Stroke Overview

Stroke /Cerebrovascular Accident (CVA): disease of cerebral vasculature resulting in failure to supply oxygen to cells.

• Two types
  • Ischemic (~80%):
    • Thrombotic stroke: development of abnormalities in arterial vessel wall
      • Common causes: Artherosclerosis (buildup of plaque in artery- most common), dissections, and external compression of vessels.
    • Embolic stroke: plaque clots (thrombi)  that block, or travel and lodge in blood vessels blocking blood flow. Usually presents as an abrupt and sudden onset of symptoms.
      • Blood vessels typically involved: middle cerebral artery (MCA), Posterior cerebral artery (PCA), and other areas of vertebral artery branches; more rarely, can involve artery, proximal internal carotid artery, patent foramen ovale (PFO)- pediatric patients, and metastatic tumors.
  • Hemorrhagic (~20%): cerebellar bleeding due to artery wall bursting due to weakness from ballooning (aneurysm) or torn artery 

Arteries of the brain

• Crucial to know location of CVA, areas of brain supplied by each artery and anticipated areas of deficit. 

Netter (2014), plate 141.

https://bodymindandbrain.com.au/huh-what-does-my-brain-have-to-do-with-it/

Areas to assess & treat:

1. Level of pain
2. Cognition
3. Safety awareness, insight, judgment and impulsivity
4. Skin integrity and ability to weightshift independently
5. Range of motion and manual muscle testing- all joints and extremities, with exception for those with precautions or weight bearing restrictions
   1. Flaciddity or hemiparesis
6. Strength, dexterity and coordination
7. Proprioception
8. Sensation: sharp/dull, hot/cold
9. Motor planning
10. Vision & oculomotor control, pupil alignment; smooth pursuits,saccades, nystagmus
    1. Neglect, inattention, hemianopsia
11. Balance, seated vs standing (only if standing is safe)- is patient leaning towards one side or the other? Does the patient recognize deviation from midline?
12. Vitals management
13. Self Care
14. Transfers/ mobility
15. Tone
16. Synergy Pattern