Causes of Stroke

80%80%InfarctionInfarction

60%60%CerebrovascularCerebrovascularatherosclerosisatherosclerosis

20%20%Penetrating arteryPenetrating arterydisease (lacunes)disease (lacunes)

15%15%Cardiogenic embolismCardiogenic embolism

5%5%Other,Other,

unusualunusualcausescauses

HemorrhageHemorrhage - Intracerebral- Intracerebral - Subarachnoid- Subarachnoid20%20%

Lacunar Stroke

Types of CNS Hemorrhage

Arteriovenousmalformation

Summary Diagram of Causes of Stroke

Atrial Fibrillation (AF) Predisposes to Atrial Fibrillation (AF) Predisposes to StrokeStroke

• Physical– Right hemiplegia

• Cognitive– Aphasia, agraphia, alexia, ataxia, memory impairments– Confabulation, attentional deficits

• Emotional– Lability, low tolerance, depression (more common with right CVA)

• Assisting the Patient with a Left CVA– Speak slowly! Learn to recognize nonverbal cues from the patient– Let patient learn through imitation

Left CVA

Right CVARight CVA Physical

left hemiplegia

Cognitive Difficulty with time and space, increased perceptual problems,

decreased ability to recognize faces, decreases mathematical and reasoning skills

Decreased eye-hand coordination

Emotional Lability, low tolerance, depression, denial

Assisting the Patient with a Left CVA Emphasize verbal cues, use visual fields appropriately, keep

everything related to safety on the right!!!!! Decrease stimuli, break tasks into small steps

Lee, CD, AR Folsom, and SN Blair. Physical activity and stroke risk: A meta-analysis. Stroke 34:2475-2482, 2003.

LOW vs. HIGH PHYSICAL ACTIVITY AND STROKE RISK

Wendle-Vos et al. International Journal of Epidemiology 33:787-798, 2004.

RELATIVE RISK: PHYSICAL ACTIVITY AND STROKE

Potempa et al. Stroke 26:101-105, 1995.

PHYSICAL WORK CAPACITY

Potempa et al. Stroke 26:101-105, 1995.

BLOOD PRESSURE

Potempa et al. Stroke 26:101-105, 1995.

EXERCISE BLOOD PRESSURESEXERCISE BLOOD PRESSURES

Rimmer, JH., et al. Medicine and Exercise in Sports and Exercise 32:1991-1996, 2000.

PHYSICAL WORK CAPACITY

Rimmer, JH., et al. Medicine and Exercise in Sports and Exercise 32:1991-1996, 2000.

SRENGTH

Rimmer, JH., et al. Medicine and Exercise in Sports and Exercise 32:1991-1996, 2000.

FLEXIBILITY

Macko, R.F., et al Stroke 28:326-330, 1997.

EFFICIENCY OF MOVEMENT