Clinical manifestation : Stroke

Clinical manifestation

  • Related to location of stroke
    • Neural tissue destruction is basis for neurologic dysfunction
    • Affects many body functions
      • Related to artery involved and area/half of brain it supplies
      • Time of the onset of symptoms /length of period of ischemia is important
  • Manifestation of right-brain and left brain stroke

Right-brain damage (stroke on right side of the brain)

Left-brain damage (stroke on left side of the brain)

  • Paralyzed left side: hemiplegia
  • Paralyzed right side: hemiplegia
  • Left-sided neglect
  • Impaired speech/language aphasias
  • Spatial-perceptual deficits
  • Impaired right/left discrimination
  • Tends to deny or minimize problems
  • Slow performance, cautious
  • Rapid performance, short attention span
  • Aware of deficits: depression, anxiety
  • Impulsive, safety problems
  • Impaired comprehension related to language, math
  • Impaired judgment
  • Impaired time concepts
  • Motor function
    • Most obvious effect of stroke
    • Include impairment of
      • Mobility
      • Respiratory function
      • Swallowing and speech
      • Gag reflex
      • Self-care abilities
    • An initial period of flaccidity
      • May last from days to several weeks
      • Related to nerve damage
    • Spasticity of muscles follows flaccid stage
      • Related to interruptions of upper motor neuron influence
  • Communication
    • Aphasia occurs when stroke damages dominant hemisphere of brain and affects language
      • Receptive –  loss of comprehension
      • Expressive – loss of production of language
      • Global – total inability to communicate
    • Dysphasia refers to impaired ability to communicate
      • Before initiation of feeding, assess the gag reflex by gently stimulating the back of the throat with a tongue blade.
      • If a gag reflex is present, the patient will gag spontaneously. If it is absent, defer the feeding and begin exercises to stimulate swallowing.
      • To assess swallowing ability, elevate the head of the bed to an upright position (unless contraindicated) and give the patient a small amount of crushed ice or ice water to swallow.
    • Used interchangeably with aphasia
      • Nonfluent
        • Minimal speech activity with slow speech
      • Fluent
        • Speech is present but contains little meaningful communication