CVA
CEREBROVASCULAR
ACCIDENT OR STROKE
BY: THALIA NICOLE SANCHEZ
DEFINITION:
Cerebrovascular Accident (CVA)/Stroke
- is an interruption of the blood supply to any part of the brain,
resulting in damaged brain tissue.
- A sudden neurological deficits char by loss of motor control, altered
sensation, cognitive or language impairment & disequilibrium or
coma.
.
ETIOLOGY & EPIDEMIOLOGY:
- 4th leading cause of death and the leading cause of disability
of adults.
- Women < Men if Less than 85 y/o
- Atherosclerosis – the major contributory factor in CVD. A
plaque formation with an accumulation of lipids, fibrin,
complex carbohydrates and calcium deposits in arterial walls.
Most common sites for lesions:
- origin of the common carotid artery
- middle cerebral artery
- main bifurcation of the middle cerebral artery
- junction of the vertebral arteries w/ the basilar artery
ANATOMY & PHYSIOLOGY:
BRAIN
1. Cerebrum- It performs higher functions like
interpreting touch, vision and hearing, as well as
speech, reasoning, emotions, learning, and fine
control of movement.
2. Cerebellum- Its function is to coordinate muscle
movements, maintain posture, and balance.
3. Brainstem- acts as a relay center connecting the
cerebrum and cerebellum to the spinal cord.
RIGHT & LEFT
HEMISPHERE
RIGHT HEMISPHERE
➢ mnemonics: MICA LEFT HEMISPHERE
• Memory & Music ➢ mnemonics: MALL
• Insight Mathematical
• Creativity Analytical
• Arts Logical
Language
4 LOBES OF THE BRAIN:
1. FRONTAL LOBE: Complex Functioning- personality,
judgement, insight, reasoning, problem solving, abstract
thinking and working memory
2. PARIETAL LOBE: Spatial orientation, perception and
comprehension of language function recognizing object by
touch. Links visual and somatosensory information together
3. TEMPORAL LOBE: Involved in receiving and processing
auditory information, higher order visual information,
complex aspects of memory and language.
4. OCCIPITAL lOBE: Visual processing area
CIRCLE OF
WILLIS
ANTERIOR CIRCULATION:
- Internal Carotid Artery: main branch/root of ant. circulation.
1. Ophthalmic Artery: responsible for the blood supply in
the orbitals of the eyes.
2. Anterior Cerebral Artery: supplies the frontal & medial
parietal lobe
3. Middle Cerebral Artery: supplies the cerebellum
4. Anterior Communicating Artery: it connects the right
& left ACA.
POSTERIOR CIRCULATION:
- Vertebral Artery: main branch/root of post. circulation
BASILAR ARTERY
4 Branches:
1. Posterior Inferior Cerebellar Artery (PICA):
Supplies the medulla oblongata & cerebellum
2. Anterior Inferior Cerebellar Artery (AICA): First
branch of vertebral artery. Supplies the PONS &
Cerebellum.
3. Superior Cerebellar Artery: Supplies the Midbrain
& Cerebellum
4. Posterior Cerebral Artery: supplies the cerebrum
- Post. Communicating Artery: connects the ant & post
circulation to form circle of willis.
TEMPORAL ETIOLOGIC
CLASSICIFICATIONS: CLASSIFICATIONS:
1.) Ischemic stroke
- is caused by a blockage in an artery that
a. Transient Ischemic Attack (TIA) – supplies blood to the brain.
deficits disappear within 24 hours a. Thrombotic – Assoc. with atherosclerotic
plaque formation occurring frequently at major
b. Reversible Ischemic Neurologic Disease
branching sites
(RIND) – Deficits resolve within a week
b. Embolic - Travelling bits of matter
c. Stroke in evolution –progressing stroke c. Lacunar - Small vessels affected
2.) Hemorrhagic stroke
d. Crescendo TIA –deficits over several - happens when a blood vessel bursts, causing
hours or days (on/off) bleeding in the brain.
e. Completed stroke – neurologic deficits a. Intracerebral hemorrhage - site of rupture:
stabilize deep perforating cerebral arteries
b. Subarachnoid hemorrhage (aneurysms) -
bleeding that occurs within the dural space
around the brain
RISK
FACTORS:
Modifiable: Non-Modifiable:
• Cigarette smoking • Age
• Hypercholesterolemia • Sex
• Obesity • Race
• heart disease • history of stroke
TYPES OF STROKE SYNDROMES:
MIDDLE CEREBRAL ARTERY ANTERIOR CEREBRAL
SYNDROME ARTERY SYNDROME
C/L hemiplegia/hemianesthesia UE>LE
contralateral hemiplegia;
upper division: Broca aphasia
LE>UE
lower division: Wernicke’s aphasia
Global aphasia contralateral hemianesthesia
Limb kinetic apraxia Urinary incontinence
Loss of conjugate gaze to the opposite side Problems w/ imitation &
Ataxia of C/L limb(s) bimanual tasks, apraxia
akinetic mutism (abulia)
C/L grasp reflex & sucking
reflex
VERTEBROBASILAR
POSTERIOR CEREBRAL ARTERY SYNDROME
ARTERY SYNDROME
Problems with vital functions (eg,
C/L homonymous hemianopsia breathing)
visual impairment Difficulty with chewing, swallowing, and
visual agnosia speaking
prosopagnosia Weakness or paralysis in the arms, legs,
dyslexia without agraphia and/or face
Problems with sensation
memory deficits
Hearing loss
hemisensory deficit
Vision problems
Involuntary movements Vertigo (feeling of spinning or whirling
C/L hemiplegia when you are not moving)
Weber’s syndrome “Locked-in syndrome” (only the eyes are
able to move)
Coma
HOW TO ASSESS & DIAGNOSE:
CT scan of head:
- to detect a stroke from a blood clot or bleeding within the brain.
DIFFIRENTIAL
DIAGNOSIS
ASSESSMENT TOOLS:
1. Functional Independence Measure
(FIM) ASSESSMENT:
- grade the functional status of a person based
on the level of assistance he or she requires.
ASSESSMENT TOOLS:
2. Deep Tendon Reflex:
-testing primarily assesses the
integrity of the motor system
3. Modified Ashworth Scale:
- used to measure the increase of
muscle tone.
ASSESSMENT TOOLS:
4. Fugl-Meyer :
- is a stroke-specific, performance-based
impairment index. It is designed to assess
motor functioning, balance, sensation and
joint functioning in patients with post-
stroke hemiplegia
5. Brunnstrom Stage of Recovery (BSOR):
- describes the sequence of motor
development and reorganization of the brain
after stroke.
ASSESSMENT TOOLS:
6. Pathological Reflex - are reversions to primitive responses and indicate loss of cortical
inhibition.
7. RLA Gait Analysis- is a standardized approach utilized to assess gait impairment for
various diagnoses
PT MANAGEMENTS:
• Bobath: Focuses to control responses from damaged postural reflex mechanism. Emphasis
is placed on affected inputs facilitation and normal movement patterns.
• Brunnstrom: is one form of neurological exercise therapy in the rehabilitation of stroke
patients.
• Rood: Emphasize the use of activities in developmental sequences, sensation stimulation
and muscle work classification. Cutaneous stimuli such as icing, tapping and brushing are
employed to facilitate activities.
• Proprioceptive neuromuscular facilitation (PNF) Pattern
• Sensory re-education
• Balance retraining
• Fall prevention
• Gait re-education
• Upper limb training
