The document discusses stroke, including its definition, causes, risk factors, symptoms, diagnosis and treatment. Some key points: - Stroke is caused by an interruption of blood flow to the brain, which can be due to blockage (ischemic) or bleeding (hemorrhagic). - Risk factors include age, family history, smoking, obesity, diabetes and hypertension. - Symptoms depend on the affected brain region and can include weakness, speech problems, sensory issues and more. - Diagnosis involves imaging tests like CT scans and MRI to identify lesions and rule out other causes. - Treatment aims to improve functions like strength, balance and mobility through physical therapy and manage

1. QURATULAIN MUGHAL
ISRA UNIVERSITY
BATCH IV
DOCTOR OF PHYSICAL THERAPY

2.  Stroke is also known as “cerebrovascular
accident or attack”.
 “It is an acute onset of neurological
dysfunction due to an abnormality in cerebral
circulation with resultant signs & symptoms
which corresponds to involvement of focal
areas of the brain”.
2

3.  It is defined as:
“The sudden onset of neurological deficits due
to an abnormality in cerebral circulation with
the signs and symptoms lasting for more
than 24 hours or longer”.
3

4.  It is defined as:
“The sudden onset of neurological deficits due
to an abnormality in cerebral circulation with
the signs and symptoms lasting for less than
24 hours”.
The major clinical
significance of TIA is as a precursor to
susceptibility for
both cerebral infarction and
myocardial infarction.
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5.  Stroke is the fourth leading cause of death and
the leading cause of long-term disability among
adults in the United States.
 An estimated 7,000,000 Americans older than 20
years of age have experienced a stroke.
 Women have a lower age-adjusted stroke
incidence than men.
 Compared to whites, African Americans have
twice the risk of first-ever stroke; rates are also
higher in Mexican Americans, American Indians,
and Alaska Natives.
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6.  Increases dramatically with age, doubling in
the decade after 65 years of age.
 28% of strokes occur in individuals younger
than 65 years of age.
 Between 5% and 14% of persons who survive
an initial stroke will experience another one
within 1 year; within 5 years stroke will recur
in 24% of women and 42% of men.
 Strokes account for 1 of every 18 deaths in
the United States.
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7.  Patients with hemorrhagic stroke accounts for
the largest number of deaths, 37% to 38% at
1 month.
 Whereas ischemic strokes have only 8% to
12% at 1 month.
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8.  Atherosclerosis
 Cerebral Thrombus
 Cerebral embolus
 Embolism from the heart (cardiac origin)
 Intracranial hemorrhage
 Subarachnoid hemorrhage
 Intracranial small vessel disease
 Arterial aneurysms
 Arterio-venous malformation
 Haematological disorders (haemoglobinopathies,
leukemia)
Atherothromboembolism
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9.  Perinatal arterial ischemic stroke
 Sickle cell disease
 Congenital HD
 Thrombophlebitis
 Trauma.
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10.  Origin of the common carotid artery.
 At its transition into the middle cerebral
artery.
 At the main bifurcation of the middle cerebral
artery.
 At the junction of the vertebral arteries with
the basilar artery.
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11. 11

12.  Infective endocarditis & HIV infection
 Tumour
 Perioperative stroke (due to hypotension and boundary
zone infarction, trauma to and dissection of neck arteries,
paradoxical embolism, fat embolism, infective endocarditis)
 Migraine
 Chronic meningitis
 Inflammatory bowel disease (ulcerative and Crohn's
colitis)
 Hypoglycemia
 Snake bite, fat embolism
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13. Non Modifiable
modifiable
 Ageing & gender
 Positive family history
 Circadian and seasonal
factors (peaks between
10 am till noon)
 Smoking
 Obesity
 Lack of physical exercise or
sedentary life style
 Diet & excess alcohol
consumption
 Oral contraceptives
 Infection (meningeal infection)
 Psychological factors
 Vasectomy
 Heart disease
 Diabetes mellitus
 Hypertension
 Peripheral arterial disease
 Blood pathology (increased
haematocrit, clotting
abnormalities, sickle cell
anaemia etc)
 Hyperlipidemia
 TIA
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14. 14

15.  Sudden cessation of cerebral blood flow and
oxygen-glucose deprivation sets in motion a
series of pathological events.
 Within minutes neurons die within the
ischemic core tissue, while the majority of
neurons in the surrounding penumbra survive
for a slightly longer time.
 Cell survival depends largely on the severity
and the duration of the ischemic episode. For
cells to survive, 20% to 25% of regular blood
flow is required.
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16.  Ischemia triggers a number of damaging
cellular events, termed ischemic cascade.
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17. 17

18.  Decreasing level of consciousness (stupor
and coma)
 Widened pulse pressure
 Increased heart rate
 Irregular respirations (Cheyne-Stokes
respirations)
 Vomiting
 Unreacting pupils [CN] III signs
 Papilledema.
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19.  Depending on the cause
 Depending on the severity
 Depending on the duration
 Depending on vascular symptoms
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20. 1. Haemorrhagic stroke
 Intracranial haemorrhage
 Subarachnoid haemorrhage
Signs of raised ICP will
be evident with a
history of a traumatic
accident
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21. 2. Ischemic stroke
a) Thrombotic: more common. Usually occurs in the
sleeping hours. Characterised by gradual onset of
symptoms
b) Embolic: Occurs in the waking hours of the day.
Sudden onset of symptoms preceded by giddiness in
most conditions
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22. ◦ Mild stroke: symptoms subside with no deficit in a
week period
◦ Moderate stroke: symptoms recover in a period of 3
- 6 months with minimal neurological deficit
◦ Severe stroke: there is no complete recovery of the
symptoms even after 1 years. Always ends up with
severe neurological deficit
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23. ◦ Acute stroke: to a period of one week or until
spasticity develops
◦ Sub acute stroke: after the development of
spasticity & last for a period of 3-12 months
◦ Chronic stroke: more than 12 months
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24. ◦ MCA Syndrome
◦ ACA Syndrome
◦ PCA syndrome
◦ Vertebro basilar artery syndrome
 Vertebral artery
 Basilar artery
 Internal carotid artery
◦ Lacunar syndrome
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25.  Vertebral arteries
 Subclavian artery
 Basilar artery
 Posterior cerebral
arteries
 Internal carotid arteries
 Common carotid artery
 ophthalmic and
anterior choroidal
arteries
 Middle and anterior
cerebral arteries.
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26. 26

27. 27

28. 28

29. 29

30. 30

31. 31

32. 32

33.  Caused by small vessel disease of deep white
mater
◦ Pure motor lacunar stroke: posterior limb of internal
capsule, pons, & pyramids
◦ Pure sensory lacunar stroke: ventrolateral thalamus
or thalamocortical projections
 Ataxic hemiparesis
 Dysarthria
 Clumsy hand syndrome
 Sensory/motor stroke
 Dystonia/involuntary movements
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34.  Altered Consciousness
 Disorders of Speech and Language
 Dysphagia
 Cognitive Dysfunction
 Altered Emotional Status
 Hemispheric Behavioral Differences
 Perceptual Dysfunction
 Seizures
 Bladder and Bowel Dysfunction
 Cardiovascular and Pulmonary Dysfunction
 Deep Venous Thrombosis and
 Pulmonary Embolus
 Osteoporosis and Fracture Risk
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35. Hemispheric Behavioral Differences.
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36.  Urine analysis
 CBC count
 Blood sugar level
 Blood cholesterol & lipid profile
 Cardiac evaluation
 Lumbar puncture
 CT scan
 MRI
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37.  CT Scan
◦ In acute phase, CT scans are used to rule out brain
lesions such as tumor or abscess & to identify
hemorrhagic stroke
◦ In sub-acute phase, CT scans can identify
development of cerebral edema (within 3 days) &
cerebral infarction (within 3 to 5 days) by showing
areas of decreased density.
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38.  Magnetic Resonance Imaging (MRI).
◦ MRI is more sensitive in diagnosis of acute strokes,
allowing detection of cerebral infarction within 2 to
6 hours after stroke.
◦ It is also able to detail extent of infarction or
hemorrhage & can detect smaller lesions
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39. ◦ Involves injection of radiopaque dye into blood
vessels with subsequent radiography.
◦ It provides visualization of vascular system and
used when surgery is considered (carotid stenosis,
AVM).
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40.  Positioning strategies
◦ In supine
◦ In side lying on normal side
◦ In side lying on affected side
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41.  Aerobic Capacity and Endurance
 Integumentary Integrity
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42.  To Improve Strength
 To Manage Spasticity
 Exercise Precautions
 To Improve Functional Status
 Improve Postural Control and Balance
 Improve Gait and Locomotion
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43. 1. Behavioral Inattention Test
2. Canadian Neurological Scale
3. Fugl-Meyer Assessment
4. Mini-Mental State Examination
5. Modified Ashworth Scale
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44. 1. Barthel Index
2. Berg Balance Scale
3. Functional Independence Measure
4. Motor Assessment Scale
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45. 1. Reintegration to Normal Living Index
2. Stroke Specific Quality of Life
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46.  O’ Sullivan SB, Schmitz TJ. Stroke. Physical
rehabilitation. 6th ed., New Delhi: Jaypee
Brothers, 2007.
 Stroke rehabilitation A call to action in Saudi
Arabia Saad M. Bindawas, PT, PhD, Vishal S.
Vennu, BSc, MSc.
 Davidson’s , 2nd ed
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