CVA

Overview of Pathology for Physical Therapy

  • Focus: Neurologic Interventions for Physical Therapy

  • Related Topics:

    • Cerebrovascular Accident (Stroke)

    • Medical Terminology

Objectives of Stroke Education

  • Differentiate types of cerebrovascular accidents

  • Identify signs and symptoms of stroke

  • Recognize clinical manifestations based on lesion location

  • Define the role of PTA in post-stroke care

Medical Terminology Related to Stroke

  • Aphasia: impairment of speech

  • Ataxia: lack of muscle coordination

  • Dysphagia: difficulty swallowing

  • Dysarthria: disturbance in articulation

  • Hemiparesis: weakness on one side

  • Hemiplegia: paralysis on one side

  • Paresthesia: abnormal sensations (e.g., burning, tingling)

  • Electroencephalography: records electrical activity in the brain

  • Anesthesia: loss of sensation through medication

Combining Forms in Medical Terminology

  • Angi/o: vessel

  • Arteri/o: artery

  • Crani/o: skull

  • Hemat/o: blood

  • Hydr/o: water

  • Isch/o: to hold back

  • Spin/o: spine

  • Thalam/o: thalamus

  • Vascul/o: blood vessel

  • Ventricul/o: ventricle

Stroke Overview (Goodman p. 667)

  • Stroke (CVA): disruption of blood supply to the brain due to hemorrhage or ischemia.

    • Sudden onset of neurological signs and symptoms.

    • Most common neurological condition in adults.

    • Transient Ischemic Attack (TIA): temporary symptoms resolving in 1-24 hours but indicates risk for future stroke.

Transient Ischemic Attacks (N.I. p. 349)

  • Characteristics:

    • Temporary loss of motor, sensory, or speech function.

    • Resolves within 24 hours, typically no permanent damage.

    • Significant risk (40%) of subsequent stroke within days.

    • Treatment includes lifestyle changes and medications.

Stroke Risk Factors (Goodman p. 668)

  • Non-modifiable: Age, race, sex (higher incidence in African Americans).

  • Modifiable: Hypertension, heart disease, diabetes, smoking, alcohol use, high cholesterol.

  • Risk doubles every decade post-55 years; men at higher risk than women.

Warning Signs of Stroke (Goodman p. 670)

  • Sudden weakness/numbness (face, arm, leg)

  • Loss of vision, especially in one eye

  • Difficulty speaking or understanding speech

  • Sudden severe headache

  • Dizziness or unsteadiness

Cerebral Arteries and Blood Supply

  • Circle of Willis: arterial network supplying blood to the brain.

    • Components:

      1. Internal Carotid Artery (ICA)

      2. Anterior Cerebral Artery (ACA)

      3. Anterior Communicating Artery

      4. Posterior Cerebral Artery (PCA)

      5. Posterior Communicating Artery

      6. Middle Cerebral Artery (MCA)

      7. Basilar Artery

Types of Stroke: Ischemic vs. Hemorrhagic

  • Hemorrhagic Stroke:

    • Causes: Abnormal bleeding from ruptured vessels, 20% incidence, 80% mortality.

    • Predisposing factors: Aneurysm, hypertension.

  • Ischemic Stroke:

    • Caused by decreased oxygenation to brain tissues, 80% incidence, 40% mortality.

    • Types: Thrombotic (gradual onset) and Embolic (sudden onset).

Diagnosis of Ischemic Stroke (Goodman p. 674-675)

  • Neuroimaging Techniques:

    • CT Scan: Fast, confirms diagnosis, rules out other conditions, detects areas of decreased brain density.

    • MRI: Identifies ischemic events within 2-6 hours; contrasts ischemia vs hemorrhage.

    • PET Imaging: Detects brain activity; more sensitive than CT or MRI.

    • Angiography: Invasive, used to highlight blood vessels when other imaging fails.

Treatment of Ischemic Stroke (Goodman p. 675-677)

  • Focus on cerebral perfusion and management of blood pressure.

  • Thrombolytic agents (e.g., t-PA) are crucial for early treatment within 3-4.5 hours.

  • Anticoagulants and antiplatelets (e.g., aspirin) prescribed to prevent future strokes.

Hemorrhagic Stroke Diagnosis and Treatment

  • Immediate CT scan for hematoma assessment.

  • Manage blood pressure, utilize Glasgow Coma Scale for consciousness.

Recovery and Prognosis

  • Recovery is most rapid in the first few months, 90% of recovery within 3 months.

  • Factors affecting recovery include the type of stroke and the severity of symptoms.

  • Stroke survivors may achieve improvement in motor function for up to 5 years post-event.