STROKE
Ratheesh R.L

THE NORMAL BRAIN

BLOOD SUPPLY TO BRAIN

DEFINITION
It is a sudden loss of function resulting from disruption of
the blood supply to the part of the brain. The C.V.A is also
termed as “Brain attack”. This event is usually result of
long standing cerebro vascular disease.

CAUSES
• Hypertension
• Heart disease
• DM
• Sleep apnea
• Increased blood cholesterol level
• Smoking
• Sickle cell disease
• Substance abuse
• Living in the stroke belt

ISCHEMIA
↓
ENERGY FAILURE
↓
↑ GLUTAMATE PRODUCTION AND ABSORPTION
↓
INTRACELLULAR CALCIUM INCREASED
↓
SLOWS THE INTRACELLULAR PROTEIN SYNTHESIS
↓
CELL INJURY AND DEATH

CLINICAL MANIFESTATIONS
1. Weakness of the face, arm, leg, especially on one side of the
body.
2. Confusion or Mental changes.
3. Trouble Speaking.
4. Visual disturbances.
5. Difficulty in walking, dizziness, or loss of balance or
coordination.
6. Sudden severe headache.

1. MOTOR LOSS:-
A). Hemiplegia (paralysis of one side of the body)
B). Hemiparesis (weakness of one side of the body)
2. COMMUNICATION LOSS:-
A). Dysarthria (difficulty in speaking)
B). Aphasia (loss of speech)
C). Apraxia (inability to perform previously learned
actions)
3. PERCEPTUAL DISTURBANCES:-
A).Hemianopsia (loss of half of the visual field)
4. SENSORY LOSS:-
A). Loss of proprioception( ability to perceive the position
and motion of the body parts)
B). Difficulty in interpreting visual,tactile,and auditory
stimuli.

(A) Physical
Examination
Demographic
data
Vital signs
History taking
Motor
assessment
Sensory
assessment
Cranial
assessment
DIAGNOSIS

(B) Lab &
radiological
investigation
1. Blood
test
2. Brain
imaging test
3. Heart &
Blood vessel
test
5. Electrocardiogram
4. Leg
ultrasound
6. Transcranial
Doppler (TCD)

• High cholesterol, sugar level, blood clotting time
1.Blood test
• CT Scan - detect bleeding in brain
(hemorrhagic stroke)
• MRI – detect damaged brain tissue
• MRA (Magnetic Resonance Angiography) –
visualize narrowing blood vessel
2. Brain Imaging Test
• Carotid ultrasonography- clotting in arteries
leading to brain
• Catheter angiography (arteriography)
3. Heart & Blood Vessel Test

CT Scan result

(a) Carotid Ultrasound
(b) Result(normal)
(c) Result (narrowing)
(a) (b)
(c)

• Identify problem with electrical conduction of heart
• Regular heart beat rhythmic pattern smooth
blood flow
• Defect arrhythmia form blood clot stroke
5. Electrocardiogram (ECG)
• Detect blood clot in deep vein in legs
• Clot movement to brain leads to stroke
4. Leg Ultrasound
• Sound waves – measure blood flow blood vessel
of hemorrhagic area
6. Transcranial Doppler (TCD)

(a) Leg Ultrasound
(b)Result

Result of Electrocardiogram (ECG)

TREATMENT
Pharmacological Therapy
Stroke with Cardiogenic cause should treat promptly with
warfarin sodium, Platelet inhibiting drugs (aspirin, clopidogrel,
ticlopidine) can decrease the incidence of cerebral infarction.

(A) MEDICATION
1. Alteplase (tissue
plasminogen
activator- TPA)
Injected to vein
in arm
Given 4½ hour after
onset of symptoms
Dissolve blood clot –
restore blood flow
2. Anticoagulant
Drugs to thin
blood
Ex: Aspirin,
Heparin,
Warfarin
3. Statin
Reduce
cholesterol in
blood
TREATMENT

(B) SURGERY
1. Carotid endarterectomy
Incision in neck
open carotid artery
remove fatty acids
2. Craniotomy
Small section of skull cut
away
Remove blood clot / repair
burst in blood vessel

Carotid Endarterectomy

Craniotomy

Steps
Diet
(low fat, high
fiber)
Quit smoking &
alcohol intake
Controlling
diabetes
Maintain
healthy weight
Exercise
Avoiding
illicit drugs
PREVENTION

Nursing Management
1. Improving Mobility.
2. Preventing Joint deformity.
3. Changing Position.
4. Establishing Exercise Programme.
5. Improving Communication.
6. Improving Thought Process.
7. Improving Skin Integrity.
8. Improving Family coping.

NURSING DIAGNOSIS
• Ineffective cerebral tissue perfusion related to decreased
cerebral blood flow.
• Impaired physical mobility related to hemiparesis
• Self care deficit related to loss of ability to use extrimities
• Disturbed sensory perception related to changes in visual
field
• Impaired verbal communication related to cerebral injury
• Impaired swallowing related to weakness or loss of
coordination of the tongue
• Impaired urinary elimination related to neurological
deficits