1. Morgann Loaec and Laila Siddique MS2
Strokes
Morgann Loaec and Laila Siddique MS2

2. Blood Supply to the Brain

3. Blood Supply of the Brain

4. What is a stroke? Poor blood flow to the brain resulting in cell death
What can cause poor blood flow to the brain?

5. Types of Strokes Hemorrhagic - due to bleeding
Ischemic - due to lack of blood flow, usually from a blood clot
85-90% of strokes

6. Risk Factors for Stroke
Family History
Hypertension (high blood pressure)
Smoking
Alcohol Intake
Obesity
High cholesterol
Diabetes
Atrial fibrillation
Aneurysm
What do all of these factors put you at risk for that increases your risk of having a stroke?

7. Clinical Presentation of a Stroke
Inability to move or feel one side of the body
Problems understanding or speaking
Feeling like the world is spinning
Loss of vision to one side
severe headache with no known cause
dizziness and lightheadedness
weakness of any kind
confusion, trouble speaking/understanding
numbness of face arm or leg especially on one side of body
passing out or fainting

9. NIH Stroke Scale Level of Consciousness LOC Responsiveness
LOC Questions
LOC Commands
Horizontal Eye Movement
Visual field test
Facial Palsy
Motor Arm
Motor Leg
Limb Ataxia
Sensory
language
Speech
Extinction and Inattention

10. Pathophysiology of Strokes

11. Main points
Ischemic strokes are formed by blockage of blood vessels that starve brain tissue of oxygen and nutrients
Clots can either form in the unhealthy vessel within the brain = thrombus
Or clots can form somewhere else and travel to the brain = embolism (This is why atrial fibrillation is a risk factor for strokes)
Hemorrhagic strokes are caused by a rupture of a blood vessel within the brain or from the rupture of an aneurysm
Hemorrhagic strokes destroy brain tissue directly with the leak of blood on to brain tissue and indirectly by cutting off the blood supply to brain tissue

12. Treatment of Strokes tPA = Gold standard for ischemic stroke treatment
tissue plasminogen activator = breaks down clots
Endovascular procedures to remove the clot is your next option
Mechanical thrombectomy using a stent retriever
Hemorrhagic strokes are treated with endovascular procedures or surgical procedures
Catheter procedure to prevent rupture of aneurysm or AVM
Surgical repair of burst aneurysm or AVM using metal clips

13. Natural History
Disability after a stroke correlates with the amount of time between the stroke onset and treatment.
The longer a patient’s brain is deprived of blood supply, the more it will start to die.
If treatment is started early, within the first few hours, many of the stroke symptoms will not be permanent; but if treatment is delayed, the brain damage may be permanent and symptoms can persist.
75% of patients experience some kind of disability after their stroke: - muscle weakness - numbness - loss of speech - loss of vision - pain
This is a traumatic experience for all patients and support is imperative for their recovery

14. Life After Stroke
Stroke patients often need rehabilitation to regain function after a stroke
They work with OT and PT to regain skills such as:
Self-care skills such as feeding, grooming, bathing, toileting and dressing
Mobility skills such as transferring, walking or self-propelling a wheelchair
Communication skills in speech and language
Cognitive skills such as memory or problem solving
Social skills for interacting with other people
This often takes place in a variety of settings
Acute care in the hospital
Long term care facilities
Home health care

15. Prevention Prevention includes:
Decreasing the risk factors we discussed earlier (high blood pressure, diabetes, obesity, smoking, alcohol consumption, high cholesterol etc)
Aspirin (blood thinner to break down clots or prevent formation)
Statins (helps to lower high cholesterol levels)
Surgery to open up the arteries to the brain in those with problematic narrowing
Warfarin (another blood thinner) in those with atrial fibrillation