Stroke
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Stroke (cerebrovascular accident [CVA]) is the sudden loss of neurological function caused by an interruption of the blood flow to the brain. Impairments may resolve spontaneously as brain swelling subsides (reversible ischemic neurological deficit), generally within 3 weeks. Residual neurological impairments are those that persist longer than 3 weeks and may lead to lasting disability
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Stroke
- 1. STROKE Dr. Maheshwari harishchandre Neurosciences (M.P.Th) Asst. Professor DVVPF College of Physiotherapy, Ahmednagar
- 2. Contents • Definition • Epidemiology • Pathophysiology • Cerebral circulation • Territary involvement • Clinical features • Stages • Physiotherapy management 11-04-2018stroke 2
- 3. Objectives • After end of this lecture students should be able to know– • Brain circulation, types of stroke & physiotherapy management for the same. 11-04-2018stroke 3
- 4. Def’n • Stroke (cerebrovascular accident [CVA]) is the sudden loss of neurological function caused by an interruption of the blood flow to the brain. • Impairments may resolve spontaneously as brain swelling subsides (reversible ischemic neurological deficit), generally within 3 weeks. . 11-04-2018 4
- 5. • Residual neurological impairments are those that persist longer than 3 weeks and may lead to lasting disability 11-04-2018stroke 5
- 6. Types • Ischemic • stroke is the most common type, affecting about 80% of individuals with stroke, and results when a clot blocks or impairs blood flow, depriving the brain of essential oxygen and nutrients. 11-04-2018stroke 6
- 7. • Hemorrhagic stroke occurs when blood vessels rupture, causing leakage of blood in or around the brain. 11-04-2018stroke 7
- 8. Risk factors • Major risk factors for stroke are - • Hypertension, heart disease (HD) • Diabetes mellitus (DM). • In patients with ABI, approximately 70% have hypertension, 30% HD, 15% congestive heart failure (CHF), 30% peripheral arterial disease (PAD) and 15% DM. 11-04-2018stroke 9
- 9. • Warning signs – 1. Sudden numbness or weakness of face, arm, leg specially one side of body. 2. Sudden confusion, trouble in speaking or understanding 3. Sudden trouble in seeing in one or both eyes. 4. Sudden trouble in walking, dizziness, loss of balance or coordination. 5. Sudden severe headache with unknown cause. 11-04-2018stroke 10
- 15. • ACA supplies – • MCA supplies – • PCA supplies - 11-04-2018stroke 16
- 21. Anterior Cerebral Artery Syndrome 11-04-2018stroke 22
- 22. ACA Sign & symptoms Structure involved Contralat hemiparesis involving mainly LL (UL is spared) Primary motor area, medial aspect of cortex, internal capsule Contralat hemisensory loss Primary sensory area, medial aspect of cortex Urinary incontinence Posteromed aspect of sup. Frontal gyrus Problems with imitation & bimanual tasks, apraxia Corpus callosum Abulia (lack of will power 0r inability to take decision) Uncertain localization 11-04-2018stroke 23
- 24. Sign & Symptoms Structure involved Contralat hemiparesis involve UL &face Primary motor cortex & int capsule Contralat hemisensory loss Primary sensory cortex & int capsule Motor speech impairment – Broca’s Aphasia Broca’s cortical area Wernicke’s aphasia Wernicke’s cortical area Global Aphasia Post portion of sup. Temporal gyrus Perceptual deficit – unilat neglect, agnosia (inability to process sensory information) Parietal sensory asso cortex Contralat homonymous hemianopsia Optic radiation in int capsule 11-04-2018stroke 25
- 26. Sign & symptoms Structure involved Peripheral territory – Contralat homonymous hemianopsia Primary visual cortex or optic radiation B/L homonymous hemianopsia calcarine cortex Visual agnosia Left occipital lobe Prospagnosia (inability to recognize face) Visual asso. Cortex Dyslexia (learning disorder) Post part of corpus callosum Memory defect Lesion of inferomed temporal lobe Central territory – Thalamic pain, sensory impairment Ventral posterolat nucleus of thalamus Invol movt Subthalamic nucleus Contralat hemiplegia Cerebral peduncle of midbrain Weber syndrome(Occulomotor N palsy) Third nerve & cerebral peduncle of midbrain 11-04-2018stroke 27
- 27. Lat medullary (wallenburg’s ) Syndrome Sign & Symptoms Structure involved Decreased pain & temp sensation over face Nucleus of V C.N Cerebellar ataxia (gait & limb ataxia) Cerebellum or inf cerebellar peduncles Vertigo, nausea, vomitting Vestibularnuclei Nystagmus Vest nuclei Horner’s syndrome Decending sympathetic tract Dysphagia & dysphonia IX & X C.N nuclei Sensory involvement of ipsilat UE,trunk, LE Cuneate & gracile nuclei Contralat. Lesion – Impaired pain & thermal sensation Spinothalamic tract 11-04-2018stroke 28
- 29. Lacunar Syndrome • Caused by small vessel disease deep in the cerebral white matter. • Pure motor lacunar stroke – involvement of – post limb of Int cap, pons & pyramids • Pure sensory lacunar stroke - – involvement of – ventrolat thalamus. 11-04-2018stroke 30
- 30. Stages 1. Acute stage/flaccid /cerebral shock – (max 2wks) 2. Subacute stage/stage of spasticity – (upto 2 years) 3. Chronic stage/stage of relative recovery – (more then 2 years) 11-04-2018stroke 31
- 31. Medical management • Improve (O2)/cerebral perfusion – • Maintain adequate B.P – • Maintain cardiac output – • Maintain electrolyte balance- • Maintain BSL- • Control ICP – • Maintain bladder function- • Maintain skin integrity & joint by protective positioning • Pharmacological management – • Anticoagulant drugs ---, Antiplatelet ---, Antihypertensive 11-04-2018stroke 32
- 32. Stages Stage 1 (Acute):- - contra. Hemiparesis / paralysis - Hypotonicity - Reflexes – Sup- diminished or may be absent - Deep – absent - Loss of vol movt - Loss of bowel / bladder function 11-04-2018stroke 33
- 33. Stage 2 – - Hypertonicity - Reflexes – Sup – diminished Deep – Hyperreflexia Babinski sign +ve - Loss of vol control- UL & LL synergy pattern • In both synergic pattern – Wrist & finger flexors & Ankle invertors are involved • In both synergic pattern – Latissimus dorsi, wrist & finger extensors, ankle evertors & teres major are not involved. 11-04-2018stroke 34
- 34. Stage 3 • No recovery • Abnormal tone with multiple contracture & deformity 11-04-2018stroke 35
- 36. Shoulder hand syndrome • A/K/A – RSD • Begins with pain & progress to stiffness • Stages - stage 1 - pain, oedema & stiffness over the shoulder joint & wrist joint - loss of abduction, ext rotation in shoulder & wrist extension - pallor & hypersensitivity to touch 11-04-2018stroke 37
- 37. Stage – 2 • subsiding of pain • Dystrophy of skin & muscles • Early osteoporosis Stage – 3 • Atrophic phase • Periarticular fibrosis • Intrinsic deformity of hand i.e claw hand • irreversible 11-04-2018stroke 38
- 38. Management of complications • Shoulder subluxation • Shoulder hand syndrome –prevention : mobilization, reduce odema, proper handling & transfer tech. • T/t – TENS, compression & elevation, icing, sympathectomy 11-04-2018stroke 39
- 63. -Definition -Epidemiology -Pathophysiology -Cerebral circulation -Territary involvement -Clinical features -Stages -Physiotherapy management SUMMARY 11-04-2018stroke 64