A stroke is caused by the interruption of the blood supply to the brain, usually because a blood vessel bursts or is blocked by a clot. This cuts off the supply of oxygen and nutrients, causing damage to the brain tissue

1. CEREBROVASCULAR
ACCIDENT
Aditya Johan .R, M.Fis

2. Introduction
• Also called “brain attack”, cerebral infarction, cerebral hemorrhage,
ischemic stroke or stroke
• A stroke is caused by the interruption of the blood supply to the
brain, usually because a blood vessel bursts or is blocked by a clot.
This cuts off the supply of oxygen and nutrients, causing damage to
the brain tissue

3. • Cells with CBF <10ml/100g tissue/min will die within minutes of a stroke -
the ‘core’
• Cells with CBF <25ml/100g tissue/min can remain viable for several hours
- the ‘penumbra’

4. What happens when blood supply to brain is reduced?
• Certain functional changes occur once blood flow to the brain
decreases.
• Critical values for loss of synaptic transmission, corresponding to loss
of neuronal function, are between 15 and 18 ml/100 gram/minute
• The threshold for membrane pump failure. and thus for loss of
cellular integrity and cell death, is approximately 10 ml/100 gram/
minute
• It is generally assumed that if CBF stays above 18 ml/100 g/min but
below 20–25 ml/100 g/min neurons will survive but may not
function

6. Causes
 CEREBRAL THROMBOSIS
 a blood clot or plaque blocks an artery that supplies a vital brain
center
 CEREBRAL HEMORRHAGE/ANEURYSM
an artery in the brain bursts, weakens the aneurysm wall; severe rise
in BP causing hemorrhage and ischemia
 CEREBRAL EMBOLISM
a blood clot breaks off from a thrombus elsewhere in the body,
lodges in a blood vessel in the brain and shuts off blood supply to that
part of the brain

8. Types
 ISCHEMIC STROKE
Occurs when a clot or a mass clogs a blood vessel, cutting off the
blood flow to brain cells.
The underlying condition for this type of obstruction is the
development of fatty deposits lining the vessel walls. This condition is
called atherosclerosis.
Almost 85% of strokes are ischemic

9. Atherosclerosis
• “hardening of the arteries”
• “athero” – gruel or paste
• “sclerosis” – hardness
• It’s the process in which deposits of fatty substances, cholesterol,
cellular waste products, calcium and other substances build up in the
inner lining of an artery
• This buildup is called plaque

10. Types
 HEMORRHAGIC STROKE
• Results from a weakened vessel that ruptures and bleeds into the surrounding
brain.
• The blood accumulates and compresses the surrounding brain tissue.
• About 15% of all strokes but responsible for 30% of stroke deaths
2 TYPES
SUBARACHNOID HEMORRHAGE (SAH)
occurs when a blood vessel on the surface of the brain ruptures and bleeds into
the space between the brain and the skull
INTRACEREBRAL HEMORRHAGE (ICH) Occurs when a blood vessel bleeds into the
tissue deep within the brain.

11. Stages of CVA
 Transient Ischemic Attack
sudden and short-lived attack
Is a "mini stroke" that occurs when a blood clot blocks an artery for a short
time.
 Reversible ischemic neurologic deficit (RIND)
similar to TIA, but symptoms can last up to a week
 Stroke in evolution (SIE)
Gradual worsening of symptoms of brain ischemia
 Completed stroke (CS)
symptoms of stroke stable over a period and rehab can begin

12. Signs & symptoms
In embolism
• Usually occurs without warning
• Client often with history of cardiovascular disease
In thrombosis
• Dizzy spells or sudden memory loss
• No pain, and client may ignore symptoms
In cerebral hemorrhage
• May have warning like dizziness and ringing in the ears (tinnitus)
• Violent headache, with nausea and vomiting
Sudden Onset CVA
• Usually most severe
• Loss of consciousness
• Face becomes red
• Breathing is noisy and strained

13. Major effect of CVA
• HEMIPLEGIA – most common result of CVA
Paralysis of one side of the body
May affect other functions, such as hearing, general sensation and
circulation
The degree of impairment depends on the part of the brain affected
• Stages:
Flaccid – numbness and weakness of affected side
Spastic – muscles contracted and tense, movement hard
Recovery – therapy and rehab methods successful

14. Brunnstrom stages of motor recovery

15. ACT FAST
F – FACE
• Ask the person to smile. Does one side of the face droop?
A – ARMS
• Ask the person to raise both arms. Does one arm drift downward?
S – SPEECH
• Ask the person to repeat a simple sentence. Does the speech sound
slurred or strange?
T – TIME
• Call 911 Immediately

17. Supranuclear lession

18. Pyramidal Tracts

19. Overactivity of reticulospinal (Extra-pyramidal)

20. Medications

21. THANK YOU