🧠 Stroke: Definition, Causes, Symptoms & Physiotherapy Management
Comprehensive notes for Physiotherapy students by Harikrishna M S
Definition
Stroke is a sudden onset of neurological deficit caused by an interruption of blood supply to the brain (ischemia) or rupture of a blood vessel (hemorrhage), leading to loss of brain function.
WHO Definition:
“Stroke is a rapidly developing clinical sign of focal (or global) disturbance of cerebral function, lasting more than 24 hours or leading to death, with no apparent cause other than vascular origin.”
Causes / Etiology
1️⃣ Ischemic Stroke (≈ 85%)
- Thrombosis – clot formation in cerebral arteries (e.g., atherosclerosis)
- Embolism – clot or debris traveling from heart or carotid arteries
- Systemic hypoperfusion – due to cardiac failure or shock
2️⃣ Hemorrhagic Stroke (≈ 15%)
- Intracerebral hemorrhage (ICH): rupture of small arteries (often due to hypertension)
- Subarachnoid hemorrhage (SAH): rupture of aneurysm or trauma
Types of Stroke
| Type | Subtype | Description |
|---|---|---|
| Ischemic Stroke | Thrombotic / Embolic | Blockage of blood vessel due to local clot or embolus |
| Hemorrhagic Stroke | Intracerebral / Subarachnoid | Rupture of vessel leading to bleeding inside brain or subarachnoid space |
| Transient Ischemic Attack (TIA) | – | “Mini-stroke” – temporary symptoms lasting <24 hrs, no permanent damage |
Clinical Features / Symptoms
| System | Typical Symptoms |
|---|---|
| Motor | Hemiplegia or hemiparesis (weakness/paralysis on one side) |
| Sensory | Numbness or loss of sensation (usually same side as weakness) |
| Speech | Aphasia (if dominant hemisphere affected) |
| Vision | Visual field defects (homonymous hemianopia) |
| Coordination | Ataxia, balance problems |
| Cognition | Confusion, poor memory, neglect |
| Cranial Nerves | Facial droop, dysphagia |
| Other Signs | Headache, vomiting, loss of consciousness (esp. in hemorrhagic stroke) |
FAST Test for Stroke Recognition
- F – Facial drooping
- A – Arm weakness
- S – Speech difficulty
- T – Time to call emergency
Management
A. Medical Management
1️⃣ Acute Phase
Ischemic Stroke:
- Thrombolytic therapy: IV tPA within 4.5 hours
- Antiplatelet: Aspirin (after 24 hrs if tPA not given)
- Anticoagulants: Warfarin or Heparin (if cardioembolic)
Hemorrhagic Stroke:
- Control blood pressure
- Manage ICP (mannitol, hyperventilation)
- Neurosurgical evacuation of hematoma if indicated
- Supportive care: Maintain airway, hydration, nutrition, bladder/bowel care
2️⃣ Secondary Prevention
- Control risk factors – hypertension, diabetes, smoking, obesity
- Statins for lipid control
- Lifestyle modification
B. Physiotherapy Management
- Acute Stage: Positioning, ROM exercises, breathing exercises, early mobilization
- Subacute Stage: Facilitate normal movement, improve balance, gait training
- Chronic Stage: Strengthening, CIMT, FES, ADL retraining
- Patient Education: Fall prevention, home exercises, stroke awareness
Prognosis
Depends on type, severity, age, and speed of treatment. Early rehabilitation improves functional recovery and independence.