REVISION
:
STROKE
LEON
YAO
.
SSTTRROOKKEE
NNEEUURROOLLOGGKEAALL DDEEFFK
STROKE
/
ISCHAEMIC (n 80% )
blood
supply
I
EMBOLUS
THROMBUS
"
pusomiem.io?dsfI7I
locally
ii.
↳
platelets + fibrin
blood vessel
in the
↳
t
that blocks vessel
ATHEROSCLEROTIC
RUPTURE
thrombosis
ligemenddeotfreieaeo
TYPES
-
/
Acute tin arterial
:/
it"TfFFE{FIfe¥oscEEioEis,
.
°
VVAASSCCUULLAARR OORRIIGGKNN
OFF
Tl
AIR BUBBLE
HAEMORRHAGIC C- 20% )
/
SUBARACHNOID
T.ph?n eodebig:daivnes e s/h7n:YeIabh:.diaus9a
INTRACEREBRAL
↳
!
#
#
CAUSES
CAUSES
④
Art
↳
ceros ,
blood vessel
+
:÷ ÷ ÷ t÷ ÷ ÷ :÷ ÷ ÷ ÷
:/
④
Hypertension
\
/
=
brittle
ripnrpoerepfikely
to
TRAUMATIC INJURY
space break
MICRO ANEURYSMS
"
subarachnoid
in
↳ arteries
smmoareyliarkeend
⑦
G. g. lenticular striate)
easily
ANEURYSMS
most
↳
commonly
SACULAR
get
.FI?rhaifofbrainPATHoptYysioLoGy
¥⑥M¥¥
y
.
t¥€→€
NEURONS BOMBARDED WITH GLUTAMATE
↳ EXCESSIVE ZINC
④ CAH
t
Zn
't
t
CALCIUM ENTER
TRIGGER Apoptosis
/
CELL
-
* AREA
OF
CELL DEATH
↳ collateral
flow
allows
CELL
DEATH
SURROUNDED
BY ISCHAEMIC PENUMBRA
oxygen ( glucose to reach surrounding
neurons
↳
neuron
activity
A
↳
decreases
,
but can remain viable
.s÷÷¥÷÷÷±÷:c:c
(salvageable)
.mn
°
t
qiftp.gqq.ongE.EB
-
RESOLVES OVER
2-4 WEEKS
( hemicraniatomy improves outcome)
PENUMBRA
"
HAEMORRHAGE
CONVERSION
"
↳ pressure
TISSUE
↳
PATHOPHYSIOLOGY
INCREASED
on
SKULL
,
ons
BRAIN
BLOOD VESSELS
HEALTHY TISSUE
CAN
DIE
DOWNSTREAM
dqownsqhe.am?ntisbsyooed.deprived
INTRACRANIAL PRESSURE
↳ pressure
on
SKULL
,
BRAIN TISSUE
BLOOD VESSELS
↳
↳
t
,
DECREASED BLOOD FLOW
②
④
mased
③ AeERl0m¥f¥£mAe
:÷÷÷÷÷÷÷÷÷÷÷o
:÷÷÷÷÷÷÷÷÷÷÷÷¥÷i
÷÷
:÷ :÷ ÷ ÷ ÷ ÷ ÷ ÷
③ Postsynaptic
EFFIE:L
↳
,
③
↳
HEALTHY assure CAN
DIE
VASO SPASM
occurs when blood vessels
s.it?jn9aifen.blg:dncYaYconoshEict
: ÷÷÷÷÷÷÷÷÷÷÷÷÷÷ .÷÷÷÷÷÷÷÷÷÷
.
brain
such
as :
-
divides spheres
÷÷÷
""
.
;
:Ef£FImEB¥a←p*u
:
space irritates meninges
:÷i÷:
causes
inflammation
t
scarring
,
"
n÷÷÷÷÷÷÷:*:
RRKSSKLFFAACCTTORRSS
I
SSTTRROOKKEE
STROKE
,E
RANG ENE
↳
same
°
•
↳
pathophysiology
Blockage
Symptoms
•
No
°
No
clears
resolve
ischaemic
visible
t
Management
blood
visible
infarcts
on
w/
is
but
stroke ,
a
oxygen
minutes
or
( glucose supply
o
BLOOD PRESSURE (Z
"" " " '
on
the
ABIDI
140/90 mmHg
)
{÷÷}÷÷÷g⇐÷e
:*.si
ane
's
DURATION
•
°
cell
damage
.
restored
hours
→
(260 yrs H )
AGE
is
permanent
CTIA)
MRI
based
°
no
ATTACK
MRL
on
CT
ISCHAEMIC
as
within
TYPES
score
(determines
÷÷÷÷¥i?}
HIGH SCORE
DIABETES
risk
( G -7) :
of
CVA
following
)
TIA
hospitalisation
hospital.se
t
monitor
immediately
for
24 hrs
.
SSTTRROOKKEERRKSSIKL FFAACCTTORRSS
AGE 265
yrs
•
FAMILY HISTORY
•
FEMALE
•
GENDER
•
PRIOR
•
SMOKING
°
STROKE , TIA
or
HEART ATTACK
HIGH BLOOD PRESSURE
DIABETES
°
HIGH LDL
•
t
Low HDL
ATHEROSCLEROSIS
°
↳
°
manage
ATRIAL
↳
w/
stent
if
excessive
damage
FIBRILLATION
reduce risk
of
clotting w/
blood thinners
SSYYMMPPTTOOMMSS
=D
SSTTRROOKKEE
SSYYMMPPTTOOMMSS
EACH HEMISPHERE
=
5 LOBES
BROCA'S
.
.
HAS ITS OWN BLOOD SUPPLY
↳
.
VASCULAR
DAMAGE
PRODUCES SPECIFIC
FUNCTIONAL DEFECTS
'S
WERNICKE
LATERAL
MEDIAL
VIEW
VIEW
MIDDLE CEREBRAL ARTERY
* LATERAL HEMISPHERES
°
.
FRONTAL LOBE
Broca 's area
↳
speech production
ANTERIOR CEREBRAL ARTERY
'
°
↳
•
head
→
hips
MEDIAL
0
PARIETAL LOBE
°
SENSORY
↳ head
→
°
AT
MOTOR CONTROL
↳
hips
o
↳
language
hips
→
feet
PARIETAL LOBE
SENSORY
°
↳
WERNICKE 'S AREA
°
.
°
CONTROL
TEMPORAL LOBE
°
HEMISPHERES
FRONTAL LOBE
MOTOR CONTROL
hips
→
CONTROL
feet
otnseumohfionumrsic
comprehension
HEARING
)
POSTERIOR CEREBRAL ARTERY
*
POSTERIOR
°
BRAIN
OCCIPITAL LOBE
↳
vision
.
COMMON
PRIMARY IMPAIRMENTS
°
o
Homs Boats
spasticity
o
cognitive deficits
o
vestibular
°
o
o
"" " '
Y " SS
visual
defects
ataxia
defects
*¥i÷÷÷¥÷÷÷÷÷
/
SYMPTOMS
SECONDARY
°
o
weakness
contractures
IMPAIRMENTS
"
""
o
+
stiffness
respiratory
issues
/
OTHER
has " "
°
neglect
o
o
o
IMPAIRMENTS
dementia
depression
has"
of
o
o
""
cognitive
apraxia (
Phobia
function
dyspraxia
incontinence
MMAANNAAGGEEMMEENNTT #
SSTTRROOKKEE
MMEEDDKCCAALL MMAANNAAGGEEMMEENNTT
DIAGNOSIS
SCAN
CT
:÷÷÷:÷g
QUICK , SAFET EASY
'
÷
II:
'
..
n
.in/su*.:.: : .i:.!: E:no:mcs:n-EEwe
LUMBAR PUNCTURE
:&
:: :O: :O
'
.
ANGIOGRAPHY
shows exact area where blood is
✓
ISCHAEMIC
TREATMENT
ANTICOAGULANT
\ YNO OR THROMBOLYTIC S
flow
Re-establish blood
HAEMORRHAGE
↳ THRO M BOLUS IS
(
•
blocked
↳
°
TISSUE PLASMINOGEN ACTIVATOR GPA)
o
•
activates
body 's
penumbra dies
( n-sorgEIY.qabii tg.ae
(
CLOT BUSTING mechanisms
*
after
platelets
-
3
to
-
4.5 hrs
.
.
°
°
°
Blood thinner
Surgery
in
(e.g Heparin)
past
.
14
Previous ischaemic stroke
in last 3 months
High
risk
""
last 48 hrs
in
days
.
↳
.
platelets too
ooo
Most
°
50
•
d÷÷÷÷:÷÷÷÷÷÷÷÷÷÷÷÷÷:*
MECHANICAL EMBOLUS
is
contraindicated
REMOVAL
in
n
•
↳ SURGERY CTHROMBECEOMY)
CEREBRAL ISCHEMIA
:÷÷
-
who
for
intracerebral
60%
90%
of
INDICATORS
1st
month
survivors
become
survive
of
survivors
POSITIVE
°
.
.im
:÷÷i÷÷÷÷÷÷÷÷÷÷÷÷÷
PROGNOSTIC
CAN CAUSE
°
subarachnoid
HYPERTENSION DRUGS
•
,
spasm
÷÷÷÷÷÷÷±÷i÷÷÷e:c;
of haemorrhage
HAEMORRHAGE CONVERSION
e.g
For
head trauma
or
Vaso
oil"sft%Y÷Ya9ne.ba?Yonprobm!EedIEsp.7maa.on
c÷÷÷÷÷÷÷÷÷÷÷::*
°
subarachnoid
Prevents
SURGERY
↳
together ,
stick
For
0
time sensitive!
↳
CALCIUM CHANNEL BLOCKER
urinary continence
return home
will improve
functionally
independent
NEGATIVE
incontinence
o
:÷÷÷÷÷
:*
o
o
no cognitive
defects
early consciousness
o
cognitive defence't
PPHHYYSSIIOOTTHHEERRAAPPYY =D
SSTTRROOKKEE
HMMPPKKEAATTHOONNSS FFOORR PPHHYYSSIIOOTTHHEERRAAPPYY
WHY DO STROKE PATIENTS NEED
l
I
PREVENT 2NDARE
COMPLICATIONS
NEUROPLASTICITY
Drive cortical
remaining
•
e.
g
o
.
o
neural
denervation
restore
Early
(penumbra)
mobilisation
OUTCOMES
improves patient
outcomes
hypersensitivity
-
synapse
length joint
'
maintain
+
connections
IMPROVE
viability of
maintain
t
¥•fn%I977
atrophy
of muscle
•
re-organisation
respiratory infection
muscle
EARLY PHYSIO ?
l
MSK
ROM
o
axonal
integrity
regeneration
f-( TILL
°
collateral
sprouting
E.ec#i-c7E.i-c
•
unmasking
of
silent
synapses
÷i ÷ ÷ ÷ ÷ ÷: ÷ !÷ ÷ ÷ ÷ ÷ ÷ :/ /
MOBILISATION
respiratory
blood
•
*
status
is
pressure
stable
is
stable
0
(patient specific)
-
o
o
DO NOT
r
TPA
MOBILISE WITHIN
(discuss
24 HRS
OF
patent airway
promote optimal respiratory function
Maintain
prevent
a
aspiration
SITTING UP
ISSUES
AIM :
WHEN :
SAFE
o
RESPIRATORY
t
chest
infection
BENEFITS :
o
lung
ventilation
scanning of
increased
visual
o
increased
attention
o
safety w/ neurologist)
improved
o
trains
environment
posture
:÷÷÷÷÷÷÷÷÷÷
.
HIERARCHY
1)
2)
BED
:
MOBILITY
SO F- OB
3) STS
4) Soo B
5)
WALKING
:÷÷÷÷÷÷÷÷÷÷÷÷÷÷÷÷
ROLE
°
anticipate
•
°
OF
load
low
train
PHYSIO
t
prevent
prolonged
endurance
t
contracture
stretch
cardiovascular
fitness
o÷÷÷÷÷÷÷÷÷÷::s