CNS pathology for the

physiotherapists

STROKE
Dr Yasar Yousafzai
Assistant Professor Haematology
Khyber Medical University

STROKE

Also known as cerebrovascular accident

Neurological deficit of cerebral causes that
persists beyond 24 hours or is interrupted by
death within 24 hours
Transient ischemic attack
When poor blood flow results in death of brain
cells
In what conditions would there be poor blood
flow?

Stroke

What will cause a stroke?

What would death of CNS tissue lead to?

Think how ischemia will effect brain function?

Stroke
When the blood stops flowing....

Ischemic stroke

Haemarrhagic stroke

Ischemic stroke

87% stroke cases are due to ischemia

Ischemic stroke may ultimately become

haemorrhagic

Caused by thrombosis, embolism, shock,

atherosclerosis

Ischemic stroke

Small infarcts may go without clinical symptoms

Total anterior circulation infarct

Partial anterior circulation infarct

Lacunar infarct

Posterior circulation infarct

Etiologically

Atherosclerosis of large artery

Embolism originating in the heart

Complete blockage of a small artery

Undetermined cause

Haemorrhagic stroke

Intracranial haemorrhage is defined as

accumulation of blood within the cranial cavity
Main types

Epidural haematoma

Subdural haematoma

Subarachnoid haemorrhage

Cerebral haemorrhage

Symptoms and signs

Typically start suddenly

Hemiplagia and muscle weakness

Numbness

Reduction in sensations and vibration

Flacidity followed by spasticity

Usually unilateral. Why?

Altered smell, taste, vision

Facial muscle paralysis

Decreased reflexes

Stroke signs and symptoms

If the cerebral cortex is involved, CNS

pathways may be affected leading to:

Aphasia difficulty with verbal expression

Dysarthria motor speech disorders

Apraxia involuntary movements

Visual field defects

Memory deficit

hemineglect

Stroke diagnosis

History and clinical examination

CT scan

MRI

Doppler ultrasound

Diagnosis of the underlying cause

Stroke management

Treatment is according to the cause

Thrombolytic therapy

Surgery thrombodectomy

Nursing and supplementary care

Stroke unit

Management of the predisposing cause

Stroke management

Stroke rehabilitation

A process by which stroke patients are rehabilitated

to help them return to normal life as much as
possible

A rehabilitation team is usually multidisciplinary as

it involves staff with different skills working together
to help the patient

Interdisciplinary team consisting of

Doctors, nurses, physical therapists, speech

therapists, occupational therapists