Stroke, types, causes, clinical features ,Examination, investigation

 Stroke is a focal neurological defect resulting in the destruction of brain tissues / lasting more than 24 hours of sudden development due to a defect in cerebral blood vessels.

 Types:-

  1. Ischaemic stroke - Damage to the brain from interruption of its blood supply
  2. Hemorrhagic stroke - a ruptured blood vessel causes bleeding inside the brain.
  3. Embolic stroke - blood clot or debris (embolus) travels from one part of the body and lodges in a narrower brain artery, blocking blood flow to the brain.
  4. Lacunar stroke -  artery to the deep part of the brain,  like the thalamus or basal ganglia, is blocked       
 Causes for Ischaemic stroke  main cause is Thrombo embolism, which is caused by 

  • Mitral stenosis with A trial fibrillations
  • Sub Acute Bacterial Endocarditis
  • Ischaemic heart disease especially MI
Causes for haemorrhagic stroke
  • Hypertension
  • Arteriovenous Malformation
  • Rupture of Aneurysms. 
Clinical features:-
Ca be present as either Hemiplegic/ Monoplegia
  1. In case of Haemorrhagic Stroke, the following features will be present:-
  • Head ache
  • Visual disturbance
  • Vomiting
  • Fits
  • Aphasia - absence of speech
  • Semi consciousness/ Unconscious

2. In case of Ischaemic stroke, the fids & Vomitings are very rare & usually Ischaemic stroke occurs during rest

Common features of any Stroke:-
  • Hemiplegia/ hemiparesis
  • Hemianaesthesia
  • Hemi anopia ( loss of vision in either right/ left half Homonymous of the field of vision)
The limbs will be usually Spastic
  • Spasticity - Hypertonicity due to Pyramidal tract lesions
  • Rigidity- due to extrapyramidal lesion
Muscle power is reduced
  • Deep tendon reflexes are exaggerated (Hyperreflexia) 
  • Babinski's sign is +ve (extension of Big toe fanning of Other toes on stroking the sole)
 Features of Intracranial lesion Vomiting, Bradycardia, Papilloedema. 

Distension of Bladder - facial Nerve palsy on the affected side( facial numbness) 

Dysphasia

Flaccidity initially, later Spasticity

Ataxia

Nystagmus

Palatal palsy


Impairment of pain & temperature sensation contralaterally. 

Examination:-

Investigation:-
  • Routine tests Complete blood count, ESR
  • Serological tests
  • Blood glucose
  • Blood urea, electrolytes, proteins
  • Chest X- ray, ECG
  • CT scanning
  • Angiography
  • Echo cardiography




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