Question

9. Describe a possible clinical presentation of a patient with a CVA involving the right middle cerebral artery. What medical/diagnostic testing would be part of the initial evaluation? How would medical management differ between an occlusive vs. hemorrhagic stroke? Describe occupational management for the post stroke patient in detail.

Answer 1

Answer:-

Common impairments seen with middle cerebral artery (MCA) stroke include

1. hemiparesis,
2. ataxia,
3. perceptual deficits,
4. cognitive deficits,
5. speech deficits,
6. visual disorders.

Diagnostic evaluation will be:-

1.Physical Examination:

Auscultate heart sounds and monitor blood pressure. Neurological examination to see how a potential stroke is affecting the nervous system.
2.Blood Test

Including tests to check how fast blood clots, blood sugar is too high or low, and whether have an infection.

3.Computerized tomography(CT)

A CT scan uses a series of X-rays to create a detailed image of brain. A CT scan can show bleeding in the brain, an ischemic stroke, a tumor or other conditions.
4.Magnetic resonance imaging (MRI)

An MRI uses powerful radio waves and magnets to create a detailed view of brain. An MRI can detect brain tissue damaged by an ischemic stroke and brain hemorrhages.
5.Carotid ultrasound

In this test, sound waves create detailed images of the inside of the carotid arteries in neck. This test shows buildup of fatty deposits (plaques) and blood flow in your carotid arteries.
6.Cerebral Angiogram

In this uncommonly used test, doctor inserts a thin, flexible tube (catheter) through a small incision, usually in your groin, and guides it through major arteries and into carotid or vertebral artery. Then your doctor injects a dye into your blood vessels to make them visible under X-ray imaging. This procedure gives a detailed view of arteries in brain and neck.
7.Echocardiogram (ECG)

An echocardiogram uses sound waves to create detailed images of heart.

​​​​​​This is how medical management of occlusive stroke is different from hemorrhagic stroke :-

​​​​​​Occlusive stroke or Ischemic strokes occur when blood flow to the brain is blocked by a blood clot.

There are two major types of ischemic stroke:

• Thrombotic strokes are caused when a blood clot forms in an artery leading to the brain.

• Embolic strokes begin with a clot forming elsewhere in the body —such as the heart or neck — that breaks loose and travels to the brain.

treatment of occlusive stroke is:-

Many ischemic stroke patients receive tPA (tissue plasminogen activator) as treatment. This medication, administered via an IV in the arm, helps dissolve the clot.

Larger clots may require a minimally invasive procedure known as a thrombectomy. A stent retriever is inserted through an artery, in the groin, and routed up to the brain,and remove the clot.

• A hemorrhagic stroke occurs when a weak blood vessel bursts and bleeds into the brain.

Patients may experience one of the following types:

• Intracerebral hemorrhage, a weak blood vessel breaking inside the brain

• A subarachnoid hemorrhage, a weak blood vessel breaking on the surface of the brain

treatments are:-

A surgical clip may be placed at the base of the brain aneurysm to remove blood flow and stop the bleeding. This is known as clipping.

A craniotomy, which involves removing a portion of the skull to access the brain is necessary for this procedure.

Ocupational management for post stroke patient:-

After stroke, occupational therapists work

To facilitate and improve motor control.

To maximize the person's ability to undertake his or her own personal self-care tasks and domestic tasks;

To help the patient learn strategies to manage the cognitive, perceptual, and behavioral changes associated with stroke;

To prepare the home and work environment for the patient's return.

Activities of Daily Living (ADL)

The initial process of occupational therapy assessment involves interviews with the patient and the carer to establish previously held life roles and the tasks and activities that were completed within these roles. Observational assessment is undertaken of personal self-care tasks, including showering, dressing, toileting, grooming, and eating, and domestic tasks, shopping, cleaning, and management of finances and medications.

Occupational therapy intervention improves participation in meaningful roles, tasks, and activitivites.

Treatment, including individually selected and graded tasks and activities, involves retraining motor, sensory, visual, perceptual, and cognitive skills within the context of functional activities; minimizing secondary complications; and providing education and support to the patient and caregivers.