A stroke occurs when there is interruption of the blood supply to a particular area of the brain, ultimately leading to cell injury and cell death.
Strokes can be classified as either:
Ischaemic strokes are the most common, accounting for up to 80% of strokes, and occur when there is an occlusion of a blood vessel impairing the flow of blood to the brain.
Ischaemic strokes are divided into:
1. thrombotic – where a blood clot forms in a main brain artery or within the small blood vessels deep inside the brain. The clot usually forms around atherosclerotic plaques.
2. embolic – a blood clot, air bubble or fat globule forms within a blood vessel elsewhere in the body and is carried to the brain.
3. systemic hypoprofusion – a general decrease in blood supply, eg. in shock.
4. venous thrombosis
Haemorrhagic strokes occur when a blood vessel in the brain ruptures and bleeds.
1. Intracerebral haemorrhagic stroke — there is bleeding from a blood vessel within the brain. High blood pressure is the main cause of intracerebral haemorrhagic stroke.
2. Subarachnoid haemorrhagic stroke — there is bleeding from a blood vessel between the surface of the brain and the arachnoid tissues that cover the brain.
Nb. Some experts do not classify subarachnoid haemorrhage as stroke because subarachnoid haemorrhages present differently from ischaemic strokes and intracerebral haemorrhagic strokes.
Physiotherapists should be involved early, and should make their own assessment of how much they can work with a patient. Early mobilization is associated with better outcomes – even after taking account of the potential confounding influence of disease severity. If rehabilitation is to take place on a different ward from acute care, the care received should be made as seamless as possible. Type and intensity of therapy should be determined by the patient’s needs not location.
Management / Interventions
Early management of acute stroke: The goal for the acute management of patients with stroke is to stabilize the patient and to complete initial evaluation and assessment, including imaging and laboratory studies, within a short time frame. Critical decisions focus on the need for intubation, blood pressure control, and determination of risk/benefit for thrombolytic intervention.
Patients presenting with Glasgow Coma Scale scores of 8 or less or rapidly decreasing Glasgow Coma Scale scores, require emergent airway control via intubation.
Hypoglycemia and hyperglycemia need to be identified and treated early in the evaluation. Not only can both produce symptoms that mimic ischemic stroke, but they can also aggravate ongoing neuronal ischaemia.