(Stroke)
JACQUELYN ARAO
I.Definition of Terms:
Cerebrovascular Accident
- Also know as stroke and brain attacks
-is a sudden loss of neurological function
caused by an interruption of the blood flow to
the brain
I. Definition of terms
Aneurysm
Embolus
Hematocrit
Hemorrhage
Ischemic
-Insufficient blood flow to an organ cause by
the blockage of the artery.
Transient Ischemic Attack
-(Mini Stroke) Caused by changes in blood
supply in the brain produces same
manifestation as stroke within 24 hours.
I. Definition of Terms
Thrombus
Causes Percentage
Large vessel 32
occlusion/infarction
Embolism 32
Small vessel occlusion/ 18
lacunar
Intracerebral hemorrhage 11
Subarachnoid hemorrhage 7
A. Atherosclerosis
-Major contributory factor of Cerebrovascular
Accident.
-accumulation of lipids, fibrins, complex
carbohydrates and calcium deposit on the arterial
walls that leads to progressive narrowing of blood
vessels.
Found in the bifurcations of MCA and origin of ICA.
II. Etiology
B. Ischemic Strokes
-Results from a thrombus, embolism or
conditions that produce low systemic
perfusions pressures.
II. Etiology
C. Cerebral Thrombosis
– Refers to the formation of development of
a blood clot within the arteries and their
branches.
– Moving thrombus is called embolus.
II. Etiology
-PrimaryCEREBRAL Hemorrhage
-occurs in small blood vessels weakened
by atherosclerosis produces aneurysm.
-SUBARACHNOID hemorrhage
-hemorrhage occurs at the sub arachnid
space typically from a saccular or berry
aneurysm affecting primary vessels.
II. Etiology
E. Artriovenous malformation
– Is a congenital defect that can cause
stroke.
-The arteries and veins are tortuous tangled
with interposing capillaries system.
III. Risk Factors of Stroke
2. Heart disease
– Is an important risk factor for stroke
– Atrial fibrillation and valvular heart disease
increase the risk of cerebral infarction
because of presence of cerebral emboli.
III. Risk Factors of Stroke
3.Diabetes Mellitus
Independent risk factor that doubles
the risk of stroke.
It increases the risk of ischemic stroke
to three to six times.
The prevalence of diabetes among
stroke survivors is 20%.
III. Risk Factors of Stroke
4. Hyperlipidemia
– Poses only small additional risk for strokes
mainly for individuals younger at age of
55.
– Increase in blood viscosity, hematocrit and
serum fibrinogen have been implied the
risk factor of stroke.
Risk Factors of stroke
Smoking
– It is an important factor for cardiovascular
disease but influence for stroke is not
cleared.
– The risk for heavy smokers (>40
cigarettes) is twice than light smokers (<10
cigarettes).
III. Risk Factors Of Stroke
7. Obesity
– Hypertension and diabetes mellitus are in
common in obese and strong influences
risk of stroke.
– Some studies says that weight loss has
positive influences on blood pressure and
diabetic control and also helps in reduction
of risk of strokes.
IV. Stroke Prevention
Antiplatelet Therapy
-Aspirin is the most frequently prescribe
antiplatelet agent.
-Aspirin achieves a significant anti platelet
effect at fairly low serum concentrations.
IV. Stroke Prevention
Anticoagulation
Carotid Endarterectomy
– Is a surgical procedure that use to correct
the carotid stenosis
– It is the removal of material inside the
artery.
PATHOPHYSIOLOGY
PRINCESS PUNO
CEREBRAL BLOOD FLOW (CBF)
• Ischemic
Thrombus
Embolism
Lacunar
• Hemorrhagic
Subarachnoid
Intracerebral
ISCHEMIC STROKE
Thrombus
Due to Atherosclerotic Plaque Formation
Occurs frequently at major vascular branching
sites including COMMON CAROTID and
VERTEBROBASILAR ARTERIES.
Occurs often in the presence of chronic
hypertension.
ISCHEMIC STROKE
Embolism
Major Source of cerebral emboli is the
heart.
– Atrial fibrillation
– Most emboli lodge in the middle
cerebral artery distribution because
80% of the blood carried by the large
neck arteries flow through the middle
cerebral arteries.
ISCHEMIC STROKE
Lacunars Infarct
Lacunar infarcts occur as a result of an
occlusion of small, deep penetrating arteries
known as Lenticulostriate Arteries branch from
the MCA.
Occlusions of these vessels or penetrating
branches of the circle of Willis, including
vertebral or basilar arteries, are referred to as
lacunar strokes.
ISCHEMIC STROKE
Subarachnoid Hemorrhage
Bleeding that occurs between the Dura
and Pia Mater.
Commonly caused by:
3.ARTERIOVENOUS MALFORMATION
(AVM)
1.ANEURYSMS
HEMORRHAGIC STROKE
2. AVM
• Tangled, dilated blood vessels in which arteries flow
directly into veins.
• Occur most often at the junction of cerebral arteries,
usually within the parenchyma of the frontal-parietal
region, frontal lobe, lateral cerebellum, or overlying
occipital lobe.
• Results to seizures.
HEMORRHAGIC STROKE
2. Aneurysms
• Focal dilations in the artery
• Found in the anterior region of the Circle of Willis,
particularly near branches of the Anterior Communicating
Artery, ICA, MCA and junctions of almost any branch site.
• Contributing factors include atherosclerosis and
hypertension.
HEMORRHAGIC STROKE
Intracerebral Hemorrhage
Originates from deep penetrating vessels and causes
injury to the brain tissue by disrupting connecting
pathways and causing localized pressure injury.
Bleeding in the surrounding brain tissue.
Also caused by AVM and aneurysms.
OCCLUSIONS IN THE ARTERIES
ICA
OCCLUSIONS IN THE ARTERIES
PCA
OCCLUSIONS IN THE ARTERIES
• VERTEBROBASILAR ARTERY
Arise from the subclavian arteries and travel
into the brain along the medulla where they
merge at the inferior border of the pons to form
the basilar artery.
It supplies the pons, internal ear, and the
cerebellum.
The basilar artery terminates at the upper
border of the pons and gives rise to two PCA.
SIGN AND SYMPTOMS
COMPLICATION
MARIVIC CALINGA
DEFINITION OF TERMS
MARIVIC R. CALINGA
SIGN AND SYMPTOMS…
Central territory
Central post-stroke (thalamic) Ventral posterolateral nucleus of
pain thalamus
Spontaneous pain and
dysenthesias; sensory
impairments (all modalities)
Involuntary movements; Subthalamic nucleus or its
choreoathetosis, intention tremor, pallidal connections
hemiballismus
Contralateral hemiplegia Cerebral peduncle of midbrain
Clinical Manifestations of Posterior
Cerebral Artery Syndrome
THROMBOPHLEBITIS/DVT
PULMONARY FUNCTION
- ↓lung volume
- ↓pulmonary perfusion
- ↓vital signs
- altered chest wall excursion
- ↑fatigue
- ↓endurance
CARDIOVASCULAR/PULMONARY
KAREN BARRACA
Differential Diagnosis
Lethargy
Dizziness/Vertigo
Slurred speech
Loss of coordination
Uncontrollable eye movements
Behavioral changes
Differential Diagnosis
NEEMA ESTORES
NEUROVASCULAR TEST
- Neck Flexion
- Palpation of arteries
- superficial and deep
- Auscultation of heart and blood vessel
-Ophthalmic pressure
TEST AND MEASURES
1. Urinalysis
-Detects infection, diabetes, renal
failure, dehydration
-can reveal diseases that have gone
unnoticed because they do not
produce striking signs or symptoms.
TEST AND MEASURES
2. Blood analysis
-Provides complete blood count,
platelet count, prothrombin time,
partial thromboplastin time, and
erythrocyte sedimentation rate.
TEST AND MEASURES
9. Lumbar puncture
-diagnostic and at times therapeutic
procedure that is performed in order to
collect a sample of cerebrospinal fluid
(CSF) for biochemical, microbiological,
and cytological analysis, or occasionally
as a treatment ("therapeutic lumbar
puncture") to relieve increased
intracranial pressure.
IMAGING
1. Computerized Tomography
-Commonly used imaging technique
-Allows identification of large arteries
and vein, and venous sinuses
-Used to rule out other brain lesions
Hemorrhagic stroke Ischemic stroke
IMAGING
5. Cerebral Angiography
-Invasive and involves the
injection of radiopaque dye into
blood vessels with subsequent
radiography
Cerebral Angiogram showing a transverse projection of
vertebrobasilar and posterior cerebral circulation
PT Management
JENNYLYN C. PASSILAN
• Recovery begins as people get better from the
immediate effects of a stroke. Over months and even
years, other areas of the brain might learn to take
over from the dead areas.
passive range of motion exercises are done for the shoulder, elbow, wrist,
fingers, hip, knee, ankle, foot, and toes
Active Range of Motion Exercises