Stroke (cva)

Stroke (cva)

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  STROKE PREPARED BY: NOOR HAZILAH BT OMAR
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  Anatomy
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  Definition • Alsoknown as cerebrovascular accident (CVA). • A stroke is the sudden death of brain cells in a localized area due to inadequate blood flow. • Sudden onset of neurological sign and symptoms, usually focal and acute. • It involve blood vessels which can cause temporary or permanent loss of function. (World Health Organization, 1989)
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  Risk Factors •Hypertension • Diabetes Mellitus • Heart disease • Cigarette or other tobacco use. Cigarettes cause the carotid arteries to develop severe atherosclerosis or to close. Atherosclerosis is accelerated by smoking. • Head injury • Obesity
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  Etiology CEREBRAL HEMORRHAGE - Often d/t HPT & combination of weakness of vessel wall & lead to hemorrhage ISCHAEMIA -gradual occlusion of blood vessel (slow onset of symptoms) SUBARACHNOID HEMORRHAGE - d/t berry aneurysm with hemorrhage into subarachnoid type CEREBRAL EMBOLISM Block of blood vessel to the brain
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  Types of stroke Ischemic Hemorrhagic -Interruption of blood supply depress oxygen and nutrient to brain cell and make severity brain death/ damage depending on total blood supply lack. - Ischemic embolism - Ischemic thrombotic - lacunar syndrome -d/t burst of blood vessel that supply brain - commonly d/t aneurysm & TIA - Intracerebral haemorrhage -Subarachnoid heamorrhage
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  Classification of Stroke • 1) Transient Ischemic Attack – Acute of focal cerebral or monocular function with symptoms lasting <24 hr. – The patient may not loss consciousness and there may be an initial weakness of muscles. • 2) Cerebral Hemorrhage /CVA – A cerebral hemorrhage occurs when a blood vessel in the brain ruptures and bleeds into the surrounding brain tissue – Rapidly developing clinical symptoms lasting > 24hr
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  • 3) Arterioscleroticdementia - Deterioration in previously normal memory/intellect d/t repeated episode of cerebral ischemic infarction or hemorrhage ( Ann thompson,1994)
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  Symptoms • Suddennumbness or weakness of face, arm or leg, especially on one side of the body • Sudden confusion, trouble speaking or understanding • Sudden trouble seeing in one or both eyes • Sudden trouble walking, dizziness, loss of balance or coordination • Sudden severe headache with no known cause Other important but less common symptoms include: • Sudden nausea, and vomiting - different from a viral illness because of how fast it begins (minutes or hours vs. several days) • Brief loss of consciousness or a period of decreased consciousness (fainting, confusion, convulsions or coma) (National Stroke Association)
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  PATHOPHYSIOLOGY Atheroma causethe narrowing of arteries Cause increase in blood pressure Rupture of the vessel. Internal bleeding – blood clot or hematoma Cause ischemia-necrosis Brain cell damage
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  Dr’s Investigation •CT Scan –Computed Tomography Scan • MRI-Magnetic Resonance Imaging. • MRA-Magnetic Resonance Angiography. • Lumbar Puncture-CSF test. Dr’s Management • Medical –antibiotics ,IV Methanol . • Surgical –Craniotomy, Vascular reconstructive surgery, Clipping of rupture aneurysm. (Tidy’s physiotherapy,1991)
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  Physiotherapy Management AcuteCare Aims : 1)Prevent recurrent stroke 2)Monitor vital signs, dysphasia adequate nutrition, bladder & bowel function. 3)Prevent complications 4)Mobilize the patient 5)Encourage resumption of self-care activities 6)Provide emotional support & education for patient & family 7)Screen for rehabilitation and choice of settings
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  Rehabilitation care Aims: 1)Set rehabilitation goals; develop rehabilitation plan and monitor progress 2)Manage sensory-motor deficits 3)Improve functional mobility & independence 4)Prevent & treat complications 5)Monitor functional health conditions 6)Discharge planning (safe residence recommendation, patient & caregivers education & continuity of care) 7)Community – reintegration (Physiotherapy Practice Guidelines for Stroke Rehabilitation, May 2000)