Stroke (Hemiplegia/Falij) – Causes, Symptoms & Physiotherapy Treatment in Lahore
What is Stroke (Hemiplegia/Falij)?
A stroke is a medical emergency. It happens when blood flow to part of your brain is lost by blockage or rupture of an artery to the brain. Without blood, your brain cells start to die. This can cause serious symptoms, lasting disability, and even death.
There are three main types of stroke
- transient ischemic attack
- schemic stroke
- hemorrhagic stroke
It’s estimated that 87 percent of strokes are ischemic
Causes of Stroke (Falij)
🔹 High blood pressure (Hypertension) – Major risk factor
🔹 Diabetes & High Cholesterol – Increase risk of blood clots
🔹 Smoking & Alcohol – Damage blood vessels
🔹 Obesity & Sedentary Lifestyle – Lead to poor circulation
🔹 Heart Diseases – Can cause blood clot formation
🔹 Family History – Genetic risk factors
Symptoms of Stroke (Brain Stroke/Hemiplegia)
✅ Sudden weakness or paralysis on one side of the body
✅ Difficulty speaking or understanding speech
✅ Face drooping on one side
✅ Loss of balance and coordination
✅ Severe headache with no known cause
✅ Blurred or lost vision in one or both eyes
TRANSIENT ISCHEMIC ATTACK
A transient ischemic attack (TIA) is a short period of symptoms similar to those of a stroke that’s why it is often called a ministroke. It’s caused by a brief blockage of blood flow to the brain. A TIA usually lasts only a few minutes and doesn’t cause long-term damage. However, a TIA may be a warning. About 1 in 3 people who has a TIA will eventually have a stroke, with about half occurring within a year after the TIA
Symptoms
Transient ischemic attacks usually last a few minutes. Most symptoms disappear within an hour. Rarely, symptoms may last up to 24 hours. The symptoms of a TIA are similar to those found early in a stroke. Symptoms happen suddenly and may include:
- Weakness, numbness or paralysis in the face, arm or leg, typically on one side of the body.
- Slurred speech or trouble understanding others.
- Blindness in one or both eyes or double vision.
Dizziness or loss of balance or coordination
Diagnosis
- Physical exam and tests. Your healthcare professional performs a physical exam and a neurological exam. Tests of your vision, eye movements, speech and language, strength, reflexes, and sensory system are included. healthcare professional may use a stethoscope to listen to the carotid artery in your neck. During this exam, a whooshing sound called a bruit may mean that you have atherosclerosis. Or your healthcare professional may use an ophthalmoscope. This instrument looks for cholesterol fragments or platelet fragments called emboli in the tiny blood vessels of the retina at the back of the eye.
- Carotid ultrasonography
- Computerized tomography (CT) or computerized tomography angiography (CTA) scans
- Magnetic resonance imaging (MRI) or magnetic resonance angiography (MRA
- Electrochardiography
- Arteriography
Differential Dignosis
- Carotid Artery Dissection
- Hemorrhagic Stroke
- Ischemic Stroke
- Meningitis
- Meningococcal Meningitis
- Multiple Sclerosis
- Subarachnoid Hemorrhage
- Syncope
Treatment options
- Medicines: Several medicines may lower the risk of stroke after a TIA. These medicines are given below
- Antiplatelet drugs( Aspirin, Clopidogril)
- Anticoaagulants (heparin, warfarin)
- Surgery: Carotid Endarterectomy
Angioplasty: Carotid angioplasty or stent placement
HEMORRHAGIC STROKE
A hemorrhagic stroke is a life-threatening emergency that happens when a blood vessel in your brain breaks (ruptures) and bleeds. A “hemorrhage” is the medical term for bleeding inside your body.
The bleeding disrupts normal circulation in your brain and prevents it from getting the blood and oxygen it needs to survive and function. The stroke also adds extra pressure inside your brain, which can damage or kill brain cells.
Symptoms
The symptoms of a hemorrhagic stroke can include one or more of the following:
- Thunderclap headaches
- Light sensitivity (photophobia)
- Dizziness or vertigo
- Trouble understanding or speaking (aphasia)
- Slurred or garbled speaking (dysarthria)
- One-sided weakness or paralysis
- Loss of senses, like vision, hearing and touch
- Neck stiffness
- Nausea and vomiting
- Seizures
- Passing out or fainting
- Coma
Warning Signs
Hemorrhagic strokes can cause lots of different symptoms. To recognize the warning signs in yourself or a loved one, remember the acronym BE FAST
Balance: Watch for a sudden loss of balance.
Eyes: Look out for sudden vision loss or changes in one or both eyes.
Face: Smile. Look for a droop on one or both sides of your face.
Arms: Raise both arms. If you’re having a stroke, one arm may not move, sag or be very weak.
Speech: You might slur your speech or have trouble choosing the right words.
Time: Time is critical — call for help immediately.
Diagnosis
- Physical exam and tests.
- Carotid ultrasonography
- Computerized tomography (CT) or computerized tomography angiography (CTA) scans
- Magnetic resonance imaging (MRI) or magnetic resonance angiography (MRA
- Electrochardiography
- Arteriography
Differential diagnosis
- Hypertensive encephalopathy
- Infection
- Headache syndrome
- Metabolic abnormality
- Seizures
- Toxicities
Treatment options
The two main treatments for hemorrhagic strokes are medications and surgery.
- Hemorrhagic stroke medications
There are many medications that providers use to treat hemorrhagic strokes. They work in one of two ways:
Clotting support: vitamin K therapy or prothrombin complex
Blood pressure management: intravenous (IV) blood pressure medication
- Hemorrhagic stroke surgery
Accumulated blood from a stroke puts too much pressure on brain tissue around the bleeding blood vessel. You might need emergency surgery if the stroke increases your intracranial pressure. Your surgeon will remove the extra blood and relieve the pressure buildup on your brain.
- Stroke Rehabilitation: Speech therapy, physical therapy, occupational therapy, cognitive therapy
ISCHEMIC STROKE
An ischemic stroke happens when something blocks blood flow from getting to your brain. It’s a life-threatening medical emergency. Ischemic strokes can cause permanent brain damage and death. If enough brain cells die, you can lose the abilities or body functions those cells control. They’re the most common type of stroke — around 80% of all strokes.
Symptoms
The ischemic stroke symptoms you experience will depend on which area of your brain it affects. Some of the most common symptoms include:
- Weakness or paralysis on one side of your face and body
- Aphasia (trouble speaking or a complete loss of speech)
- Slurred or garbled speaking (dysarthria)
- Loss of muscle control on one side of your face
- Sudden worsening or loss of your senses (including vision, hearing, smell, taste and touch)
- Blurry vision or double vision (diplopia)
- Loss of coordination or clumsiness (ataxia)
- Dizziness or vertigo
- Nausea and vomiting
- Neck stiffness
- Mood swings or sudden personality changes
- Confusion or agitation
- Seizures
- Memory loss (amnesia)
- Headaches (usually sudden and severe)
- Passing out or fainting
- Coma
Warning signs
Ischemic strokes can cause lots of different symptoms. To recognize the warning signs in yourself or a loved one, remember the acronym BE FAST:
Balance. Watch for a sudden loss of balance.
Eyes. Look out for sudden vision loss or changes in one or both eyes.
Face. Smile. Look for a droop on one or both sides of your face.
Arms. Raise both arms. If you’re having a stroke, one arm will sag or drop in a way that it usually doesn’t.
Speech. You might slur your speech or have trouble choosing the right words.
Time. Time is critical — call for help immediately
Diagnosis
- Physical exam and tests.
- Carotid ultrasonography
- Computerized tomography (CT) or computerized tomography angiography (CTA) scans
- Magnetic resonance imaging (MRI) or magnetic resonance angiography (MRA
- Electrochardiography
- Arteriography
Differential Diagnosis
- brain tumor
- hemorrhagic stroke
- subdural hemorrhage
- Neurosyphilis
- complex or atypical migraine
- hypertensive encephalopathy
- Wernicke’s encephalopathy
- CNS abscess
Treatment options
The most important part of treating an ischemic stroke is restoring blood flow to your brain. Spome treatment options include
- Thrombolytic therapy
- Thrombectomy
- Oxygen therapy
- Blood sugar management
- Mild intentional hypothermia
- Speech therapy
- Physical therapy
- Occupational therapy
Best Stroke (Hemiplegia) Physiotherapy Treatment
- Positioning: Ability to change position and posture is affected in many individuals post stroke as a result of varying degrees of physical impairments.Arm Support devices such as a Lap Tray may be used to assist with arm positioning for those at risk of shoulder subluxation. Elevation of the limb when resting should be considered for individuals who are immobile to prevent swelling in the hand and foot.
- Early mobilisation: Commence mobilisation (out of bed activity) within 24 – 48 hrs of stroke onset unless receiving palliative care
- Balance: trunk exercise training improve trunk performance and dynamic sitting balance [5], while task specific training improves dynamic balance in both sitting and standing.
- Gait and mobility: Tailored repetitive practice of walking should be practiced as often as possible for individuals with difficulty walking. The following modalities can be used to achieve this
- Circuit Class Therapy (with a focus on overground walking practice)
- Treadmill Training with or without body weight support
- Virtual Reality Training
- Constraint-induced movement therapy: CIMT involves intensive targeted practice with the affected limb while restraining the non-affected limb, which means that during task-specific practice, individuals with hemiplegic stroke are forced to use their affected limb.
- Electrical Stimulation: Functional Electrical Stimulation appears to moderately improve upper limb activity compared with both no intervention and training alone. Current evidence suggest that electrical stimulation should be used in stroke rehabilitation to improve the ability to perform functional upper limb activities
- Mirror Therapy: Mirror Therapy may be used as an adjunct to routine therapy to improve arm function after stroke for individuals with mild to moderate weakness, complex regional pain syndrome and/or neglect
- Cardiorespiratory Training: here is an increasing range of aerobic exercise options being accessed by people with following Stroke. These range from aerobic exercise programme (e.g. overground walking or treadmill training programme) and an array of sporting and exercise classes to the use of technology (e.g. virtual reality training).
- Contracture Management: For stroke survivors, serial casting may be trialed to reduce severe, persistent contracture when conventional therapy has failed. For stroke survivors at risk of developing contracture or who have developed contracture, active motor training to elicit muscle activity should be provided.