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OBJECTIVES

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  • 1) Understand the pathophysiology of stroke

  • 2) Relate the common risk factors for stroke to the cardiovascular changes created

  • 3) Identify the typical symptoms of common stroke syndromes and the associated areas of brain damage

  • 4) Identify assessment tools for use in individuals post-stroke across all settings

  • 5) Identify and choose optimal treatment interventions for individuals post-stroke

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CASE A, PART I

Richard Brown (ht. 6’1”, wt. 245) is a 62-year-old African American, former college football linebacker, who experienced a left ischemic cerebrovascular accident (CVA or stroke) yesterday. He arrived in the Emergency Room per ambulance and was given TPA within 6 hours of symptom onset. He has a history of hypertension and was diagnosed as prediabetic 6 months ago. He takes atenolol for his hypertension, and a diet of lowered carbohydrates and fats has been recommended but inconsistently followed. He presents with moderate hemiparesis of the right arm and leg and expressive aphasia. Comprehension of verbal and written language appears intact, and he is oriented to time, place, and person. Right hemianopia is present. He is married with two grown children, who live in town; he and his wife, Sherryl, live in a two-story house, where they raised their children. She is also a teacher. He has been a history teacher and football coach for the city schools for 30 years.

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PATHOPHYSIOLOGY

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What Is a stroke?

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Stroke, or cerebrovascular accident, is the leading cause of adult disability with an estimated 15 million people around the world experiencing a stroke each year.1 In the United States, it is estimated that more than 7 million people are living with disability post-stroke. A stroke occurs when there is interruption of blood flow within brain blood vessels; this can result from either blockage of the vessel (ischemia) or rupture of the vessel (hemorrhage). Ischemic strokes are about seven times more common than hemorrhagic strokes, accounting for 87% of strokes2; conversely, hemorrhagic strokes typically produce much greater consequences than ischemic strokes and are more likely to result in death.

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FIGURE 10-1

Ischemic stroke pathology. A. Right – Schematic of embolus from heart that enters cerebral circulation and is caught in the atherosclerotic cerebral artery. Left – Stenosis of the carotid artery can result in diminished cerebral blood flow and ischemia within the penetrating arteries of the cerebral hemispheres. B. Illustrates the division of the common carotid into the internal and external carotids. C. A CT image of the carotid arteries as they enter the cranium. (Adapted with permission from Hauser SL (ED) Harrison’s Neurology in Clinical Medicine 3rd Ed, New York, NY: McGraw-Hill; 2013, Fig 27-3, pg. 262.)

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Ischemia can result from either an embolism, which is a clot that forms elsewhere, often in the heart, and then ...

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