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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


Richard Brown (ht. 6′1″, wt. 245 lbs.) 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 4 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 non-fluent (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, Sheryl, live in a two-story house, where they raised their children. She is a teacher. He has also been a history teacher and football coach for the city schools for 30 years.


What Is a Stroke?

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. In the United States, nearly 800,000 people experience a stroke each year; of these, approximately ¼ are recurrent strokes, meaning the individual has had one or more prior strokes. 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 strokes; conversely, hemorrhagic strokes typically produce much greater impairment than ischemic strokes and are more likely to result in death.1 Notably, the incidence of stroke and death from stroke have decreased over the last several decades due to improved management of risk factors and improved emergency care. However, since the risk of stroke increases with age and we have an aging population, stroke incidence is expected to increase over the next decade.1

Ischemia can result from either an embolism, which is a clot that forms elsewhere, often in the heart, and then travels to the brain and lodges in one of the cerebral vessels, or a thrombus, which is a blockage of an artery that develops from a buildup of plaques, typically made up of fatty ...

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