Cerebro vascular accident

This ppt is particularly made for II Year B.Sc OTT students SUB:- Med. Relevant To OT

1. MEGHANA C DOTT, BOTT, M.Sc Medical Biochemistry Cerebro Vascular Accident

2. What Is Stroke ? A stroke occurs when blood flow to the brain is interrupted by a blocked or burst blood vessel When brain tissue is deprived of blood flow, neurons die within minutes. Surrounding a core of infarction is an “ischemic penumbra,” poorly perfused but viable tissue at risk for imminent infarction. The goal of acute stroke care is the revival and rescue of the ischemic penumbra by rapid restoration of blood flow. The goal of acute stroke care is the revival and rescue of the ischemic penumbra by rapid restoration of blood flow.

3. Causes If blood flow is stopped for longer than a few seconds the brain cannot get blood and oxygen brain cells can be causing permanent damage Types of stroke There are two major types of stroke namely; Ischemic stroke and Hemorrhagic stroke

4. TYPES OF STROKE

5. ISCHEMIC STROKE Ischemic stroke occurs when a blood vessel that supplies blood to the brain is blocked by a blood clot, This may happen in two ways; Thrombotic stroke Embolic stroke (cerebral embolism) 1. Thrombotic stroke a blood clot from thrombosis may form in an artery that is already very narrow this is called a thrombotic stroke in this case sufficient amount of blood is not supplied to the brain resulting in stroke. 2. Cerebral embolism or an embolic stroke A clot may break off from another place in the artery blood vessel of the brain (one of the complication of aneurysm)or some other part of the body and travel up to the brain this is called cerebral embolism or an embolic stroke.

6. HEMORRHAGIC STROKE A   hemorrhagic stroke  is also called an intracerebral   hemorrhage , or an ICH. An ICH occurs when a blood vessel ruptures and blood accumulates in the tissue around the rupture. This puts pressure on the brain and causes a loss of blood to the surrounding areas . High blood pressure and trauma are two leading causes. Taking blood-thinning drugs may also increase a person's risk . Symptoms can vary based on the location of the haemorrhage in the brain, but may include numbness or weakness in part of the face, difficulty speaking or difficulty walking.

7. DIAGRAMATIC REPRESENTATION OF CVA TYPES

8. STROKE RISK FACTOR High blood pressure is the number one risk factor for stroke Diabetes mellitus Family history of stroke High cholesterol Increasing age especially after age 55 Race (black people are more likely to die of stroke) Birth control pills contraceptive pills can increase the chances of having blood clot (thrombosis).The risk is highest in women who smokes and are older than 35 years Cardiac patients or patients with poor blood flow in their legs caused by narrowed arteries are also more likely to have a stroke

9. THE CHANCE OF STROKE IS HIGHER IN PEOPLE WHO LIVE AN UNHEALTHY LIFESTYLE BY ; BEING OVERWEIGHT OR OBESE DRINKING HEAVILY (ALCOHOLIC) EATING TOO MUCH OF SALT OR FAT SMOKING DRUG ADDICTS (TAKING COCAINE AND OTHER ILLEGAL DRUGS)

10. STROKE SYMPTOMS The symptoms of stroke depend on what part of the brain is damaged. In some cases a person may know that he or she has had a stroke. Headache occur especially if the stroke is caused in the brain by bleeding Change in alertness (sleepiness and consciousness and coma) Changes in hearing Changes in taste Clumsiness Vertigo Muscle weakness in the face arm or leg (usually one side) Lack of control over the bowel or bladder Problem with vision including decreased vision and Numbness on one side of the body

11. DIAGNOSIS OF CVA Physical examination Lab test

12. PHYSICAL EXAMINATIONS INCLUDE; Check the BP which may be high Listen for abnormal sound called "BRUIT" by using a stethoscope, listen to carotid artery in the neck - a "BRUIT" is caused by abnormal blood flow Check for problems with vision moment feelings reflexes understanding and speaking

13. LAB TEST INCLUDES Bleeding time BT Blood cholesterol Blood sugar Blood clotting test ( prothrombin time, or partial thromboplastin time) Complete blood count ECG Heart rhythm monitoring

14. FOLLOWING TESTS CAN HELP TO FIND THE TYPE LOCATION AND CAUSE OF THE STROKE Angiogram of the head can show which blood vessels is blocked or bleeding Carotid duplex ultrasound can show carotid arteries in the neck have narrowed CT scan of the brain MRI scan Echocardiogram may be done if the stroke could have been caused by a blood clot from the heart Magnetic resonance angiography (MRA) or CT angiography may be done to check for abnormal blood vessels in the brain.

15. COMPLICATION Loss of moment or feeling in one or more part of body muscle spasticity problem speaking and understanding problem thinking and focusing loss of mobility

16. TREATMENT FOR CVA - STROKE Stroke is a medical emergency immediate treatment can save life and reduce disability Treatment depends on how severe the stroke was and what caused it a bleeding (hemorrhagic) or A clot (ischemic, thromboembolic ) Thrombolytic therapy :- If if the stroke is caused by a blood clot, a blood clot bursting drug or (thrombolytic drugs) may be given to dissolve the clot. These medicines breaks up blood clot and helps bring back blood flow to the damaged area. However,everyone can not get this type of medicine. For these drugs to work a treatment must begin within 3 hours when the symptoms first started. NOTE: A CT scan must be done to see whether the stroke is from A clot or from bleeding. If the stroke is caused from a bleeding instead of clotting, clot-busting drugs thrombotics can cause more bleeding.

17. TREATMENT FOR CVA - STROKE Blood thinners such as a heparin or warfarin may be used to treat stroke due to blood clots Aspirin or clopidogrel ( plavix ) may also be used Other medicines may be used to control symptoms which has high BP If bleeding occured , surgery is often needed to remove blood from around the brain and fix damaged blood vessels. Surgery on the carotid artery may be needed Physical therapy, occupational therapy, speech therapy and swallowing therapy will begin in hospital. Precautions and clothes prevention of further strokes