Assessing a stroke patient :Assessing a stroke patient Presented by: kola akinlabi Senior physiotherapist ASU, NMH.


This presentation aims at giving understanding into: :This presentation aims at giving understanding into: Evaluating type of stroke based on clinical presentation Relating clinical features to possible area of brain damage. Important area in history taking and Main neuro assessment.


definition :definition Stroke = acute brain attack An acute disruption of blood supply to part of the brain due to blockage or bursting of the blood vessel.


What kind of stroke is it? :What kind of stroke is it? Infarct: thrombo-embolic and ischemia Or Haemorrhage: burst of an artery Only a CT can tell


According to oxford community stroke project 1991 :According to oxford community stroke project 1991 Cerebral infarction 82% Primary I.C Haemorrhage 10% Sub-arachnoid haemorrhage 8%


Can you tell which part the brain is damaged :Can you tell which part the brain is damaged Clinical features and examination can help you to do this. Different type of stroke


Common type of infarct :Common type of infarct Bamford definition T.A.C.I: Total anterior circulation infarct P.A.C.I: Partial anterior circulation infarct L.A.C.I: Lacunar infarct P.O.C.I: Posterior circulation infarct The individual infarct problems are best referred to as syndrome due to several clinical features seen from each one; e.g. TACS


Total anterior circulation infarct :Total anterior circulation infarct All 3 of Higher function loss dysphasia dyspraxia visuospatial neglect inattention Homonymous hemianopia Motor/sensory deficit >2/3 face, arm, leg


Partial anterior circulation infarct :Partial anterior circulation infarct Any one of these 2 out of 3 of TACI 1. higher function loss 2. homonymous hemianopia 3. motor and sensory deficits Higher function loss alone Limited motor / sensory deficit


Lacuna infarct :Lacuna infarct Any one of these Pure motor stroke ( in 2 of 3 of arm, face or leg ) Pure sensory stroke ( in 2 of 3 of arm, face or leg) Sensorimotor stroke ( in 2 of 3 of arm, face or leg) Ataxic hemiparesis


Lacunar infarction must have none of these: :Lacunar infarction must have none of these: New dysphasia New visuospatial No vertebrobasilar features Proprioceptive sensory loss alone


Posterior circulation infarct :Posterior circulation infarct Any of these features: Cranial nerve palsy and contralateral motor/sensory deficit Bilateral motor OR sensory deficit Conjugate eye movement problems ( diplopia) Cerebella signs in limbs or truncal ataxia


Illustration of anterior, posterior circulation + lacunar arteries :Illustration of anterior, posterior circulation + lacunar arteries


Medial view of blood supply :Medial view of blood supply


Areas of circulation :Areas of circulation Anterior circulation: divided into 1.anterior sup frontal , medial aspect of parietal and occipital lb 2.middle cbr art sup fro par, and somatosensory Posterior circulation: divided into 1.posterior cbr art sup occipital and inferior temporal 2. cerebella art supl cerebellum Lacunes or penetrating arteries: arise from ant & post communicating art to supply thalamus and basal ganglia. And the penetrating arteries from basilar supl the pons.


Now match clinical features with possible of area of brain damage :Now match clinical features with possible of area of brain damage We would have case scenario later.


Stroke evaluation important points in history :Stroke evaluation important points in history Onset record time & rate of onset Risk factors previous stroke, TIAs Hypertension PVD Hyperlipideamia Smoking Alcohol diabetes


Stroke evaluation important point in history :Stroke evaluation important point in history Check pre stroke functions ADL ( walking, stairs, transfering,bathing dressing, grooming, toileting,feeding) Community ADL(driving, public transport, shopping etc.) Employment Hobbies Use of help services at home


Stroke evaluationNeurological assessment :Stroke evaluationNeurological assessment Pointer to ASX Consciousness level Eye movement Limb power Communication Trunk control Gait Sensory status And to RX Visual field Swallowing Visuospatial function Balance Reflex Coordination


Medical investigations :Medical investigations CT scan and MRI Glucose Lipids Haemoglobin WCC Platelets ECG Carotid Doppler Echo BP Clotting factors. Etc…….


Questions…………. :Questions………….