WEEK 1 Lecture 1.1 PTY 223 Introduction to stroke.pptx

INTRODUCTION TO STROKE LECTURE 1.1 (1.5 HOURS) PTY 223 PHYSIOTHERAPY FOR NEUROLOGICAL CONDITIONS – NEUROLOGY (THEORY) AIMS OF THE LECTURE Revise arterial supply to the brain Identify pathophysiology of acute stroke Describe risk factors for stroke Describe typical presentations of acute...

INTRODUCTION TO STROKE LECTURE 1.1 (1.5 HOURS) PTY 223 PHYSIOTHERAPY FOR NEUROLOGICAL CONDITIONS – NEUROLOGY (THEORY) AIMS OF THE LECTURE Revise arterial supply to the brain Identify pathophysiology of acute stroke Describe risk factors for stroke Describe typical presentations of acute stroke Describe medical management of stroke Identify some prognostic indicators for stroke outcome 2 REQUIREMENT: KNOWLEDGE OF BRAIN ANATOMY 3  REQUIREMENT: KNOWLEDGE OF BRAIN’S CIRCULATION Territory of anterior, middle and posterior cerebral arteries; vertebrobasilar artery 4 ‘STROKE’ AKA ‘CVA’ = cerebrovascular accident Due to cerebrovascular disease Brain disease occurs secondary to pathological disorder of blood vessels or blood supply 5  RISK FACTORS Risk factors for stroke = risk factors for cardiovascular disease Hypertension Cardiac disease (AF - Atrial fibrillation is a quivering or irregular heartbeat (arrhythmia) that can lead to blood clots, stroke, heart failure and other heart-related complications, CCF- congestive cardiac failure is a condition in which the heart muscle is weakened and can't pump as well as it usually does.) Diabetes Heredity Blood lipids, cholesterol, smoking, 6 OCP (oral contraceptives)? 7  PATHOPHYSIOLOGY Cerebral infarct/is a brain lesion in which a cluster of brain cells die when they don't get enough blood- 85% Occlusion of vessel due to thrombus/clot or embolus Cerebral haemorrhage/rupture 15% Rupture of vessel wall 8  PATHOPHYSIOLOGI CAL CHANGES In normal brain, cerebral blood flow (CBF) = metabolic requirements (oxygen & glucose) After infarction, CBF < metabolic requirements Note: period of ‘reversible’ ischemia, if CBF is restored within critical time period, infarction (tissue death) will 9 not occur 10 11  TRANSIENT ISCHEMIC ATTACK TIA ‘mini stroke’ Early warning sign CBF- cerebral blood flow restored before permanent infarction Complete resolution of symptoms within 24/24 Requires urgent attention to risk factors 12  Face – Check their face. Has their mouth drooped? Arms – Can they lift both arms? Speech – Is their speech slurred? Do they understand you? Time – Time is critical. If you see any of these signs, call 998 now! 13 DEFICITS RELATE TO ARTERIAL TERRITORY 14 ARTERIAL SUPPLY 15 MCA/ MIDDLE CEREBRAL ARTERY TERRITORY STROKE Most common presentation of cerebral infarct Due to anatomical location of common carotid relative to MCA (pathway for Embolus/blood clot) 16  MCA STROKE R MCA (non dominant) L MCA (dominant) L hemiplegia, UL>LL R hemiplegia, UL>LL L hemisensory loss R hemisensory loss L homonymous hemianopia/ vision R homonymous hemianopia loss on the same side of the visual field in both eyes Motor/sensory/visual neglect Dysphasia- difficulty or discomfort in swallowing/aphasia - It can affect your ability to speak, write and understand language, both verbal and written. Spatial/perceptual dysfunction- Apraxia- by loss of the ability to execute affects how we focus and understand our or carry out skilled movements and body's relationship to the environment gestures, despite having the desire and the physical ability to perform them. 17  OTHER STROKE PRESENTATIONS Cerebellar infarct ACA infarct/ Anterior cerebral artery Ipsilateral ataxia- same side of the Contralateral paresis/weakness LL body - the loss of full control of bodily movements. Dysarthria- difficult or unclear Contralateral sensory loss LL articulation of speech Vertigo/dizziness incontinence Nystagmus- rapid involuntary movements of the eyes NO sensory loss 18 HEMIPLEGIC STROKE PRESENTATION 19  INTRA CEREBRAL HAEMORRHAGE ICH = intracerebral haemorrhage/ruptured blood vessel (SAH = sub arachnoid haemorrhage) Note: EDH/Extradural hematoma & SDH/ subdural hematoma not considered ‘strokes’ as do not involve arterial circulation to brain 20  ICH- INTRACEREBRAL HAEMORRHAGE Greater mortality (approaching 50%) Frequently associated with BP Blood ruptures into cerebral tissue and forms clot May require neurosurgical intervention (decompression of clot to relieve ICP) 21 SUBARACHNOID HAEMORRHAGE 22  SUBARACHNOID HAEMORRHAGE 10-15/100,000 per year 75% due to ruptured aneurysm/swelling of the wall of artery. 5% arterio venous malformation (AVM) 20% other rare causes eg vasculitis/ inflammation of blood vessels Usually require neurosurgical procedure (clipping, wrapping, coiling) 23  SUBARACHNOID HAEMORRHAGE Sudden SEVERE headache Vomiting Seizure or loss of consciousness Neck stiffness (signs of meningism) 24  SUBARACHNOID HAEMORRHAGE Neurological symptoms due to: Bleeding directly into brain tissue (ICH- intracerebral haemorrhage +/- bleeding into ventricles) Secondary ischemia from ‘vasospasm- narrowing of the arteries’ 25  ACUTE MEDICAL MANAGEMENT FOR ALL STROKE TYPES Diagnosis! Underlying cause of stroke – treatment Maintain vital functions Initiate secondary prevention Treat coincidental disorders eg UTI, DVT Initiate early rehabilitation 26  ACUTE MEDICAL MANAGEMENT Management of primary cause eg drugs for AF, BP Fluid management eg IVT Nutritional management eg NGT- Nasogastric tube Respiratory management eg oxygen, suction Reduce complications eg heparin for anti-DVT 27 ACUTE MEDICAL MANAGEMENT: ‘BRAIN ATTACK’ Can a stroke be ‘cured’? If not, what’s the rush? 28  TISSUE PLASMINOGEN ACTIVATOR (TPA) ‘Clot busting’ drug For use in thrombolytic stroke (infarct/small dead tissue) Must be administered