Cerebrovascular accident

• Cerebral vascular accident
• Stroke

• 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

• 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

• 5D: Impaired Motor Function and Sensory Integrity Associated With Nonprogressive Disorders of the Central Nervous System - Acquired in Adolescence or Adulthood

Description

• 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

Essentials of Diagnosis

• 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

General Considerations2

• 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

Demographics

• 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%)

Signs and Symptoms

• 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...