STROKE
STROKE
STROKE
Depending on etiology
Ischemic
Hemorrhagic
Depending on management
TIA, minor stroke, established stroke,
deteriorating, young stoke
Depending on territories of vessels-
MCA, ACA, PCA, ICA, etc.
Classification of stroke
Hemorrhagic type -
Intracerebral haemorrhage (IH)
Subarachnoid hemorrhage (SAH)
Subdural Hemorrhage(SDH)
Ischemic stroke –
Atherosclerosis
Thrombus
Emboli
Ischemic penumbrae
Classification of stroke
Ischemic stroke
Non
Modifiable modifiable
Smoking Age ( 55 risk is
Obesity 1 in 6)
Lack of Gender
exercise Race (African &
Diet American)
Excess alcohol Family history
Indicators
National Stroke
Other important but less
common
Heart attack
Accident
Head injury
Stroke
Brain attack
Anterior Cerebral Artery
Syndrome
Hemiparesis mainly lower limb
Contralateral hemi sensory loss mainly lower
limb
Urinary incontinence
Imitation and bimanual tasks (Corpus
callosum)
slowness, delay, lack of spontaneity, motor
inaction
Contralateral grasp reflex, sucking reflex
Middle Cerebral Artery
Syndrome
Hemiparesis mainly upper limb
Contralateral hemi sensory loss mainly
upper limb
Broca’s or non fluent aphasia
Wernicke’s or fluent aphasia
Perceptual deficits(non dominant
hemisphere)
Contralateral homonymous hemianopsia
Loss of conjugate gaze to the opposite
side
Primary impairments
Sensation
STAGE 1
period of flaccidity immediately
following the acute episode.
Primary impairments
Motor Recovery Stages
STAGE 2
limb synergies or some of their
components may appear as
associated reactions, At this time,
spasticity begins to develop.
Primary impairments
Motor Recovery Stages
STAGE 3
Established movement synergy,
Spasticity has further increased
and may become severe.
Primary impairments
Motor Recovery Stages
STAGE 4
Some movement combinations
that do not follow the paths of
either synergy are mastered,
spasticity begins to decline.
Primary impairments
Motor Recovery Stages
STAGE 5
More difficult movement
combinations are learned as the basic
limb synergies lose their dominance
over motor acts.
Primary impairments
Motor Recovery Stages
STAGE 6
disappearance of spasticity,
coordination approaches normal.
normal motor function is restored
Flaccidity (hypotonicity)
Spasticity (hypertonicity)
Abnormal Synergy
Patterns
Upper extremity
Flexion Synergy Components
Scapular retraction/elevation abduction,
external rotation, Elbow flexion Forearm
supination Wrist and finger Flexion
extensor Synergy Components
Scapular protraction, Shoulder adduction, internal
rotation, Elbow extension, Forearm pronation, Wrist
and finger flexion
Abnormal Synergy
Patterns
Lower limb synergy
Flexor synergy
Hip flexion, abduction, external
rotation, Knee flexion Ankle
dorsiflexion, inversion, toe dorsiflexion.
Extensor synergy
Hip extension, adduction, internal
rotation, Knee extension, Ankle plantar
flexion, inversion, Toe plantar flexion
Primary impairments
Abnormal Reflexes
Altered Coordination - problems with timing
and sequencing of muscles
Altered Motor Programming - The patient
demonstrates difficulty planning and executing
purposeful movements
Ideational apraxia-inability to produce movement
either on command or automatically.
ideomotor apraxia the patient is unable to
produce a movement on command but is able to
move automatically.
Some common associated reactions
Primary impairments
Aphasia -
Fluent aphasia
(Wernicke’s/sensory/receptive),
Non fluent aphasia
(Broca’s/expressive aphasia)
Global aphasia
Primary impairments
Speech, Language, and Swallowing
Dysarthria –
Respiration, articulation, phonation
and sensory feedback may be
affected
Lesion located in the primary motor
cortex in the frontal lobe, the primary
sensory cortex in the parietal lobe.
Primary impairments
Speech, Language, and Swallowing
Dysphagia –
Delayed triggering of the swallowing
reflex
reduced pharyngeal peristalsis (58 %)
Reduced lingual control (50%)
Lesions of medullary brainstem (CN IX
and X), large vessel pontine lesions,
Acute hemispheric lesions (MCA and
Primary impairments
Perception
Body scheme/body
image
Postural model of the body
including the relationship
of the body parts to each
other and the relationship
of the body to
the environment.
Primary impairments
Perception
Agnosias
Agnosia is the inability to recognize
incoming information despite intact
sensory capacities
Visual object Agnosia,
Auditory Agnosia
Tactile Agnosia (Astereognosis)
Primary impairments
Cognitive deficits
Alertness
Attention
Orientation
Memory
Executive functions
Primary impairments
Cognitive deficits
Perseveration –
Continued repetition of words
Confabulation –
Inappropriate words or fabricated
stories
Primary impairments
Emotional Status
Euphoria–
Exaggerated
Feelings Of Well-being
Complications and Indirect
Impairments
Musculoskeletal
Cardiovascular/Pulmonary
Seizures
Bed rest complication
Risk factors
•COVID-19 infection
End of the
complaints
What am I going to
do
TESTS
A physical exam
Blood tests.
Computerized
tomography (CT)
scan.
Magnetic resonance
imaging (MRI)
Carotid ultrasound.
Echocardiogram.
Treatment
Ischemic stroke
EMERGENCY IV MEDICATION:
Therapy with drugs that can break up a clot has to be
given within 4.5 hours from when symptoms first started
if given intravenously.
The sooner these drugs are given, the better. Quick
treatment not only improves your chances of survival
but also may reduce complications.
An IV injection of tissue plasminogen activator
(TPA) — also called alteplase (Activase) or
tenecteplase (TNKase) — is the gold standard
treatment for ischemic stroke.
An injection of TPA is usually given through a vein
in the arm within the first three hours. Sometimes
TPA can be given up to 4.5 hours after stroke
symptoms started.
Emergency endovascular procedures
• Carotid
endarterectomy. Carotid
arteries are the blood
vessels that run along
each side of the neck,
supplying the brain
(carotid arteries) with
blood.
• This surgery removes the
plaque blocking a carotid
artery and may reduce the
risk of ischemic stroke.
Angioplasty and
stents. In an angioplasty,
a surgeon threads a
catheter to the carotid
arteries through an artery
in the groin.
A balloon is then inflated
to expand the narrowed
artery. Then a stent can
be inserted to support the
opened artery.
Hemorrhagic stroke
Emergency measures:blood-thinning
medications to prevent blood clots, you may
be given drugs or transfusions of blood
products to counteract the blood thinners'
effects. You may also be given drugs to lower
the pressure in the brain (intracranial
pressure), lower blood pressure, prevent
spasms of the blood vessels and prevent
seizures.
Surgery.
Surgical clipping. A
surgeon places a tiny
clamp 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.
Surgical AVM
removal:Surgeons may
remove a smaller TVM if it's
located in an accessible area
of the brain. This eliminates
the risk of rupture and lowers
the risk of hemorrhagic
stroke. However, it's not
always possible to remove
an AVM if it's located deep
within the brain, it's large, or
its removal would cause too
much of an impact on brain
function.
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.
Stereotactic
radiosurgery.: Using
multiple beams of
highly focused
radiation. stereotactic
radiosurgery is an
advanced minimally
invasive treatment
used to repair blood
vessel malformations.