaging. • MRA-Magnetic Resonance Angiography. • Lumbar Puncture-CSF test. Dr’s Management • Medical –antibiotics ,IV Methanol . • Surgical –Craniotomy, Vascular reconstructive surgery, Clipping of rupture aneurysm. (Tidy’s physiotherapy,1991)
  12. 12. Physiotherapy Management Acute Care Aims : 1)Prevent recurrent stroke 2)Monitor vital signs, dysphasia adequate nutrition, bladder & bowel function. 3)Prevent complications 4)Mobilize the patient 5)Encourage resumption of self-care activities 6)Provide emotional support & education for patient & family 7)Screen for rehabilitation and choice of settings
  13. 13. Rehabilitation care Aims : 1)Set rehabilitation goals; develop rehabilitation plan and monitor progress 2)Manage sensory-motor deficits 3)Improve functional mobility & independence 4)Prevent & treat complications 5)Monitor functional health conditions 6)Discharge planning (safe residence recommendation, patient & caregivers education & continuity of care) 7)Community – reintegration (Physiotherapy Practice Guidelines for Stroke Rehabilitation, May 2000)