This document provides information about stroke, including its definition, types, causes, risk factors, symptoms, diagnosis, treatment and rehabilitation. It defines stroke as a sudden neurological deficit lasting over 24 hours caused by a blood vessel blockage or rupture in the brain. It notes the two main types are ischemic (85% of cases, caused by blockage) and hemorrhagic (15%, caused by bleeding). Risk factors include age, family history, smoking and high blood pressure. Diagnosis involves tests like CT/MRI scans and treatment depends on the type but may include clot-busting drugs, surgery or coil embolization. Physiotherapy aims to improve mobility, prevent complications like shoulder subluxation, and help

1. WORLD
STROKE
DAY
THE POWER OF SAVING
#PRECIOUSTIME

2. WHAT IS STROKE ?
Hippocrates, the “father of medicine,” first recognized stroke more than 2,400 years
ago. Universally accepted definition for stroke by the World Health Organization is “
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”. It
occurs when a blood vessel in the brain ruptures and bleeds, or when there’s a
blockage in the blood supply to the brain. The rupture or blockage prevents blood
and oxygen from reaching the brain’s tissues.
The cumulative incidence of stroke ranged from 105-152/100,000 persons per year,
and the crude prevalence of stroke ranged from 44.29 to 559/100,000 persons in
different parts of India during the past decade.

3. ETIOLOGY
 Atherosclerosis
 Cerebral thrombus
 Cerebral embolus
 Embolism from the heart (cardiac origin)
 Intracranial hemorrhage
 Arterio-venous malformation
 Subarachnoid hemorrhage
 Intracranial small vessel disease
 Arterial aneurysms
 Haematological disorders

4. MISCELLANEOUS RARE CAUSES
 Infective endocarditis & HIV infection
 Tumor
 Migraine
 Chronic meningitis
 Inflammatory bowel disease
 Hypoglycemia
 Snake bite
 Fat embolism

5. RISK FACTORS FOR STROKE
Non-modifiable Risk Factors
•Age
•Gender
•Family history
•Heart disease ( irregular heart beat)
•High Blood pressure
•Smoking/Drinking habits
•Unhealthy diet
•Lack of physical activity
•High blood sugar level
•Higher cholesterol levels

6. PREVENTION
OF STROKE

7. THE FLAG SIGNS OF STROKE:
B.E.F.A.S.T

9. THROMBOTIC
EMBOLIC
ISCHEMIC
STROKE
HEMORRHAGIC
STROKE
BASED ON
CAUSE
CLASSIFICATION OF STROKE
SUBARACHNOID
HEMORRHAGE
INTRACRANIAL
HEMORRHAGE

10. ANTERIOR CEREBRAL
ARTERY SYNDROME
POSTERIOR CEREBRAL
ARTERY SYNDROME
VERTEBR0-BASILAR
ARTERY SYNDROME
MIDDLE CEREBRAL
ARTERY SYNDROME
BASED ON
THE
SYMPTOMS
LACUNAR
SYNDROME

11. BASED ON
MANAGEMENT
CATEGORY
TRANSCIENT
ISCHEMIC ATTACK
DETERIORATING
STROKE
MAJOR STROKE
MINOR STROKE
YOUNG STROKE

12. BASED ON THE
SEVERITY
SEVERE STROKE
MODERATE STROKE
MILD STROKE

13. BASED ON
DURATION
ACUTE STROKE
SUBACUTE STROKE
CHRONIC STROKE

15. ISCHEMIC STROKE (85%)
An ischemic stroke happens when a blood vessel supplying blood to your
brain gets blocked by a blood clot. Occurs when a blood vessel supplying
blood to the brain is obstructed. It accounts for 85% of all strokes. Ischemic
stroke is seen among those aged 15 to 42 years.
The symptoms depend on which parts of your brain is affected. They can include things like:
• Sudden numbness or weakness of your face, arm, or leg, often on one side of the body
• Confusion
• Problems speaking or understanding others
• Dizziness, loss of balance or coordination, or trouble walking
• Vision loss or double vision

16. TYPES OF
ISCHEMIC
STROKE

17. Hemorrhagic stroke contributes to 15% - 20% of strokes. It accounts for up
to 50% of all strokes that occur under the age of 45 years, it is due to
bleeding into the brain by the rupture of a blood vessel. These happen
when bleeding in your brain damages nearby cells.
HEMORRAGIC STROKE (15%)
The symptoms of Hemorrhagic stroke usually increase gradually over minutes or a few hours, which
includes:
 Intense headache
 Confusion
 Nausea or throwing up
 Sensitivity to light
 Problems with vision
 Passing out

18. TYPES OF
HEMORRHAGIC
STROKE

19. TRANSIENT ISCHEMIC ATTACK
It is also called a mini-stroke, as the symptoms are
like those of a stroke but don't last long. It occurs
when the blood flow to the brain is blocked or
reduced often by a blood clot. TIA symptoms are
similar to that of a stroke but symptoms of TIA
occurs suddenly and wont last long, mostly go
away in 10-20 minutes.
Symptoms:
Numbness, tingling, weakness or paralysis in
the face arms or legs especially on one side of
the body.
Sudden vision change, problems with walking
and balance.
Sudden trouble speaking and confusion in
understanding simple statements.
Sudden severe headache that is different from
previous headaches.

20. INVESTIGATIONS
Tests and measures
Urine analysis
NRI COUNT
CBC Count
Blood sugar level
Blood cholesterol and lipid profile
Cardiac evaluation
Lumbar puncture
Imaging
CT scan
MRI
Cerebral angiography
Carotid ultrasound
Echocardiogram

21. IMMEDIATE MANAGEMENT
The blood flow to the brain should be restored immediately. This may be done with:
• Emergency IV medication therapy: An IV injection of recombinant tissue plasminogen activator (TPA)
— also called alteplase (Activase) or tenecteplase (TNKase) — is the gold standard treatment for
ischemic stroke.
• Emergency endovascular procedures/endovascular therapy.
• Removing the clot with a stent retriever.

22. • Carotid endarterectomy, this
surgery removes the plaque
blocking the carotid artery and
may reduce the risk of
ischemic stroke.

24. • Surgical clipping: a tiny clamping at the base of the
aneurysm to stop blood flow to it. This clamp can keep
the aneurysm from bursting, or it can keep an
aneurysm that has recently hemorrhaged from
bleeding again.

25. • Coiling (endovascular embolization). Using a
catheter inserted into an artery in the groin
and guided to the brain, the surgeon will
place tiny detachable coils into the aneurysm
to fill it. This blocks blood flow into the
aneurysm and causes blood to clot.

26. PHYSIOTHERAPY INTERVENSIONS
ACUTE MANAGEMENT
»Positioning strategies
» Improve respiration and circulatory function
» prevent shoulder subluxation
» Prevent pressure sores
» Prevent from deconditioning

27.  Positioning strategies

28.  Improve respiration and circulation
 Breathing exercises
 Chest expansion exercises
 Postural drainage
 Huffing and coughing techniques
 Passive & active ankle and toe movements

29.  Prevent pressure sores
 Proper positioning
 Relieve pressure points by padding and cushion
 Frequent turning and changing positions
 Prevent from moisture
 Use cotton clothing
 Tight fitting cloth is prevented
 Use of water bed, air bed and foam mattress

30.  Prevent from deconditioning
 Early mobilization in the bed (active turning, supine to sitting, sitting to standing)
 Early propped up positioning, sitting and then later to standing
 Facilitate movement of functioning limbs
 Pelvic bridging exercises
 Moving around the bed

31. » Improve sensory function
» Flexibility and joint integrity
» Manage spasticity
» Improve motor control
» Postural control and functional mobility
» Improving functions of the extremities
» Managing shoulder pain and subluxation
» Improve balance
» Improve locomotion
» Improve aerobic functioning
» Improve motor learning
» Patient and family education
POST ACUTE MANAGEMENT

32. Shoulder subluxation happens when the upper arm bone, called the humerus, becomes partially
dislocated from the shoulder socket. This condition starts when the muscles around the shoulder become
weak or paralyzed after stroke.
SHOULDER SUBLUXATION

34. THANK YOU