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  • Cerebral vascular accident
  • Stroke

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  • 430 Subarachnoid hemorrhage
  • 431 Intracerebral hemorrhage
  • 432 Other and unspecified intracranial hemorrhage
  • 433 Occlusion and stenosis of precerebral arteries
  • 434 Occlusion of cerebral arteries
  • 434.0 Cerebral thrombosis
  • 434.00 Cerebral thrombosis without cerebral infarction
  • 434.01 Cerebral thrombosis with cerebral infarction
  • 434.1 Cerebral embolism
  • 434.10 Cerebral embolism without cerebral infarction
  • 434.11 Cerebral embolism with cerebral infarction
  • 434.9 Cerebral artery occlusion unspecified
  • 434.90 Cerebral artery occlusion unspecified without cerebral infarction
  • 434.91 Cerebral artery occlusion unspecified with cerebral infarction
  • 435 Transient cerebral ischemia
  • 436 Acute but ill-defined cerebrovascular disease
  • 437 Other and ill-defined cerebrovascular disease
  • 438 Late effects of cerebrovascular disease

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  • I63.30 Cerebral infarction due to thrombosis of unspecified cerebral artery
  • I63.40 Cerebral infarction due to embolism of unspecified cerebral artery
  • I63.50 Cerebral infarction due to unspecified occlusion or stenosis of unspecified cerebral artery
  • I66.09 Occlusion and stenosis of unspecified middle cerebral artery
  • I66.19 Occlusion and stenosis of unspecified anterior cerebral artery
  • I66.29 Occlusion and stenosis of unspecified posterior cerebral artery
  • I66.9 Occlusion and stenosis of unspecified cerebral artery

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Description

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  • Results in sudden, specific neurological deficit based on location and extent of ischemia or hemorrhage
  • May occur over seconds, minutes, hours, or few days
  • Symptoms include sensory dysfunction, aphasia, dysarthria, dysphagia, visual field defects, cognitive impairment, and most commonly hemiplegia

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Essentials of Diagnosis

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  • Brain damage may result in the following changes or dysfunction
    • Motor loss
    • Sensory loss
    • Visual impairment
    • Autonomic dysfunction
    • Perceptual changes
    • Cognitive, personality, behavioral changes
    • Changes in consciousness
    • Communication difficulties
    • Eating, swallowing, bowel and bladder changes

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General Considerations2

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  • Two major classification groups
    • Ischemic (2 types)
      • Thrombotic: atherosclerotic plaques and hypertension (HTN) produce cerebrovascular accident (CVA) due to plaques that form at the branching and curves of arteries
      • Embolic: an embolus that causes CVA can travel from the heart, internal carotid artery thrombosis, or atheromatous plaque of the carotid sinus; branches of middle cerebral artery (MCA) most commonly affected
    • Hemorrhagic: hypertension (HTN), ruptured saccular aneurysm, or arteriovenous malformation (AVM) can cause a bleed in the brain

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Demographics

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  • Largest single cause of neurological disability
  • Approximately 4 million Americans suffer physical impairments and disability from stroke
  • Two-thirds of all strokes occur in individuals aged 65 years or older
    • Risk of stroke doubles every 10 years after age 55
  • Greater incidence in men than women; twice as likely in African Americans vs. Caucasians
  • Cerebral infarction (thrombosis or embolism) is most common form (70% of all strokes), followed by hemorrhages (20%) and unspecified cause (10%)

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Signs and Symptoms

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  • Dependent on part(s) of the brain affected by CVA and amount of tissue damage from obstruction or hemorrhage2
  • Common sequelae treated by PT include...

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