Prime Centric Therapy Clinic: Special Topic Report March 23, 2023 I. Cerebrovascular Accident (CVA) II. References

Prime Centric Therapy Clinic
Door 2, ESL Building, 1st Floor, Ma-a Road, Davao City
0915 854 8508 | 0949 831 6888 / primecentrictherapy@gmail.com
Department of Occupational Therapy
SPECIAL TOPIC REPORT

March 23, 2023
I. Cerebrovascular Accident (CVA)

II. REFERENCES
▪ Atchison, B., & Dirette, D. (2016). Conditions in Occupational
Therapy: Effect on Occupational Performance. Lippincott Williams
& Wilkins.
▪ O’Sullivan, S. B., Schmitz, T. J., & Fulk, G. (2019). Physical
Rehabilitation (7th ed.). F.A. Davis.
▪ Pendleton, H. M., & Schultz-Krohn, W. (2013). Pedretti’s
Occupational Therapy - E-Book: Practice Skills for Physical
Dysfunction. Elsevier Health Sciences.
▪ Pendleton, H. M., & Schultz-Krohn, W. (2018). Pedretti’s
Occupational Therapy: Practice Skills for Physical Dysfunction.
Mosby.
▪ Radomski, M. V., & Latham, C. a. T. (2008). Occupational Therapy
for Physical Dysfunction. Lippincott Williams & Wilkins.
III. OUTLINE OF THE TOPIC
● Definition of stroke
● Etiology and epidemiology
● Risk factors
○ Nonmodifiable
■ Age
■ Gender
■ Race
■ History of previous stroke
○ Modifiable
■ Hypertension
■ Heart disease
■ Diabetes mellitus
■ Smoking
■ Sedentary Lifestyle
■ Hyperlipidemia
■ Obesity
○ Early warning signs of stroke
● Classification and effects of stroke
○ Management category
■ Transient Ischemic Attack
■ Deteriorating Stroke
■ Stroke in the young
○ Etiological classification
■ Ischemic stroke
● Thrombotic
● Embolic
● Lacunar
○ Pure Motor Lacunar Stroke
○ Pure Sensory Lacunar Stroke
○ Sensory-Motor Stroke
○ Dysarthria-Clumsy hand syndrome
○ Ataxic hemiparesis
○ Involuntary movements
■ Hemorrhagic stroke
● Intracerebral hemorrhage
● Subarachnoid hemorrhage
○ Saccular aneurysm
○ Arteriovenous malformation
○ Specific vascular territory (vascular syndromes)
■ Anterior Cerebral Artery Syndrome
■ Middle Cerebral Artery Syndrome
● Right MCA Syndrome
● Left MCA Syndrome
■ Internal Carotid Artery Syndrome
■ Posterior Cerebral Artery Syndrome
■ Vertebrobasilar Artery Syndrome

● Brainstem Stroke syndrome
○ Weber syndrome
○ Benedikt syndrome
○ Locked-in syndrome
○ Millard-Gubler syndrome
○ Wallenberg syndrome
● Associated neurological and Functional complications and
conditions
○ Altered consciousness
○ Cognitive dysfunction
○ Spasticity
○ Dysphagia
○ Aphasia
○ Apraxia
○ Gaze impairments
○ Pontine gaze pattern
● Medical management
● Intervention Principles for stroke
IV. DISCUSSION OF THE TOPIC
Cerebrovascular accident (CVA), also known as stroke or

brain attack, is the sudden loss of neurological function caused
by an interruption of blood flow to the brain and is usually
persisting for longer than 24 hours. The consequence is an
inadequate supply of oxygen and nutrients to this vital organ.
Even a brief disruption of this blood flow can lead to brain
damage. To detect the early signs of stroke, it is best to
remember the mnemonic “F.A.S.T.”
● Face drooping:
● Arm weakness
● Speech difficulty
● Time to call 9-1-1

Other signs to consider include sudden numbness or
weakness of the face, arm, or leg; especially on one side of the
body; sudden confusion, trouble speaking, or understanding;
sudden trouble seeing in one or both eyes; sudden trouble
walking, dizziness, and loss of balance or coordination; and
sudden severe headache with no known cause.
According to O’Sullivan et al. (2019), stroke is the fifth

leading cause of death and the leading cause of severe
long-term disability among adults in the United States. Stroke is
also the most common diagnostic category among patients by
occupational therapists (Rijken & Dekker,1998 in Radomski &
Latham, 2008). Furthermore, research suggests that risk factors
are associated with 90% of the risk of CVA including
nonmodifiable and modifiable risk factors.
Nonmodifiable risk factors

● Age—Risk for CVA increases with age (> 60), especially after
age 65.
● Gender—Women have a lower age-adjusted stroke
prevalence than men. However, this prevalence is reversed
in older ages; women over 85 years of age have an
elevated prevalence compared to men
● Ethnicity—Although all minority groups are at risk, CVA
death rates for African Americans are more than twice the
risk of stroke compared with other ethnicity groups.
● History of previous strokeApproximately one-quarter of the
795,000 CVAs that occur each year are secondary incidents
Modifiable risk factors

● Hypertension—Called the “silent disease,” hypertension has
long been acknowledged as the most significant
controllable risk factor for both CVA and heart attack.

Patients with a blood pressure of 160/95 mmHg are 4x-6x
prone to stroke
● Heart disease—Independent of hypertension, people with
heart disease have more than twice the risk of CVA than do
people with normally functioning hearts
● Diabetes mellitus—This disease is characterized by an
increase in blood pressure and is more common in CVA
patients than in a normal population of similar age. DM also
promotes atherosclerosis.
● Smoking—Smoking doubles the risk of CVA and is attributed
to HPN
● Hyperlipidemia—Hyperlipidemia, including elevated
triglycerides and LDL cholesterol, has long been suspected
to be a risk factor for CVA.
● Obesity—Being overweight is a known risk factor for
hypertension and diabetes mellitus and also is associated
with CVA. A weight that is centered in the abdomen
(so-called apple shape) has a particularly high association
with CVA as well as heart disease, while individuals whose
weight is distributed around the hips are less at risk.
● Sedentary Lifestyle—A sedentary lifestyle s associated with
rising levels of obesity and has been implicated in the
occurrence of CVAs, as well as hypertension. This includes
physical inactivity, diet, and emotional stress
The site and extent of the affected area, or infarct,

commonly determine the loss of function. Stroke results in upper
motor neuron dysfunction that produces hemiplegia, or paralysis
of one side of the body, including the limbs and trunk and
sometimes the face and oral structures that are contralateral to
the hemisphere of the brain with the lesion. Further classifications
of CVA are (1) management category, (2) etiological
classification, (3) specific vascular territory (vascular

syndromes), (4) vertebrobasilar artery syndrome, and (5)
brainstem stroke syndrome.
Types according to Etiological Classification

CVA, according to its etiological classification, are divided
into two main types: ischemic and hemorrhagic.
Ischemic stroke
Ischemia refers to insufficient blood flow to meet metabolic
demand. Ischemic strokes may be the result of an embolism,
thrombosis, and hypoperfusion to the brain from cardiac or
arterial sources. It is the most common type and comprises 80%
of stroke cases.
Types of ischemic stroke:
● Thrombotic - Also known as large vessel thrombosis,
is the most common type of ischemic stroke
acquiring 40% of stroke cases. Cerebral thrombosis
occurs when a blood clot forms in one of the arteries
supplying the brain, causing vascular obstruction at
the point of its formation. A major contributing factor
is atherosclerosis (a gradual degenerative disease of
the blood vessel walls).
● Embolic - Embolism occurs when a clot that has
formed elsewhere (thrombus) breaks off (embolus),
travels up the bloodstream until it reaches an artery
too small to pass through, and blocks the artery.
Embolic stroke is the 2nd most common type of
ischemic stroke that comprises about 20-25% of
stroke cases. The onset is abrupt or sudden.
● Lacunar - Also known as small vessel thrombosis,
acquires 20% of stroke cases and is secondary to
hypertension. Lacunar strokes are small infarcts,
usually lying in the deep brain structures, such as the

basal ganglia, cerebellum, pons, internal capsule, and
thalamus. It increases blood pressure which results in
leakage in the blood due to the rupture of small
vessels. The affected sites in lacunar stroke are:
● Basal Ganglia
● Cerebellum
● Pons
● Internal Capsule
● Thalamus
There are different types of Lacunar Stroke:

● Pure Motor Lacunar Stroke - the most common type of
lacunar stroke characterized by weakness or ataxia, and
C/L hemiplegia. The lesion is on the posterior limb of the
internal capsule.
● Pure Sensory Lacunar Stroke - sensory relay station is
affected. Occlusion is seen at the PCA with the thalamus as
its lesion site. C/L hemianesthesia may be observed as well
as the tingling sensation in the face and limbs
● Sensory Motor Stroke - 2nd most common type of lacunar
stroke. The lesion site is on the junction between the
thalamus and internal capsule.
● Dysarthria-Clumsy hand syndrome is the least common
type of lacunar stroke that has a lesion on the anterior limb
of the internal capsule.
● Ataxic hemiparesis - Affects Pons, Internal Capsule, Corona
Radiate, and Cerebellum. Lesion at the cerebellum can
cause I/L ataxia and C/L hemiplegia
● Involuntary movements - this includes Parkinson’s Disease
of any movement disorder. The lesion in the following sites
may have different effects.
Lesion site Impairments
Neostriatum Chorea: rapid, jerky, irregular movements
Putamen Dystonia: persistent, sustained

contraction of agonist and antagonist
muscles
Globus Pallidus Athetosis: slow writhing worm-like

movements
Subthalamus Hemiballismuss: sudden violent

movements, wild flailing, flinging
movements
Hemorrhagic stroke
Hemorrhagic strokes result from a rupture of a cerebral
blood vessel. In such strokes, blood is released outside of the
vascular space, cutting off pathways and leading to pressure
injuries to brain tissue. Hemorrhages, which are either
intracerebral (bleeding into the brain itself) or subarachnoid
(bleeding into an area surrounding the brain), may be caused by
hypertension, arteriovenous malformation, or aneurysm.
Hemorrhagic strokes are less common (an estimated 20% of
strokes), but they result in a higher mortality rate than ischemic
strokes.
● Intracerebral hemorrhage - results in bleeding
directly into the brain and accounts for a high
percentage of deaths because of CVA. It may occur
in any part of the brain and is most commonly linked
to hypertension. Other causes include blood vessel
abnormalities, such as arteriovenous malformations
or aneurysms, or trauma.
● Subarachnoid hemorrhage - account for about 3% of

all CVAs and are slightly more common in women.
About 95% are caused by the leakage of blood from
aneurysms. It also may be caused by bleeding from
an arteriovenous malformation, which is an abnormal
collection of vessels near the surface of the brain.
○ Saccular aneurysm - Also known as Berry
Aneurysm, and has a very common chief
complaint about “worst headache of my life”.
○ Arteriovenous malformation: a congenital
defect that can result in a stroke. Blood vessels
usually form incorrectly with tangled webs of
arteries and veins.
Types according to Management Category

Transient ischemic attack (TIA) refers to the temporary
interruption of blood supply to the brain. Symptoms of focal
neurological deficit may last for only a few minutes or for several hours
but by definition do not last longer than 24 hours. After the attack, there
may be evidence of residual brain damage or permanent neurological
dysfunction. The risk for recurrent stroke is 3.5%, 8%, and 9.2% at 2, 30,
and 90 days post-TIA respectively.
Deteriorating stroke (stroke in evolution) refers to a patient whose
neurological status deteriorates after admission to the hospital. This
change in status may be due to cerebral or systemic causes (e.g.,
cerebral edema, progressing thrombosis).
The category of young stroke describes a stroke affecting persons
younger than age 45. Causes of stroke in children include perinatal
arterial ischemic stroke, sickle cell disease, congenital HD,
thrombophlebitis, and trauma.
Types according to Specific vascular territory (vascular syndromes)

Anterior Cerebral Artery Syndrome

The ACA supplies the medial aspect of the cerebral hemisphere
(frontal and parietal lobes). The most common characteristics of ACA
syndrome include contralateral hemiparesis and sensory loss with
greater involvement of the lower extremity (LE) than the upper extremity
(UE) because the somatotopic organization of the medial aspect of the
cortex includes the functional area for the LE. Frontal gaze pattern,
abulia (akinetic mutism), and urinary incontinence are also present.
Middle Cerebral Artery Syndrome

Middle cerebral artery is the largest branch of ICA and the most
commonly stroked artery. The most common characteristics of MCA
syndrome are contralateral spastic hemiparesis and sensory loss of the
face, UE, and LE, with the face and UE more involved than the LE.
The affected hemispheres of MCA stroke syndrome also

determine the signs and symptoms present. The table below
summarizes the following.
Right Hemisphere Left Hemisphere
Visual-perceptual impairment Speech & Language impairment

• Agnosia • Aphasia
• Neglect syndrome • Difficulty processing verbal cues
• Difficulty in processing visual and commands
cues
Behavioral Deficits Behavioral Deficits

• Poor judgment & insight • Sad & cautious
• Anosognosia • Aware of impairment
• Quick and Impulsive • Disorganized
• Unaware of impairment
Emotional Deficits Emotional Deficits

• Difficulty in expressing negative • Difficulty in expressing positive

emotions -> happy emotions -> depression
Task Performance Task Performance

• dRessing apraxia Apraxia (parietal lobe)
• ConstRuctional apraxia • Ideomotor apraxia
• Ideational apraxia
Internal Carotid Artery Syndrome

The ICA supplies both the MCA and the ACA. Occlusion of the
internal carotid artery (ICA) typically produces massive infarction in the
region of the brain supplied by the MCA. Distinct features are amaurosis
fugax caused by a lesion in the ophthalmic artery. MCA features (UE &
face > LE) can also be observed.
Posterior Cerebral Artery Syndrome

The two posterior cerebral arteries (PCAs) arise as terminal
branches of the basilar artery, and each supplies the corresponding
occipital lobe and medial and inferior temporal lobe. The following
deficits are observed:
● Visual problems
○ C/L homonymous hemianopsia (occipital infarction)
○ Visual agnosia
○ Prosopagnosia
○ Dyschromatopsia (color agnosia)
○ Simultanagnosia (aka: Balint’s syndrome)
○ Alexia without agraphia
● Memory impairment
○ Short-term memory
○ Long- term memory
○ Immediate recall
○ Amnesia (Temporal lobe ischemia )
● C/L hemiballismus (subthalamus involvement)

● Thalamic pain syndrome: also known as central post-stroke pain
syndrome or Dejerine-Roussy Syndrome.
● Midbrain involvement
○ C/L hemiplegia (CST involvement ->motor)
○ CN 3 palsy
■ Weber syndrome
■ Benedikt syndrome
Vertebrobasilar Artery Syndrome

The vertebrobasilar system of arteries supplies blood primarily to
the posterior portions of the brain, including the brainstem, cerebellum,
thalamus, and parts of the occipital and temporal lobes.
Occlusions of the vertebrobasilar system can produce a wide

variety of symptoms with both ipsilateral and contralateral signs
because some of the tracts in the brainstem will have crossed and
others will not. The table below presents the brainstem stroke
syndrome.
Lesion site Structural Injury
Weber medial basal • CN 3 – I/L CN 3 palsy

Syndrome midbrain • Corticospinal tract (motor): C/L
hemiplegia
.Benedikt tegmentum • CN 3 – I/L CN3 palsy

Syndrome of midbrain • Spinothalamic tract (STT) – C/L
loss of pain and temperature
• Medial lemnisci (aka: dorsal
column pathway)
- C/L loss of joint position (prop)
- 2-point discrimination
- Vibration
• Red nucleus – C/L chorea
• Spinocerebellar peduncle – C/L
ataxia
Locked-in bilateral • Corticospinal tract (motor) –

syndrome basal pons bilateral hemiplegia = quadriplegia
• Corticobulbar tract
- CN 5, 6, 7 ,8 – bilateral CN
palsy
• Spared: upward gaze
Millard-Gubler Lateral Pons • CN 6, 7 – I/L palsy

Syndrome • CST – C/L hemiplegia
(MGS)
Wallenburg lateral • CN 5 – I/L loss of pain and

Syndrome medulla temperature of the face
• Spinothalamic tract – C/L loss of
pain and temperature (body)
• Spinocerebellar tract – I/L ataxia
• Vestibular nuclei – nystagmus
• Sympathetic tract – I/L Horner
syndrome
•Nucleus ambiguous – CN 9/10
•Dysphagia
•Dysphonia
Associated Neurological and Functional Complications and

Conditions
Altered consciousness
Altered level of consciousness (coma, decreased arousal levels) may
occur with extensive brain damage (e.g., large proximal MCA
occlusion). The therapist may document levels of consciousness using
standard descriptive terms: normal, lethargy, obtundation, stupor, and
coma.
Cognitive deficits
Cognitive dysfunctions may include impairments in alertness attention,
orientation, memory, and executive functions. Difficulty with alertness
results from lesions in the prefrontal cortex and reticular formation with
the person appearing lethargic. Attention disorders include
impairments in sustained attention, selective attention, divided
attention, or alternating attention. Immediate and short-term memory
impairments are also common, occurring in about 36% of patients with
stroke, whereas long-term memory typically remains intact. Patients
with lesions of the prefrontal cortex typically demonstrate impairments
in executive function including some or all of the following:
impulsiveness, inflexible thinking, lack of abstract thinking, impaired
organization and sequencing, decreased insight, impaired planning
ability, and impaired judgment.
Spasticity
Spasticity can be defined as an involuntary increase in muscle tone,
with a velocity-dependent resistance, and comprises 90% of stroke
cases. To assess spasticity, Modified Ashworth scale (MAS) is used.
Dysphagia
The most common problems seen in patients with dysphagia include
delayed triggering of the swallowing reflex, reduced pharyngeal
peristalsis, and reduced lingual control. Altered mental status, altered

sensation, poor jaw and lip closure, impaired head control, and poor
sitting posture also contribute to the patient’s swallowing difficulties.
Aphasia
Aphasia is an acquired communication disorder caused by brain
damage that is characterized by impairment of language modalities
(i.e., speaking, listening, reading, and writing). The most common types
of aphasia include:
● Anomic: Anomia, or word-finding difficulty, occurs in all types of
aphasia. However, clients in whom word-finding difficulty is the
primary or only symptom may be said to have anomic aphasia
● Wernickes: Wernicke’s aphasia is characterized by impaired
auditory comprehension and feedback, along with fluent,
well-articulated paraphasic speech.
● Broca’s: Poor speech production and agrammatism characterize
Broca’s aphasia.
● Global: Global aphasia is usually the result of involvement of the
MCA of the dominant cerebral hemisphere. A client with global
aphasia may be sensitive to gestures, vocal inflections, and facial
expression.
Summary of the different types of aphasia

Apraxia
Ideomotor apraxia is the inability to carry out the motor command but
can perform spontaneous activities. The lesion site is area 40 or the
supramarginal gyrus of the parietal lobe. Ideational apraxia, on the
other hand, is the inability to carry out facial commands and
spontaneous activities. The lesion site is the left or dominant parietal
lobe.
Other types of apraxia include oral apraxia ( inability to carry out facial
commands), dressing apraxia (inability to dress oneself), constructional
apraxia (difficulty producing 2D/3D designs), gait apraxia (inability to
initiate walking), and limb-kinetic apraxia (inability to make precise or
exact movements with a finger, an arm or a leg)
Gaze Impairments
Gaze impairments are also common in stroke. Two impairments of gaze
patterns have been identified.
1. Frontal gaze pattern: This pattern is due to anterior circulation
stroke. Patients with this gaze may look towards the lesion site
and away from the hemiplegic side. The lesion site is area 8 or the
frontal eye field of the frontal lobe.
2. Pontine gaze pattern is observed in patients with posterior
circulation stroke. They may look away from the lesion, towards
the hemiplegic side •lesion site: pontine nuclei
Medical Management
Medical management depends on the type and location of the
vascular lesion, as well as the severity of the clinical deficits. In acute
ischemic stroke, treatment concerns include restoration of blood flow
and limitation of neuronal damage. Anti-platelet and anti-coagulation
drugs, such as aspirin and heparin, are frequently used to improve flow
through occluded vessels and prevent further clotting or thrombosis.
Newer pharmacological treatments include thrombolytic drugs, such as

tissue plasminogen activator (t-PA), that can open occluded cerebral
vessels and immediately restore circulation. Their use is limited,
however, by the associated increased risk of hemorrhage and the fact
that they must be administered within 3–6 hours after stroke onset.
As the effectiveness of various medical treatments has not been

established, only a small percentage of patients with ischemic stroke
are treated with thrombolytic drugs. With a hemorrhagic stroke, acute
treatment includes control of intracranial pressure, prevention of
rebleeding, maintenance of cerebral perfusion, and control of
vasospasm.
Intervention Principles for Stroke

The degree and time course of recovery from stroke vary with the
nature and severity of the initial injury. Intrinsic recovery refers to the
remediation of neurological impairments, such as the return of
movement to a paralyzed limb. Adaptive recovery entails regaining the
ability to perform meaningful activities, tasks, and roles without full
restoration of neurological function, such as using the unaffected hand
for dressing or walking with a cane or walker.
In Pendleton and Schultz-Krohn (2018), active use of task-oriented

training with stroke survivors will lead to improvements in functional
outcomes and overall health-related quality of life. A series of
intervention principles based on the use of the OT task-oriented
approach include the following:
● Help clients adjust to role and task performance limitations by
exploring new roles and tasks.
● Create an environment that includes the common challenges of
everyday life.
● Practice functional tasks or close simulations that have been

identified as important by participants to find effective and
efficient strategies for performance.
● Provide opportunities for practice outside therapy time (e.g.,
homework assignments).
● Minimize ineffective and inefficient movement patterns
V. UTILIZATION
Stroke survivors are more likely to live with the debilitating
effects of stroke, including both physical and psychological
consequences; thus the barriers to participating in activities that
are meaningful to them. Individuals with stroke, therefore, are
among one of the primary clients of occupational therapy.
Occupational therapists help facilitate the client’s

performance of needed or meaningful occupations within
realistic contexts to promote independence. However, multiple
factors can hinder the effective and efficient performance of
various tasks in which the client with stroke wishes to engage
during OT sessions. Understanding this topic for future
applications is thus necessary for the role of occupational
therapists as one cannot intervene in something that they don’t
know. The topic can also help the therapist focus the evaluation
procedures and begin to reflect on the client factors that may
have been impaired and that affect the client’s occupational
performance based on the brain lesions.
Working collaboratively with the members of the

rehabilitation team (i.e., physician, physical therapists, speech
therapists, and nurses) is also a part of the responsibility of an
occupational therapist to assure continuity of care for better
health outcomes. Hence, it is only necessary for other members to
contribute to decision-making and play an equal role in
implementing plans for the client’s care. This topic provides

healthcare professionals in various practices with the
fundamental knowledge necessary to work with the stroke
population, allowing them to share their unique perspectives
within the team to aid the client in achieving health, well-being,
and more life involvement.
VI. REFLECTION
I was anxious as I prepared for this topic because stroke is one of
the conditions I consider complicated. Many terminologies must be
discussed, including anatomical structures and their physiological
activities, as well as the accompanying conditions that I find
intimidating. For me, it is one of those conditions that has been
discussed numerous times but is still difficult to recall.
Still, I was thrilled to be assigned this topic because I see it as an

opportunity to go over everything that had been previously covered
with us. I am not confident enough to say that I have already
improved in terms of application but I know that using this
fundamental knowledge is essential to understand the symptoms,
diagnosis, and management of stroke.
Prepared by: Noted by:
Krystel Camille G. Escano Jace Devin Lapus, OTRP

OT intern-in-charge OT Clinical Supervisor

Prime Centric Therapy Clinic: Special Topic Report March 23, 2023 I. Cerebrovascular Accident (CVA) II. References

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Prime Centric Therapy Clinic

Door 2, ESL Building, 1st Floor, Ma-a Road, Davao City

0915 854 8508 | 0949 831 6888 / primecentrictherapy@gmail.com

Department of Occupational Therapy

SPECIAL TOPIC REPORT

I. Cerebrovascular Accident (CVA)

0915 854 8508 | 0949 831 6888 / primecentrictherapy@gmail.com

0915 854 8508 | 0949 831 6888 / primecentrictherapy@gmail.com

■ Vertebrobasilar Artery Syndrome

IV. DISCUSSION OF THE TOPIC

Cerebrovascular accident (CVA), also known as stroke or

0915 854 8508 | 0949 831 6888 / primecentrictherapy@gmail.com

● Time to call 9-1-1

According to O’Sullivan et al. (2019), stroke is the fifth

Nonmodifiable risk factors

Modifiable risk factors

0915 854 8508 | 0949 831 6888 / primecentrictherapy@gmail.com

controllable risk factor for both CVA and heart attack.

The site and extent of the affected area, or infarct,

0915 854 8508 | 0949 831 6888 / primecentrictherapy@gmail.com

classification, (3) specific vascular territory (vascular

Types according to Etiological Classification

0915 854 8508 | 0949 831 6888 / primecentrictherapy@gmail.com

usually lying in the deep brain structures, such as the

There are different types of Lacunar Stroke:

0915 854 8508 | 0949 831 6888 / primecentrictherapy@gmail.com

Lesion site Impairments

Neostriatum Chorea: rapid, jerky, irregular movements

Putamen Dystonia: persistent, sustained

Globus Pallidus Athetosis: slow writhing worm-like

Subthalamus Hemiballismuss: sudden violent

0915 854 8508 | 0949 831 6888 / primecentrictherapy@gmail.com

● Subarachnoid hemorrhage - account for about 3% of

Types according to Management Category

Types according to Specific vascular territory (vascular syndromes)

0915 854 8508 | 0949 831 6888 / primecentrictherapy@gmail.com

Anterior Cerebral Artery Syndrome

Middle Cerebral Artery Syndrome

The affected hemispheres of MCA stroke syndrome also

Right Hemisphere Left Hemisphere

Visual-perceptual impairment Speech & Language impairment

Behavioral Deficits Behavioral Deficits

Emotional Deficits Emotional Deficits

0915 854 8508 | 0949 831 6888 / primecentrictherapy@gmail.com

• Difficulty in expressing negative • Difficulty in expressing positive

Task Performance Task Performance

Internal Carotid Artery Syndrome

Posterior Cerebral Artery Syndrome

0915 854 8508 | 0949 831 6888 / primecentrictherapy@gmail.com

● C/L hemiballismus (subthalamus involvement)

Vertebrobasilar Artery Syndrome

Occlusions of the vertebrobasilar system can produce a wide

Lesion site Structural Injury

Weber medial basal • CN 3 – I/L CN 3 palsy

.Benedikt tegmentum • CN 3 – I/L CN3 palsy

0915 854 8508 | 0949 831 6888 / primecentrictherapy@gmail.com

Locked-in bilateral • Corticospinal tract (motor) –

Millard-Gubler Lateral Pons • CN 6, 7 – I/L palsy

Wallenburg lateral • CN 5 – I/L loss of pain and

0915 854 8508 | 0949 831 6888 / primecentrictherapy@gmail.com

Associated Neurological and Functional Complications and

0915 854 8508 | 0949 831 6888 / primecentrictherapy@gmail.com

peristalsis, and reduced lingual control. Altered mental status, altered