🩸 1. Definition
Stroke (Cerebrovascular Accident – CVA) is a sudden loss of neurological function caused by an interruption of blood supply to the brain.
- Results in damage or death of brain tissue due to lack of oxygen and nutrients.
- Effects depend on which area of the brain is affected.
🧬 2. Causes (Etiology)
Stroke occurs due to problems in blood flow — either blocked (ischemic) or burst (hemorrhagic) vessels.
a. Ischemic Stroke (≈ 85%)
- Thrombotic: Clot forms inside a brain artery.
- Embolic: Clot travels from another body part and blocks a brain artery.
🧩 Causes: Atherosclerosis, hypertension, diabetes, heart disease.
b. Hemorrhagic Stroke (≈ 15%)
- Intracerebral hemorrhage: Bleeding within brain tissue.
- Subarachnoid hemorrhage: Bleeding between brain and skull.
🧩 Causes: Hypertension, aneurysm, trauma.
🧠 3. Types of Stroke (According to Area)
| Type | Area Affected | Common Symptoms |
|---|---|---|
| Middle Cerebral Artery (MCA) | Most common | Contralateral hemiplegia, aphasia, neglect |
| Anterior Cerebral Artery (ACA) | Frontal lobe | Leg weakness, incontinence |
| Posterior Cerebral Artery (PCA) | Occipital lobe | Visual loss |
| Vertebrobasilar Artery | Brainstem | Ataxia, vertigo, diplopia |
| Lacunar Stroke | Small arteries | Pure motor/sensory stroke |
⚡ 4. Risk Factors
Modifiable
- Hypertension
- Smoking
- Diabetes
- Obesity
- Alcohol
Non-Modifiable
- Age >55
- Male
- Family history
- Previous stroke
🧍♂️ 5. Clinical Features
Motor Impairments
- Hemiplegia / Hemiparesis
- Abnormal tone → flaccidity → spasticity
- Abnormal synergies & associated reactions
Sensory Impairments
- Loss of sensation
- Visual neglect
Cognitive Deficits
- Poor memory & attention
- Apraxia
Speech Disorders
- Aphasia (Broca/Wernicke)
- Dysarthria
- Dysphagia
Emotional Changes
- Depression
- Impulsivity
Reflexes
- Initially absent → later hyperreflexia
- Babinski positive
🩺 6. Medical Management
Emergency Care
Time = Brain — treat within 3 hours.
| Ischemic Stroke | Hemorrhagic Stroke |
|---|---|
| Thrombolytics (tPA), Antiplatelets | Control bleeding, surgical repair |
| BP and sugar control | Prevent re-bleeding |
🏃♂️ 7. Physiotherapy Management (O’Sullivan Simplified)
A. Acute Stage (Flaccid)
- Positioning
- PROM
- Facilitation
- Rolling & bed mobility
B. Recovery Stage
- PNF, NDT, Rood
- Balance training
- Task-oriented activities
C. Functional Stage
- Gait training
- Dual-task balance
- ADL training
- Home program
D. Education
- Caregiver training
- Motivation
- Fall prevention
E. Outcome Measures
- Fugl-Meyer
- Berg Balance
- FIM
- 10-Meter Walk
- Ashworth Scale
🧭 8. Prognosis
- Depends on lesion type, site, severity, early rehab.
- Better if: Young, small lesion, early motor return.
❤️ Simple Summary
Stroke = sudden brain damage from blood flow issues.
Early treatment saves neurons.
Physiotherapy restores movement, balance & confidence through structured rehab.