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Semi-protected edit request on 9 March 2014[edit]

Under Hemorrhagic

Please remove

"Hemorrhagic strokes result in tissue injury by causing compression of tissue from an expanding hematoma or hematomas. This can distort and injure tissue." In addition, the pressure may lead to a loss of blood supply to affected tissue with resulting infarction, and the blood released by brain hemorrhage appears to have direct toxic effects on brain tissue and vasculature.[27][37] Inflammation contributes to the secondary brain injury after hemorrhage.[37]"

Hemorrhagic strokes are due to cardiovascular disease - due to a weakness in the vessel wall or a chronic remodeling of the vasculature that can lead to small or large aneurysm that can rupture and bleed. They ARE NOT trauma. Which this makes it sound like. You have 2 MAIN types of hemorrhagic strokes: intracerebral and subarachnoid.

Intracerebral strokes are from a rupture of microaneurysms in lenticulostriate vessels. Subarachnoid hemorrhagic strokes are due to rupture of a weakened vessel wall in the circle of willis. The blood can compress the brain causing neurologic deficits, have a direct toxic effect on neural tissue, cause damage via secondary inflammation. Fibrosis/healing of the tissue can also lead to loss of function of the affected area.

Trauma is a separate cause of bleeding. It's pathology is getting smacked in the head.

Necrosis MD (talk) 04:39, 9 March 2014 (UTC)

The text you are commenting on does not mention external trauma at all? But of course the expanding blood causes tissue distortion. Sorry do not see the issue. Doc James (talk · contribs · email) (if I write on your page reply on mine) 06:29, 9 March 2014 (UTC)
I also find it odd, but [1] calls subarachnoid hemorrhages strokes.

This can occur following ischemia (lack of blood flow) caused by blockage (thrombosis, arterial embolism), or a hemorrhage[1] of central nervous system (CNS),[2] or intracranial blood-vessels.[3]

-- CFCF (talk · contribs · email) 08:35, 9 March 2014 (UTC)

(undent) I don't think Necrosis MD has it right. Yes, intracerebral haemorrhage results from vascular pathology but not just from microaneurysms but also from other aneurysms, arteriovenous malformations, amyloid angiopathy, large vessel aneurysms and tumours amongst other pathologies. Most professional guidelines regard subarachnoid haemorrhage as a subtype of stroke, because it leads to sudden neurological symptoms attributable to a vascular cause.

The sources in the introduction need work. I am a little puzzled to find Feigin's paper referenced there. JFW | T@lk 11:05, 9 March 2014 (UTC)

I added that, mostly because I didn't have any other source at the time, and I admit there are better sources for stating that fact. Looking into it and will replace it in the coming week. CFCF (talk · contribs · email) 20:22, 9 March 2014 (UTC)
Not done: please establish a consensus for this alteration before using the {{edit semi-protected}} template. — {{U|Technical 13}} (tec) 15:55, 9 March 2014 (UTC)
Hi JFW - I'm new here and haven't read all of the introductions just yet. Will get to them ASAP. My argument is more to disambiguate that particular paragraph. It really only mentions trauma as a cause of bleeding in the brain which is more of a cerebral vacular injury vs a CVA. Don't CVAs particulary reference vascular pathology more than vascular accidents? Yes, I would say traumas resulting in epidural hematomas and subdural hematomas can cause bleeding in the brain etc, but should be thought of more as an injury instead of a chronic process resulting in a CVA. — Preceding unsigned comment added by Necrosis MD (talkcontribs) 19:31, 9 March 2014‎
Hi Necrosis MD. I think you might have misunderstood the first sentence of the section. It doesn't make any pronouncement about the causes of haemorrhagic strokes, but moves straight on the to the sequelae - direct tissue injury, perfusion deficit, and inflammation. The underlying causes are addressed in an earlier subsection of the "Causes" section; this is where the various forms of underlying pathology are listed and the distinction from SAH is also discussed. I have added a short sentence about underlying causes in the subsection of "pathophysiology" also, but it still uncited. JFW | T@lk 19:01, 9 March 2014 (UTC)

Semi-protected edit request on 21 March 2014[edit]

"Cerebrovascular *diease* was the second leading cause of death worldwide in 2004.[5]" (talk) 07:30, 21 March 2014 (UTC)

Done CFCF (talk · contribs · email) 07:41, 21 March 2014 (UTC)
Already done .. by CFCF. Sam Sailor Sing 08:32, 21 March 2014 (UTC)

Newer Treatments in Stroke Rehabilitation through Occupational Therapy[edit]

Since Occupational Therapy is a field that is ever evolving and treatments are unique to each individual it should be noted that new techniques and forms of treatment are constantly being introduced and tested. One of these is electrographic biofeedback or EMG. In this treatment electrodes are placed over the muscle group of the affected area, the patient is then told to relax and contract the muscle. They are then shown visual and or auditory feedback (OT: Evidence Based Interventions for Stroke pg 146). This can even be in the form of a game. It is a form of operant conditioning and has proved positive results.

There have also been some studies done on the use of robotics to aide in the rehabilitation of the post-stroke treatment. This allows therapists to focus very clearly on one particular muscle group while adjusting the intensity quite accurately to the patient. However robotics can be quite expensive and not every facility will have the means to provide a service like this.

Lastly one of the newer trends is the use of virtual reality. This is somewhat similar to EMG where it provides a visual stimulus for the patient. This stimulus can be anything from watching the actual movement of a wrist or the swinging of a golf club or baseball bat. Of course this depends on the level of impairment and where they are in their recovery.

Gillen, G., & Burkhardt, A. (2004). Stroke rehabilitation: A function-based approach. St. Louis MO: Mosby. A functional guide to the rehabilitation of patients who have suffered cerebrovascular accidents (stroke).

Krug, Giulianne, MA OTR/L, and Guy McCommack, PhD, OTR/L. Occupational Therapy: Evidence Based Interventions for Stroke. 2009. MS. University of Missouri, Mar. 2009. Web. 3 Apr. 2014. A reference to current treatments in Occupational Therapy for stroke. Intended for practicing physicians and health care providers.

Teasell, Robert W., MD, and Lalit Kalra, MD. "What's New in Stroke Rehabilitation." What's New in Stroke Rehabilitation. N.p., 3 Dec. 2003. Web. 03 Apr. 2014.Somewhat outdated but trends in rehabilitation of stroke. — Preceding unsigned comment added by Cmpowers23 (talkcontribs) 19:35, 6 April 2014 (UTC)

Are you proposing to add this to the article? JFW | T@lk 21:23, 7 April 2014 (UTC)

Circulatory Shock vs Hypoperfusion[edit]

Jfdwolff - This is an interesting point and I am not sure that the two are equal. There are cases reported of watershed infarcts in patients with chronic heart failure who take too much antihypertensive medication. Would this be considered circulatory shock? Or is it rather the dysfunction of cerebral autoregulation coupled with hypotension. Perhaps the wording should be changed from "systemic hypoperfusion" to "cerebral hypoperfusion"? I do not feel strongly on this one way or another but I think it is worth mulling over. See "Mechanisms" in this article for more: "Elisa Cuadrado-Godia, Angel Ois, Jaume Roquer. Heart Failure in Acute Ischemic Stroke. Curr Cardiol Rev. 2010 August; 6(3): 202–213. PMCID: PMC2994112" Acallen88 (talk) 16:13, 9 April 2014 (UTC)

I agree cerebral hypoperfusion is better as systemic hypoperfusion may not always be present. Doc James (talk · contribs · email) (if I write on your page reply on mine) 22:19, 7 May 2014 (UTC)