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STROKE AND ITS TYPES
PREPARED BY Dr. Amjad PT
What Is Stroke ?
A stroke occurs when blood
flow to the brain is
interrupted by a blocked or
a burst blood vessel.
CVA
O Sudden loss of neurological function caused by the interruption of blood flow to brain.
O Focal neurological deficits due to ischemia
O For classical stroke it must persist for at least 24 hours
O Paralysis (Hemiplegia)
O Weakness (Hemiparesis)
O Impairments (reversible) within 3 weeks
O Residual impairment (longer than 3 weeks)
What Is the Impact of Stroke?
O Stroke is the third leading cause of death in
the United States
O On average, someone suffers a stroke every
40 seconds
O About 795,000 Americans suffer a stroke
each year
O About every 4 minutes, someone dies of a
stroke
What Is the Impact of Stroke? (Continued)
O Stroke is a leading cause of serious, long
disability
O About 6.4 million Americans are stroke
survivors
What Are the Types of Stroke ?
O Ischemic Stroke (Blockage)
O Caused by a blockage in blood vessels in
brain
O Hemorrhagic Stroke (Bleeding)
O Caused by burst or leaking blood vessels in
brain
What Are the Causes of Ischemic Stroke?
O Begins with the development of fatty
deposits lining the blood vessel wall
O Thrombus: Development of blood clot at the
fatty deposit
O Embolus: Traveling particle too large to pass
through a small vessel
Embolic Stroke
Blood clot travels to the brain
Thrombotic Stroke
Blood flow is blocked to the brain
What Are the Causes of Hemorrhagic Stroke?
O Occurs when a weakened blood vessel
ruptures
O Aneurysms: Ballooning of a weakened
region of a blood vessel
O Arteriovenous Malformations (AVMs):
abnormal blood vessels
Stroke Risk Factors That Cannot Be Treated
O Age
O Sex
O Race
O Prior stroke
O Family history
Stroke Risk Factors That Can Be Treated
O Hypertension/High Blood Pressure
O Heart Disease
O Cigarette Smoking
O Transient Ischemic Attacks
O Diabetes
O Elevated Blood Cholesterol/Lipids
Stroke Risk Factors Less Well-Documented
O Geographical Location
O Socioeconomic Factors
O Excessive Alcohol Intake
O Certain Kinds of Drug Abuse
Stroke Warning Signs
O Sudden weakness or numbness of the face,
arm or leg, especially on one side of the body
O Sudden confusion, trouble speaking or
understanding
O Sudden trouble seeing in one or both eyes
O Sudden trouble walking, dizziness, loss of
balance or coordination
O Sudden, severe headaches with no known
cause (for hemorrhagic stroke)
ACAS
O Contralateral hemiparesis (LE more than UE)
O Contralateral hemi sensory loss (LE more
than UE)
O Incontinence
O Apraxia
MCAS
Contralateral hemiparesis (UE & face more than
LE)
Contralateral Hemi sensory loss (UE & face more
than LE)
Aphasia
Perceptual deficits
PCAS
• Contralateral homonymous hemianopsia
• Memory defect
• Hemiplegia
• Eye movements
Transient Ischemic Attacks (TIAs)
O “Warning strokes” that can happen before a
major stroke
O Occur when blood flow through a brain
artery is blocked or reduced for a short time
O Symptoms are temporary but similar to
those of a full fledged stroke
O A person who has a TIA is 9.5 times more
likely to have a stroke
What Parts of the Brain Are Affected by Stroke?
O LEG
O ARM
O BODY
O HAND
O FACE
O SPEECH
O READING
O SIGHT
O HEARING
What Are the Effects of Stroke?
O Paralyzed left sight
O Spatial perceptual
defects
O Quick impulsive
behavioral style
O Memory deficits
O Right Brain
What Are the Effects of Stroke?
O Paralyzed right side
O speech-language
deficits
O Slow cautious
behavioral style
O Memory deficits
O Left Brain
Motor deficits
O Early stages flaccidity, no voluntry movement and no reflexes
O Cerebral shock lasts from 72 hours to 2 weeks (can be longer)
O This is replaced by spasticity, hyperreflexia and
mass pattern (synergies )
O Bobath divided stroke into 3 stages
O 1-The initial flaccid stages
O 2-The stage of spasticity
O 3-The stage of relative recovery
How Are Strokes Treated?
O Ischemic Stroke
O • Clot-busters e.g., t-PA
O • Anticoagulants – warfarin
O • Carotid Endarterectomy
O • Angioplasty/Stents
O Hemorrhagic Stroke
O • Surgical Intervention
O • Endovascular Procedures, e.g., coils
Prevention of Stroke
O Control high blood pressure
O Prevent heart disease
O Stop cigarette smoking
O Recognize signs of TIA and tell physician
O Reduce blood cholesterol levels
Twitchell and Brunstromdivided into 6 stages
Stage 1 periods of flaccidity , no movements
Stage 2 limb synergy ,minimal voluntary movement, spasticity starts
Stage 3 control of synergy movement, spasticity becomes severe
Stage 4 some movements without synergy happens, spasticity decline
Stage 5 difficult movement pattern develops, spasticity decreases
Stage 6 disappearance of spasticity, individual joint movement possible, coordination, normal motor function restored.
this stage is not for all patients
Rehabilitation
O After suffering a stroke,
it’s important to begin a
rehabilitation program
as soon as possible
Types of Rehabilitation Programs
O Hospital programs
O Nursing facilities
O Outpatient programs
O Home-based programs
Rehabilitation Specialists
O Physician
O Rehabilitation nurse
O Physical therapist
O Speech therapist
O Occupational therapist
O Psychiatrist
Learn to recognize a stroke.
Time lost is brain lost.Stroke is a medical emergency!
If you notice one or more stroke warning
signs,
GET HELP IMMEDIATELY
