CEREBROVASCULAR DISORDERS An umbrella term that refers to any functional abnormality of the central nervous system that occurs when the normal blood supply to the brain is disrupted.
STROKE a sudden neurological event which results in the new onset ofneurological symptoms.
ISCHEMICSTROKE “BRAIN ATTACK”
MOTOR LOSS-disturbance of voluntary motorcontrol on the side of the bodyopposite the location of thestroke lesion•Hemiplegia•Hemiparesis
COMMUNICATION LOSS•Dysarthria•Apraxia•Agnosia•Dysphasia or Aphasia
PERCEPTUAL DISTURBANCES•Homonymous Hemianopsia•Disturbance in Visual-Spatial Relations - Unilateral Neglect•Loss of Peripheral Vision•Night Blindness•Diplopia•Horner’s Syndrome
SENSORY LOSS•Slight Impairment of Touch•Loss of Proprioception•Difficulty in interpretingvisual, tactile, and auditory stimuli
COGNITIVE IMPAIRMENT & PSYCHOLOGICAL EFFECTSMemory Loss Emotional LabilityPoor Comprehension HostilityLimited Attention Span FrustrationForgetfulness ResentmentLack of Motivation Lack of CooperationDepression
ASSESSMENT & DIAGNOSTICS•Patient History•Complete Physical and Neurologic Examination•Initial Assessment: Airway Patency, CardiovascularStatus, Gross Neurologic Losses•Stroke Time Course Classification
STROKE TIME COURSE CLASSIFICATIONStage 1: Transient Ischemic AttackStage 2: Reversible Ischemic Neurologic DeficitsStage 3: Stroke in EvolutionStage 4: Completed Stroke
DIAGNOSTIC TESTS•CT Scan•12-Lead ECG•Carotid ultrasound•Cerebral Angiography•Transcranial Doppler Flow Studies•Transthoracic or Transesophageal Echocardiography•MRI of the brain and/or neck•Xenon CT•Single Photon Emission CT
MEDICAL MANAGEMENT1. Treatment of TIA from atrial fibrillation or suspected embolic or thrombotic causes2. Thrombolytic Therapy for Ischemic Stroke3. Therapy for Patients with Ischemic Stroke NOT Receiving Thrombolytic Therapy4. Managing Potential Complications
SURGICAL MANAGEMENT CAROTID ENDARTERECTOMY- Main surgical procedure for the management of TIAsand small stroke- Indicated for patients with symptoms of TIA or mildstroke found to be due to carotid stenosis- Complications: stroke, cranial nerveinjuries, infection, hematoma at the incisionsite, carotid artery disruption
NURSING MANAGEMENT•Improving Mobility and Preventing Joint Deformities•Managing Sensory-Perceptual Difficulties•Attaining Bowel and Bladder Control•Improving Thought Processes•Improving Communication•Maintaining Skin Integrity•Improving Family Coping•Helping the Patient Cope with Sexual Dysfunction