Stroke and stroke syndrome for physiotherapy.pptx

Stroke (also known as a cerebrovascular accident) is a medical condition in which poor blood flow to the brain causes cell death. There are two main types of stroke: ischemic, due to lack of blood flow, and hemorrhagic, due to bleeding. Both cause parts of the brain to stop functioning properly.

1. STROKE Dipanjan konar (Final year BPT student)

2. Definition A stroke is defined as a medical condition that occurs when the blood supply to a part of the brain is interrupted and preventing oxygen from reaching brain tissue.

3. Etiology :-

4. Types:-

5. Risk Factors:- Lifestyle risk factors Being overweight Physical inactivity Heavy drinking Use of illegal drugs Cigarette smoking Medical risk factors High blood pressure Diabetes Cardiovascular disease Other factors of stroke Age Sex Hormones

6. Modified etiology of stroke The etiology of stroke can be modified through addressing and managing various risk factors. Modified risk factors include:- Hypertension Diabetes High cholesterol Smoking Obesity Physical inactivity Unhealthy diet Alcohol consumption

7. Complications :- Complications depend on how long the brain lacks blood flow and which part is effected. Complication may include:- Loss of muscle movement, known as paralysis. Trouble talking or swallowing. Memory loss or trouble thinking. Emotional symptoms. P ain. Changes in behavior and self-care.

8. Major regions of stroke Anterior circulation MCA- Lateral frontal lobes, temporal l obes, lateral anterior parietal lobes. (Upper body, language) ACA- Medical and anterior frontal lobes, medial parietal lobes.(Lower body, pelvic floor musculature, sensory integration) Ophthalmic artery- Eyes (option)

9. Cont….. Posterior circulation PCA- Occipital lobes, posterior temporal lobes, posterior parietal lobes, midbrain. (Vision, balance, sensory integration) PICA- Posterior inferior cerebellum, posterior lateral medulla. (Facial sensation, Pain sensation from body) Basilar artery- Locked in syndrome.

10. Wallenberg syndrome Wallenberg syndrome is the most prevalent posterior ischemic stroke syndrome . There are nearly 800,000 patients who suffer from acute stroke each year in the United States . Of these, 83% are ischemic strokes . Twenty percent of ischemic strokes occur in the posterior circulation.  If clinicians assume that about half of these suffer from Wallenberg syndrome, it can be estimated that there are more than 60,000 new cases of Wallenberg syndrome each year in the United States . The condition shows a predominance for men in their sixth decade. Causes: Cerebral embolism (blood clot that travels to the brain) Vertebral artery dissection (which may be due to neck manipulation or injury) Marfan syndrome Ehler’s- Danlos syndrome Fibromuscular dysplasia

11. SYMPTOMS OF WALLENBERG SYNDROME Vertigo Nausea and vomiting Difficulty with balance and ambulation Difficulty maintaining sitting posture Blurry vision Horizontal or rotational nystagmus R eduction in facial pain & temperature sensation Contralateral reduction in trunk pain & temperature sensation Hoarseness Poor gag reflex Ataxia, both limb & gait Dysphonia (difficulty with sound production) Dysphagia (difficulty swallowing) Diplopia (double vision)

12. Benedikt Syndrome:- Benedikt syndrome is defined as a midbrain stroke. It is a rare type of posterior circulation  stroke  of the brain, with a range of neurological symptoms affecting the midbrain, cerebellum and other related structures. CN3, lemniscal tract, red nucleus. Signs & Symptom :- Occulomotor palsy. Contralateral loss of vibration. Involuntary movement (tremor, ataxia) Causes:- Infraction Haemorrhage Tumour Tuberculosis

13. Pontine syndrome DEFINATION:- A pontine stroke is a stroke that develops in the blood vessels that supply your pons, a structure in the brainstem that controls unconscious functions like the sleep-wake cycle and coordinating movements . Basilar artery is most commonly effected. SYMPTOM:- numbness or weakness in your face and limbs confusion trouble seeing trouble walking Headache Risk factors:- The risk of pontine stroke increases with age. high blood pressure diabetes dyslipidemia heart disease

14. C omplications of a pontine stroke: swelling in your brain pneumonia seizures depression physical disability

15. LOCKED IN SYNDROME it’s a rare syndrome that effect the ability of individual to communicate and move their body. Despite being physically paralyzed, the effected person remain conscious and aware about surrounding. A part of the brainstem, the pons is damaged in locked in syndrome. Causes: Stroke Traumatic brain injury Degenerative diseases Drug overdose (barbiturates) Sign & Symptom :- Paralysis Loss of speech Loss of sensation Retention of cognitive function Retention of eye movement

16. Weber’s syndrome:- Weber’s syndrome is a rare, congenital disorder classically described as a midbrain stroke syndrome. Cranial nerve, corticospinal tract, corticobulbar tract. Sings & Symptom:- Occulomotor nerve palsy Contralateral hemiparesis. Pseudobulbar palsy Causes:- It’s usually caused by a  stroke, but in rare cases, Weber’s syndrome can also be caused by a  brain tumor, a traumatic injury, or infection.

17. CLAUDE SYNDROME Claude’s syndrome is caused by midbrain infraction as a result of occlusion of a branch of the cerebral artery . This lesion is usually unilateral infarction of the red nucleus and cerebral peduncle, affecting several structures in the mid brain including: Structure damaged Effect Corticospinal tract fibers Contralateral hemiparesis Corticobulbar tract fibers Contralateral hemiplegia of lower facial muscles , tongue and shoulder Occulomotor nerve fibers Ipsilateral Occulomotor nerve palsy with a drooping eyelid and fixed wide pupil pointed down and out; and probable diplopia.

18. PARINAUD’s SYNDROME Parinaud syndrome is also known as sylvian aqueduct syndrome ,dorsal mid brain syndrome Parinaud syndrome is classically described by the triad of impaired upward gaze, convergence retraction nystagmus, and pupillary hyporeflexia. Causes : Brain tumors in midbrain Demyelination Stroke of upper brainstem. Sign and symptoms: Paralysis of upwards gaze Pseudo- Argyll Robertson pupils : Convergence-retraction   nystagmus : Eyelid  retraction ( Collier's sign )

19. Millard-Gubler Syndrome:- Millard–Gubler syndrome is a lesion of the pons. It also known as   ventral pontine syndrome. Obstruction of circumferential branches of basilar artery. Effects in CN6 & CN7 (facial palsies) Sign & Symptom :- Contralateral hemiplegia. Ipsilateral facial weakness. Ipsilateral sixth nerve palsy.

20. Treatment:- Exercise Stretching, walking, and exercises specific to trouble spots. Manual Therapy Manual techniques on joints and muscles to improve circulation and reduce pain. Education M ore advantageous methods of performing daily activities Assistive device training Transfer training

21. Cont…. Improve motor control Use several different techniques for sensory stimulation to facilitate movement. Learning theory approach Conductive education and motor relearning theory Functional electrical stimulation Help restore motor control, spasticity, and hemiplegia Biofeedback Other treatments include Tone management, Sensory re-education, Balance retraining, Fall prevention, Gait re-education, Functional mobility training