A cerebrovascular accident, or stroke, is caused by a lack of oxygenated blood flow to the brain. It can be ischemic, due to a blockage, or hemorrhagic, due to a ruptured blood vessel. Symptoms depend on the affected brain area and can include weakness, sensory changes, speech problems, and visual issues. Stroke severity is classified as mild, moderate, or severe based on symptoms and exam findings. Risk factors include hypertension, atrial fibrillation, diabetes, and lifestyle factors like smoking and diet. Prevention focuses on controlling modifiable risks while treatment involves supportive care, thrombolysis if administered early, and long-term secondary prevention with antiplatelets or anticoagul
1) The document defines terms related to strokes including stroke, transient ischemic attack, progressive stroke, and completed stroke.
2) It discusses the epidemiology of strokes, noting they are a leading cause of death and disability worldwide. Prevalence and risk factors like age, gender, and medical conditions are outlined.
3) Strokes are classified as either ischemic (caused by clot or blockage) or hemorrhagic (caused by bleeding). The major types and causes of ischemic and hemorrhagic strokes are summarized.
1) The document discusses strokes (cerebrovascular accidents or CVAs), their causes, types, symptoms, diagnosis and treatment.
2) Strokes are caused by disturbances in the vascular system and can be ischemic (caused by clot or blockage) or hemorrhagic (caused by bleeding).
3) Common symptoms of strokes include weakness or numbness on one side of the body, speech problems, and visual issues. The specific symptoms depend on the area of the brain affected.
This document provides an overview of ischaemic stroke, including its definition, risk factors, pathophysiology, clinical presentation, diagnosis and management. Key points include:
- Ischaemic stroke accounts for 80% of strokes and results from focal brain infarction due to obstruction of cerebral blood flow.
- Major risk factors include hypertension, atrial fibrillation, diabetes, hyperlipidemia and previous stroke or TIA.
- Clinical syndromes depend on the location of brain infarction and can include motor/sensory deficits, aphasia and visual field cuts.
- Diagnosis involves neuroimaging such as CT, MRI and vascular imaging to identify the cause.
- Acute
This document provides an overview of strokes, including:
1) Strokes are caused by an interruption of blood flow to the brain and are a leading cause of death and disability in the US.
2) The two main types of strokes are ischemic, caused by blockage of arteries, and hemorrhagic, caused by bleeding in the brain.
3) Warning signs of a stroke include sudden weakness, confusion, trouble speaking, and vision changes. Acting FAST (Face, Arms, Speech, Time) and calling 911 immediately can help reduce stroke damage.
Intracerebral hemorrhage is more common in Asian countries and incidence increases with age. It has a high mortality rate, especially when located in the brainstem. Clinical presentation includes altered mental status, headache, nausea and focal neurological deficits depending on the location of bleeding in the brain. CT scan is used to diagnose and determine the size and location of hemorrhage. Treatment focuses on controlling blood pressure, reducing ICP and treating the underlying cause.
This document discusses hemorrhagic stroke, including intracerebral and subarachnoid hemorrhage. Intracerebral hemorrhage is caused by bleeding into the brain tissue and accounts for 10-15% of strokes. It has high mortality, especially if the patient is in a coma. Subarachnoid hemorrhage is caused by bleeding into the subarachnoid space, often due to ruptured aneurysms. Both require imaging like CT or MRI to diagnose and determine treatment, which may include surgery to remove hematomas or clip aneurysms. Complications include cerebral vasospasm, rebleeding, and hydrocephalus. Secondary stroke prevention focuses on controlling risk factors and treating
1. Stroke is caused by disrupted blood flow to the brain, usually due to hypertension, heart disease, diabetes or other conditions, leading to brain cell death.
2. Symptoms include weakness, confusion, trouble speaking, visual issues or headaches on one side of the body.
3. Diagnosis involves physical exams, blood tests, and brain imaging scans. Treatment focuses on dissolving clots or repairing burst vessels through drugs or surgery to restore blood flow.
1) The document defines terms related to strokes including stroke, transient ischemic attack, progressive stroke, and completed stroke.
2) It discusses the epidemiology of strokes, noting they are a leading cause of death and disability worldwide. Prevalence and risk factors like age, gender, and medical conditions are outlined.
3) Strokes are classified as either ischemic (caused by clot or blockage) or hemorrhagic (caused by bleeding). The major types and causes of ischemic and hemorrhagic strokes are summarized.
1) The document discusses strokes (cerebrovascular accidents or CVAs), their causes, types, symptoms, diagnosis and treatment.
2) Strokes are caused by disturbances in the vascular system and can be ischemic (caused by clot or blockage) or hemorrhagic (caused by bleeding).
3) Common symptoms of strokes include weakness or numbness on one side of the body, speech problems, and visual issues. The specific symptoms depend on the area of the brain affected.
This document provides an overview of ischaemic stroke, including its definition, risk factors, pathophysiology, clinical presentation, diagnosis and management. Key points include:
- Ischaemic stroke accounts for 80% of strokes and results from focal brain infarction due to obstruction of cerebral blood flow.
- Major risk factors include hypertension, atrial fibrillation, diabetes, hyperlipidemia and previous stroke or TIA.
- Clinical syndromes depend on the location of brain infarction and can include motor/sensory deficits, aphasia and visual field cuts.
- Diagnosis involves neuroimaging such as CT, MRI and vascular imaging to identify the cause.
- Acute
This document provides an overview of strokes, including:
1) Strokes are caused by an interruption of blood flow to the brain and are a leading cause of death and disability in the US.
2) The two main types of strokes are ischemic, caused by blockage of arteries, and hemorrhagic, caused by bleeding in the brain.
3) Warning signs of a stroke include sudden weakness, confusion, trouble speaking, and vision changes. Acting FAST (Face, Arms, Speech, Time) and calling 911 immediately can help reduce stroke damage.
Intracerebral hemorrhage is more common in Asian countries and incidence increases with age. It has a high mortality rate, especially when located in the brainstem. Clinical presentation includes altered mental status, headache, nausea and focal neurological deficits depending on the location of bleeding in the brain. CT scan is used to diagnose and determine the size and location of hemorrhage. Treatment focuses on controlling blood pressure, reducing ICP and treating the underlying cause.
This document discusses hemorrhagic stroke, including intracerebral and subarachnoid hemorrhage. Intracerebral hemorrhage is caused by bleeding into the brain tissue and accounts for 10-15% of strokes. It has high mortality, especially if the patient is in a coma. Subarachnoid hemorrhage is caused by bleeding into the subarachnoid space, often due to ruptured aneurysms. Both require imaging like CT or MRI to diagnose and determine treatment, which may include surgery to remove hematomas or clip aneurysms. Complications include cerebral vasospasm, rebleeding, and hydrocephalus. Secondary stroke prevention focuses on controlling risk factors and treating
1. Stroke is caused by disrupted blood flow to the brain, usually due to hypertension, heart disease, diabetes or other conditions, leading to brain cell death.
2. Symptoms include weakness, confusion, trouble speaking, visual issues or headaches on one side of the body.
3. Diagnosis involves physical exams, blood tests, and brain imaging scans. Treatment focuses on dissolving clots or repairing burst vessels through drugs or surgery to restore blood flow.
1) Stroke is the fourth leading cause of death in Bangladesh. The prevalence of stroke is 0.3% and it severely impacts Bangladesh's economy.
2) The main types of stroke are ischemic (85%) caused by blockage and hemorrhagic (15%) caused by burst blood vessels. Risk factors include high blood pressure, diabetes, smoking, high cholesterol, obesity, heart disease, older age, and family history.
3) Treatment for ischemic stroke includes antiplatelet drugs, treatment for underlying conditions, and rehabilitation. Treatment for hemorrhagic stroke focuses on supportive care and sometimes surgery to remove blood from the brain. With treatment, 30-40% of patients recover, 30% remain
Stroke is the third leading cause of death in Malaysia. The document defines stroke, classifies its types, and outlines its diagnosis and management. Key points include that stroke is caused by blocked blood flow to the brain, and risk factors include age, gender, family history, hypertension, diabetes, atrial fibrillation, smoking, and high cholesterol. Diagnostic tests include CT/MRI scans and angiograms to determine the cause. Treatment focuses on rehabilitation, managing risk factors, and preventing future strokes.
Stroke occurs when blood supply to the brain is interrupted or reduced, causing brain cells to die. The most common type is ischemic stroke, which accounts for 80% of cases and occurs when a blood vessel is blocked. A stroke is a medical emergency and prompt treatment is important to minimize damage. Guidelines recommend administering thrombolysis within 3.5 hours, carefully controlling blood pressure, ordering diagnostic tests, and monitoring for potential complications. Lifestyle factors like controlling hypertension, cholesterol levels, diabetes, and use of anticoagulants can affect risk and outcomes of stroke.
Is characterized by the sudden loss of blood circulation to an area of the brain, resulting in a corresponding loss of neurologic function. Acute ischemic stroke is caused by thrombotic or embolic occlusion of a cerebral artery and is more common than hemorrhagic stroke.
It can occur
in the carotid
artery of the
neck as well as
other arteries.
When an artery is acutely occluded by thrombus or embolus, the area of the CNS supplied by it will undergo infarction if there is no adequate collateral blood supply.
Surrounding a central necrotic zone, an ‘ischemic penumbra’ remains viable for a time, i.e. it may recover function if blood flow is restored.
CNS ischemia may be accompanied by swelling for two reasons:
● cytotoxic oedema – accumulation of water in damaged glial cells and neurones,
● vasogenic oedema – extracellular fluid accumulation as a result of breakdown of the blood–brain barrier.
In the brain, this swelling may be sufficient to produce clinical deterioration in the days following a major stroke, as a result of a rise in intracranial pressure and compression of adjacent structures.
Stroke results from a disruption in blood flow to the brain. It is a leading cause of death and disability. Risk factors include hypertension, smoking, heart disease, diabetes, and older age. There are two main types - ischemic caused by blockage and hemorrhagic caused by bleeding. Treatment depends on the type but may include blood thinners, clot busters, or surgery. Physical therapy focuses on regaining mobility and function through exercises, gait training, and positioning. Prevention emphasizes controlling risk factors like blood pressure, cholesterol, diabetes, and lifestyle changes like quitting smoking.
This document discusses stroke (cerebrovascular accident or CVA), including:
- Stroke is caused by a lack of blood flow and oxygen to the brain, which can be due to blockage or rupture of an artery. The main types are ischemic (87%) and hemorrhagic (13%).
- Risk factors include hypertension, diabetes, high cholesterol, smoking, obesity, excessive alcohol, and atrial fibrillation.
- Symptoms vary depending on the affected brain region but can include paralysis, speech problems, sensory issues, and cognitive impairments.
- Diagnosis involves physical exams, neurological tests, imaging scans like CT/MRI, and other tests. Treatment includes thrombol
The document discusses stroke, including risk factors, signs and symptoms, and the importance of rapid treatment. It outlines the "Stroke Chain of Survival and Recovery" which includes early detection, emergency dispatch, pre-hospital transport and management, emergency department triage, evaluation and specific therapies, and fibrinolytic drug therapy. Rapid recognition of stroke, emergency medical response, and treatment are critical to limiting neurological damage and improving patient outcomes.
A stroke, or cerebrovascular accident (CVA), occurs when blood flow to the brain is interrupted, causing brain cells to die from lack of oxygen. The most common causes of stroke are thrombosis, where a clot blocks a blood vessel, and embolism, where a traveling clot blocks a vessel. Less common is hemorrhage, where a blood vessel ruptures in the brain. Risk factors include age, hypertension, diabetes, heart disease, and smoking. Symptoms vary depending on the affected brain region but can include paralysis, difficulty speaking, and mental status changes. Treatment involves stabilizing the patient, treating the underlying cause, and rehabilitation to regain lost functions.
The document discusses stroke, including its classification, risk factors, pathophysiology, signs and symptoms, diagnosis, and treatment. Stroke is defined as a neurological deficit lasting over 24 hours caused by a disruption of blood flow to the brain. It is classified as either ischemic, due to blockage of a blood vessel, or hemorrhagic, due to bleeding. Risk factors include modifiable factors like hypertension as well as non-modifiable factors like age. The pathophysiology involves cellular damage and death from lack of oxygen and nutrients. Diagnosis involves imaging tests and determining the cause. Treatment goals are to reduce injury, prevent complications and recurrence, and can include thrombolysis and management of risk factors.
Dr. Syed Muhammad Ali Shah provides an overview of ischemic stroke. Key points include:
- Stroke is defined as rapid onset of neurological deficit lasting over 24 hours caused by a vascular issue.
- Risk factors include atrial fibrillation, hypertension, smoking, obesity, and high cholesterol.
- Diagnosis involves investigations like CT scans and MRI. Treatment depends on the cause but may include thrombolysis within 4.5 hours, aspirin, rehabilitation, and preventing future strokes through controlling risk factors.
- Future advances include endovascular therapies to remove clots and research on neuroprotection strategies. Prevention through lifestyle changes and medications can reduce stroke risk.
This document provides information on ischemic and hemorrhagic stroke. It discusses the types, risk factors, pathophysiology, symptoms, diagnosis, and treatment of each. For ischemic stroke, it outlines the five types according to cause and details tPA administration criteria. For hemorrhagic stroke, it describes the types including intracerebral hemorrhage from aneurysms or arteriovenous malformations. Nursing interventions for recovery are also summarized.
A stroke occurs when the blood supply to the brain is interrupted or reduced, causing brain cells to die. It is a medical emergency. There are two main types of strokes: ischemic, caused by a blockage in a blood vessel, and hemorrhagic, caused by a ruptured blood vessel. Symptoms vary depending on the affected area of the brain but can include paralysis, confusion, and headaches. Diagnostic tests including CT scans and MRI images are used to determine the type and location of the stroke. Treatment options depend on the type of stroke but may include clot-busting drugs or surgery to repair damaged blood vessels. Prevention is key through controlling risk factors like high blood pressure, diabetes, and smoking.
A stroke occurs when blood flow to the brain is interrupted, depriving brain cells of oxygen and nutrients. There are two main types of strokes: ischemic, caused by a blockage in an artery, and hemorrhagic, caused by a ruptured blood vessel. The brain is divided into left and right hemispheres that control opposite sides of the body and have distinct functions like language processing and spatial awareness. Nursing interventions for stroke patients focus on monitoring vital signs, neurostatus, preventing injury, and managing medications or treatments like tPA to reduce disability from the stroke.
1. The document discusses increased intracranial pressure (ICP), including its causes, signs and symptoms, monitoring, and treatment approaches.
2. Key points include the Monroe-Kellie hypothesis which states that an increase in one component (blood, CSF, brain tissue) within the rigid skull causes changes in the others, and complications of increased ICP include brain herniation and death if not treated.
3. Treatment involves reducing cerebral edema, lowering CSF volume, decreasing cerebral blood volume, while maintaining cerebral perfusion pressure through interventions like mannitol infusion, CSF drainage, sedation, and hyperventilation. Surgical options include decompressive craniectomy.
Management of patient with increased intracranial pressuresalman habeeb
This document discusses the management of increased intracranial pressure. It defines intracranial pressure and its normal compensatory mechanisms. Common causes of increased ICP including brain edema are explained. Signs and symptoms as well as diagnostic tests and methods for measuring ICP are covered. Goals and approaches for medical and surgical management to reduce ICP are outlined.
Head injuries can range from minor scalp lacerations to severe traumatic brain injuries. The document defines different types of head injuries including closed and open injuries, skull fractures, and brain injuries such as concussions, contusions, and intracranial hemorrhages. Treatment depends on the severity but may include managing increased intracranial pressure, antibiotics, anti-seizure medications, surgery, and supportive care including monitoring neurological status, maintaining hydration and oxygenation, and preventing complications.
This document provides an outline and overview of key topics related to stroke. It begins with definitions and classifications of stroke, including transient ischemic attack (TIA) and different types of stroke. It then covers risk factors, pathophysiology, signs and symptoms, investigations, and management approaches for stroke. Specific sections address hemorrhagic versus ischemic stroke, localization of stroke syndromes, and differentiating features between anterior and posterior circulation strokes. Differential diagnoses are also listed. The document aims to present essential information on stroke for medical education purposes.
This document discusses hypertensive crises, including definitions, epidemiology, pathophysiology, assessment, diagnosis, and management. It defines hypertensive emergencies as elevated blood pressure with acute end-organ damage, while hypertensive urgencies involve impending end-organ damage. The typical patient presenting with crisis is middle-aged, noncompliant with medications, and may use substances. Treatment of emergencies requires immediate blood pressure reduction in the ICU to prevent further damage, while urgencies can be treated gradually as uncontrolled hypertension. Nitroprusside is very effective but has limitations like toxicity risks with prolonged use.
A stroke occurs when blood supply to the brain is interrupted, depriving brain cells of oxygen. Strokes can be either ischemic (88%), caused by clot or embolism blocking an artery, or hemorrhagic (12%), caused by bleeding within the brain. Diagnosis involves physical exam, blood tests, CT/MRI scans of the brain, and tests of the heart and arteries. Ischemic strokes result from plaque buildup in arteries leading to clot formation, while hemorrhagic strokes damage brain tissue through blood toxicity. Prompt treatment is needed to minimize brain injury from loss of oxygen and blood toxicity.
This document provides information about cerebrovascular accidents (strokes), including:
1. Strokes occur when blood supply to the brain is disrupted, causing brain cells to die from lack of oxygen and nutrients.
2. There are two main types of strokes - ischemic (lack of blood flow) and hemorrhagic (bleeding in the brain).
3. Signs and symptoms of strokes vary depending on the area of the brain affected but may include weakness, confusion, vision problems, and headaches.
This document provides an overview of strokes, including:
- Strokes are caused by a blockage or rupture of an artery to the brain, cutting off oxygen flow.
- Symptoms include weakness, paralysis, difficulty speaking or swallowing.
- Diagnosis involves medical imaging, blood tests, and physical exams to determine the type and location of blockage or rupture.
- Treatment depends on the type of stroke but may include clot-busting drugs, surgery, medication, and lifestyle changes to prevent future strokes.
1) Stroke is the fourth leading cause of death in Bangladesh. The prevalence of stroke is 0.3% and it severely impacts Bangladesh's economy.
2) The main types of stroke are ischemic (85%) caused by blockage and hemorrhagic (15%) caused by burst blood vessels. Risk factors include high blood pressure, diabetes, smoking, high cholesterol, obesity, heart disease, older age, and family history.
3) Treatment for ischemic stroke includes antiplatelet drugs, treatment for underlying conditions, and rehabilitation. Treatment for hemorrhagic stroke focuses on supportive care and sometimes surgery to remove blood from the brain. With treatment, 30-40% of patients recover, 30% remain
Stroke is the third leading cause of death in Malaysia. The document defines stroke, classifies its types, and outlines its diagnosis and management. Key points include that stroke is caused by blocked blood flow to the brain, and risk factors include age, gender, family history, hypertension, diabetes, atrial fibrillation, smoking, and high cholesterol. Diagnostic tests include CT/MRI scans and angiograms to determine the cause. Treatment focuses on rehabilitation, managing risk factors, and preventing future strokes.
Stroke occurs when blood supply to the brain is interrupted or reduced, causing brain cells to die. The most common type is ischemic stroke, which accounts for 80% of cases and occurs when a blood vessel is blocked. A stroke is a medical emergency and prompt treatment is important to minimize damage. Guidelines recommend administering thrombolysis within 3.5 hours, carefully controlling blood pressure, ordering diagnostic tests, and monitoring for potential complications. Lifestyle factors like controlling hypertension, cholesterol levels, diabetes, and use of anticoagulants can affect risk and outcomes of stroke.
Is characterized by the sudden loss of blood circulation to an area of the brain, resulting in a corresponding loss of neurologic function. Acute ischemic stroke is caused by thrombotic or embolic occlusion of a cerebral artery and is more common than hemorrhagic stroke.
It can occur
in the carotid
artery of the
neck as well as
other arteries.
When an artery is acutely occluded by thrombus or embolus, the area of the CNS supplied by it will undergo infarction if there is no adequate collateral blood supply.
Surrounding a central necrotic zone, an ‘ischemic penumbra’ remains viable for a time, i.e. it may recover function if blood flow is restored.
CNS ischemia may be accompanied by swelling for two reasons:
● cytotoxic oedema – accumulation of water in damaged glial cells and neurones,
● vasogenic oedema – extracellular fluid accumulation as a result of breakdown of the blood–brain barrier.
In the brain, this swelling may be sufficient to produce clinical deterioration in the days following a major stroke, as a result of a rise in intracranial pressure and compression of adjacent structures.
Stroke results from a disruption in blood flow to the brain. It is a leading cause of death and disability. Risk factors include hypertension, smoking, heart disease, diabetes, and older age. There are two main types - ischemic caused by blockage and hemorrhagic caused by bleeding. Treatment depends on the type but may include blood thinners, clot busters, or surgery. Physical therapy focuses on regaining mobility and function through exercises, gait training, and positioning. Prevention emphasizes controlling risk factors like blood pressure, cholesterol, diabetes, and lifestyle changes like quitting smoking.
This document discusses stroke (cerebrovascular accident or CVA), including:
- Stroke is caused by a lack of blood flow and oxygen to the brain, which can be due to blockage or rupture of an artery. The main types are ischemic (87%) and hemorrhagic (13%).
- Risk factors include hypertension, diabetes, high cholesterol, smoking, obesity, excessive alcohol, and atrial fibrillation.
- Symptoms vary depending on the affected brain region but can include paralysis, speech problems, sensory issues, and cognitive impairments.
- Diagnosis involves physical exams, neurological tests, imaging scans like CT/MRI, and other tests. Treatment includes thrombol
The document discusses stroke, including risk factors, signs and symptoms, and the importance of rapid treatment. It outlines the "Stroke Chain of Survival and Recovery" which includes early detection, emergency dispatch, pre-hospital transport and management, emergency department triage, evaluation and specific therapies, and fibrinolytic drug therapy. Rapid recognition of stroke, emergency medical response, and treatment are critical to limiting neurological damage and improving patient outcomes.
A stroke, or cerebrovascular accident (CVA), occurs when blood flow to the brain is interrupted, causing brain cells to die from lack of oxygen. The most common causes of stroke are thrombosis, where a clot blocks a blood vessel, and embolism, where a traveling clot blocks a vessel. Less common is hemorrhage, where a blood vessel ruptures in the brain. Risk factors include age, hypertension, diabetes, heart disease, and smoking. Symptoms vary depending on the affected brain region but can include paralysis, difficulty speaking, and mental status changes. Treatment involves stabilizing the patient, treating the underlying cause, and rehabilitation to regain lost functions.
The document discusses stroke, including its classification, risk factors, pathophysiology, signs and symptoms, diagnosis, and treatment. Stroke is defined as a neurological deficit lasting over 24 hours caused by a disruption of blood flow to the brain. It is classified as either ischemic, due to blockage of a blood vessel, or hemorrhagic, due to bleeding. Risk factors include modifiable factors like hypertension as well as non-modifiable factors like age. The pathophysiology involves cellular damage and death from lack of oxygen and nutrients. Diagnosis involves imaging tests and determining the cause. Treatment goals are to reduce injury, prevent complications and recurrence, and can include thrombolysis and management of risk factors.
Dr. Syed Muhammad Ali Shah provides an overview of ischemic stroke. Key points include:
- Stroke is defined as rapid onset of neurological deficit lasting over 24 hours caused by a vascular issue.
- Risk factors include atrial fibrillation, hypertension, smoking, obesity, and high cholesterol.
- Diagnosis involves investigations like CT scans and MRI. Treatment depends on the cause but may include thrombolysis within 4.5 hours, aspirin, rehabilitation, and preventing future strokes through controlling risk factors.
- Future advances include endovascular therapies to remove clots and research on neuroprotection strategies. Prevention through lifestyle changes and medications can reduce stroke risk.
This document provides information on ischemic and hemorrhagic stroke. It discusses the types, risk factors, pathophysiology, symptoms, diagnosis, and treatment of each. For ischemic stroke, it outlines the five types according to cause and details tPA administration criteria. For hemorrhagic stroke, it describes the types including intracerebral hemorrhage from aneurysms or arteriovenous malformations. Nursing interventions for recovery are also summarized.
A stroke occurs when the blood supply to the brain is interrupted or reduced, causing brain cells to die. It is a medical emergency. There are two main types of strokes: ischemic, caused by a blockage in a blood vessel, and hemorrhagic, caused by a ruptured blood vessel. Symptoms vary depending on the affected area of the brain but can include paralysis, confusion, and headaches. Diagnostic tests including CT scans and MRI images are used to determine the type and location of the stroke. Treatment options depend on the type of stroke but may include clot-busting drugs or surgery to repair damaged blood vessels. Prevention is key through controlling risk factors like high blood pressure, diabetes, and smoking.
A stroke occurs when blood flow to the brain is interrupted, depriving brain cells of oxygen and nutrients. There are two main types of strokes: ischemic, caused by a blockage in an artery, and hemorrhagic, caused by a ruptured blood vessel. The brain is divided into left and right hemispheres that control opposite sides of the body and have distinct functions like language processing and spatial awareness. Nursing interventions for stroke patients focus on monitoring vital signs, neurostatus, preventing injury, and managing medications or treatments like tPA to reduce disability from the stroke.
1. The document discusses increased intracranial pressure (ICP), including its causes, signs and symptoms, monitoring, and treatment approaches.
2. Key points include the Monroe-Kellie hypothesis which states that an increase in one component (blood, CSF, brain tissue) within the rigid skull causes changes in the others, and complications of increased ICP include brain herniation and death if not treated.
3. Treatment involves reducing cerebral edema, lowering CSF volume, decreasing cerebral blood volume, while maintaining cerebral perfusion pressure through interventions like mannitol infusion, CSF drainage, sedation, and hyperventilation. Surgical options include decompressive craniectomy.
Management of patient with increased intracranial pressuresalman habeeb
This document discusses the management of increased intracranial pressure. It defines intracranial pressure and its normal compensatory mechanisms. Common causes of increased ICP including brain edema are explained. Signs and symptoms as well as diagnostic tests and methods for measuring ICP are covered. Goals and approaches for medical and surgical management to reduce ICP are outlined.
Head injuries can range from minor scalp lacerations to severe traumatic brain injuries. The document defines different types of head injuries including closed and open injuries, skull fractures, and brain injuries such as concussions, contusions, and intracranial hemorrhages. Treatment depends on the severity but may include managing increased intracranial pressure, antibiotics, anti-seizure medications, surgery, and supportive care including monitoring neurological status, maintaining hydration and oxygenation, and preventing complications.
This document provides an outline and overview of key topics related to stroke. It begins with definitions and classifications of stroke, including transient ischemic attack (TIA) and different types of stroke. It then covers risk factors, pathophysiology, signs and symptoms, investigations, and management approaches for stroke. Specific sections address hemorrhagic versus ischemic stroke, localization of stroke syndromes, and differentiating features between anterior and posterior circulation strokes. Differential diagnoses are also listed. The document aims to present essential information on stroke for medical education purposes.
This document discusses hypertensive crises, including definitions, epidemiology, pathophysiology, assessment, diagnosis, and management. It defines hypertensive emergencies as elevated blood pressure with acute end-organ damage, while hypertensive urgencies involve impending end-organ damage. The typical patient presenting with crisis is middle-aged, noncompliant with medications, and may use substances. Treatment of emergencies requires immediate blood pressure reduction in the ICU to prevent further damage, while urgencies can be treated gradually as uncontrolled hypertension. Nitroprusside is very effective but has limitations like toxicity risks with prolonged use.
A stroke occurs when blood supply to the brain is interrupted, depriving brain cells of oxygen. Strokes can be either ischemic (88%), caused by clot or embolism blocking an artery, or hemorrhagic (12%), caused by bleeding within the brain. Diagnosis involves physical exam, blood tests, CT/MRI scans of the brain, and tests of the heart and arteries. Ischemic strokes result from plaque buildup in arteries leading to clot formation, while hemorrhagic strokes damage brain tissue through blood toxicity. Prompt treatment is needed to minimize brain injury from loss of oxygen and blood toxicity.
This document provides information about cerebrovascular accidents (strokes), including:
1. Strokes occur when blood supply to the brain is disrupted, causing brain cells to die from lack of oxygen and nutrients.
2. There are two main types of strokes - ischemic (lack of blood flow) and hemorrhagic (bleeding in the brain).
3. Signs and symptoms of strokes vary depending on the area of the brain affected but may include weakness, confusion, vision problems, and headaches.
This document provides an overview of strokes, including:
- Strokes are caused by a blockage or rupture of an artery to the brain, cutting off oxygen flow.
- Symptoms include weakness, paralysis, difficulty speaking or swallowing.
- Diagnosis involves medical imaging, blood tests, and physical exams to determine the type and location of blockage or rupture.
- Treatment depends on the type of stroke but may include clot-busting drugs, surgery, medication, and lifestyle changes to prevent future strokes.
This document defines stroke, its types, causes, risk factors, symptoms, diagnosis, treatment, nursing considerations, and complications. It notes that stroke is caused by interrupted blood flow to the brain, which can be due to blood clots (ischemic) or bleeding (hemorrhagic). Risk factors include age, family history, diabetes, hypertension, heart disease, and smoking. Symptoms depend on the affected brain area but may include weakness, numbness, vision/speech issues, or loss of consciousness. Diagnosis involves imaging tests and physical exams. Treatment focuses on controlling risk factors, anticoagulants, antiplatelets, and surgery if needed. Nursing care includes monitoring, communication assistance, safe feeding,
This document provides an overview of stroke, including definitions of stroke and transient ischemic attack (TIA), typical presentation of a patient with stroke, relevant history taking and examination, initial investigations and treatment. Key points covered include causes of stroke, risk factors, classification systems, thrombolysis criteria and contraindications, complications, and secondary prevention strategies including for patients with atrial fibrillation.
This document discusses cerebrovascular accidents (strokes). It provides details on three patient cases presenting with strokes and their assessments. It then covers the types of strokes, clinical manifestations, emergency management, nursing diagnoses and management, increasing intracranial pressure signs, and rehabilitation. The types of strokes are ischemic (80-84%), which can be thrombotic, lacunar or embolic, and hemorrhagic. Right hemisphere strokes can cause left-sided weakness while left hemisphere strokes can cause aphasia or language problems.
cerebrovascular accident, commonly known as stroke is one of the most common health problems of the world. in the developing world, its increasing incidence is a matter of concern among the health workers across the globe. thus adequate knowledge about this medical condition is a must to deal with it effectively.
This document discusses cerebrovascular accidents (CVAs), also known as strokes. It defines a stroke as the rapidly developing loss of brain function due to a disturbance in blood supply to the brain caused by a blockage or hemorrhage. Risk factors include hypertension, smoking, diabetes, heart disease, and heredity. Strokes are classified as ischemic, resulting from a blockage, or hemorrhagic, resulting from a bleeding event in the brain. Signs and symptoms depend on the area of brain affected but may include weakness, numbness, vision issues, and altered mental status. Treatment involves restoring blood flow through thrombolysis or angioplasty for ischemic strokes and neurosurgery for hemorrhag
The document discusses cerebrovascular accidents (strokes), including types of strokes, risk factors, signs and symptoms, nursing management in the acute and hyperacute phases, and collaborative care approaches for prevention, diagnosis, and treatment. It provides an overview of strokes, their causes, impact, and the critical role of nurses in monitoring patients, administering treatments, and coordinating multidisciplinary care.
1) The document discusses various syndromes that can result from lesions or occlusions in different parts of the posterior circulation arteries that supply the brainstem and cerebellum.
2) Specific syndromes are described based on the location of the lesion, including PCA, vertebral artery, and basilar artery syndromes. Onset, signs and symptoms on both sides of the lesion are outlined.
3) Midbrain, pontine, and medullary syndromes are also detailed. Bilateral lesions causing Anton's syndrome and Balint's syndrome are mentioned. A variety of resulting neurological deficits are associated with different posterior circulation artery occlusions.
This document provides an overview of strokes, including:
- Globally, about 17 million strokes occur annually, making it a leading cause of death and disability.
- Strokes are caused by blockages or ruptures in blood vessels in the brain. The brain then does not receive enough blood and oxygen.
- Risk factors include high blood pressure, smoking, diabetes, high cholesterol, obesity, lack of exercise, poor diet, family history, older age, and prior heart attack or stroke.
- Early detection and treatment are important to reduce long-term effects such as paralysis or speech problems. Managing risk factors can also help prevent future strokes.
This document discusses cerebrovascular disease and stroke. It provides classifications and descriptions of different types of strokes including transient ischemic attacks, hemorrhagic strokes, and thrombotic vs. embolic ischemic strokes. It also summarizes the clinical assessment and presentation of strokes, differential diagnoses, pathophysiology of cerebral infarction, and general risk factors.
Cerebrovascular Accident CVA (Stroke), Angin Ahmar (malay)edge ryan
A cerebrovascular accident (CVA), also known as a stroke, occurs when blood flow to the brain is interrupted by a blockage or rupture of a blood vessel, depriving brain cells of oxygen and nutrients. It is the leading cause of disability. Risk factors include age, heredity, high blood pressure, diabetes, smoking, obesity, and physical inactivity. Treatment focuses on prevention through lifestyle changes and medication to prevent clots, as well as rehabilitation after a stroke to regain functions that may be lost.
This document provides biographical information about Dr. Ronald Sanchez-Magbitang, including his educational background and medical training. It lists that he received his B.S. in Biology from the University of Santo Tomas and his Doctor of Medicine degree from Saint Louis University. It also notes his current position as Chief of Hospital at Gov. Eduardo L. Joson Memorial Hospital in Cabanatuan City.
Acute management of Stroke By Dr Sanjay jaiswal Neurologist sept2012Sanjay Jaiswal
The document discusses early management of ischemic stroke. It defines stroke as a sudden neurological deficit of vascular origin lasting more than 24 hours. It emphasizes that "time is brain" and every minute of untreated stroke causes the loss of 1.9 million neurons. It outlines risk factors, signs and symptoms of different types of stroke, and the definition of transient ischemic attack. Current acute treatments for ischemic stroke including thrombolysis within 3-4.5 hours and aspirin within 48 hours are discussed.
This document provides information about hydrocephalus. It begins with definitions, noting that hydrocephalus is an excessive accumulation of cerebrospinal fluid in the brain resulting in abnormal widening of brain spaces. It describes the anatomy of the ventricles and circulation of cerebrospinal fluid. It discusses the causes of hydrocephalus, including conditions that block normal fluid flow or absorption. It outlines the main types - congenital, acquired, communicating, and non-communicating hydrocephalus - and their causes. Images are included showing examples of hydrocephalus, obstructions, treatments like VP shunts, and various conditions that can cause hydrocephalus like aqueduct stenosis and tumors.
This document provides information on cerebrovascular accidents (strokes). It defines a stroke as occurring when blood supply to the brain is interrupted, usually due to a blood clot or burst blood vessel. Strokes can be ischemic, caused by a clot cutting off blood flow, or hemorrhagic, caused by a ruptured blood vessel. Warning signs include sudden weakness, numbness, trouble speaking, and loss of vision. Acting FAST (Facial drooping, Arm weakness, Speech difficulties, Time to call for help) can help identify a stroke and get immediate medical attention, as rapid treatment improves outcomes. Risk factors include age, race, family history, high blood pressure, diabetes, smoking and more.
The document discusses stroke, including its definition, causes, risk factors, symptoms, assessment, recovery stages, and complications. Key points include:
- Stroke is defined as sudden neurological dysfunction due to abnormal cerebral circulation lasting over 24 hours.
- Common causes include atherosclerosis, cerebral thrombus, embolism from the heart.
- Risk factors include hypertension, diabetes, heart disease, smoking, obesity.
- Symptoms can include weakness, numbness, vision issues, speech problems.
- Recovery is assessed based on severity, duration, and affected brain region. Complications can include contractures, seizures, DVT.
This document provides an overview of six-stroke engine designs that aim to improve efficiency over traditional four-stroke engines. It describes the working principles of various six-stroke engine types, including single piston designs by Griffin, Bajulaz, Crower, and Velozeta as well as opposed piston designs like the Beare head engine. The document also discusses the modifications needed to convert a conventional engine to a six-stroke design and analyzes the advantages of six-stroke engines like reduced fuel consumption and emissions.
This document provides information on ischemic stroke through a case study format. It discusses the types and causes of stroke, risk factors, signs and symptoms, diagnostic studies, treatment goals, and methods for prevention. The key points are:
- Ischemic stroke is caused by a blockage in a brain blood vessel and accounts for 87% of strokes. Common causes are fatty deposits forming blood clots or traveling particles blocking small vessels.
- Risk factors include age, gender, race, family history, diabetes, heart disease, smoking, hypertension, obesity, and oral contraceptive use.
- Symptoms vary depending on the affected area of the brain but may include weakness, confusion, visual issues, difficulty walking, and severe
A Lecture on CrebroVascular Accident & Nursing careRN Yogendra Mehta
Cerebrovascular accident (CVA), commonly known as stroke, is caused by interrupted blood flow to the brain resulting in tissue damage. There are two main types of strokes: ischemic (85%) due to blockage and hemorrhagic (15%) due to bleeding. Risk factors include hypertension, diabetes, smoking, age, and family history. Symptoms depend on the affected brain region and may include weakness, speech problems, vision issues, and loss of coordination. Diagnosis involves imaging tests like CT or MRI. Treatment focuses on stabilizing vital functions and managing risk factors to prevent future strokes.
A cerebrovascular accident (CVA), also known as a stroke, is caused by disrupted blood flow to the brain resulting in the death of brain cells. There are two main types of strokes: ischemic strokes caused by blood clot blockages and hemorrhagic strokes caused by ruptured blood vessels. Treatment depends on the stroke type and may include clot-busting drugs, surgery, or controlling bleeding. Nursing care focuses on rehabilitation and prevention of complications through careful monitoring, positioning, and facilitating recovery of motor and cognitive functions. Lifestyle changes and medication can help prevent future strokes by managing risk factors like high blood pressure, smoking, obesity, and atrial fibrillation.
Cerebrovascular accident, also known as stroke, is caused by a sudden blockage or rupture of an artery in the brain, cutting off blood flow. There are two main types - ischemic (caused by clot) and hemorrhagic (caused by bleeding). Risk factors include hypertension, smoking, diabetes, heart disease, and family history. Symptoms depend on the affected brain region but may include weakness, numbness, trouble speaking, and loss of coordination. Treatment focuses on restoring blood flow, preventing further damage, and rehabilitation. Control of risk factors can help prevent strokes.
A 65-year-old man presented to the hospital with acute left-sided weakness and slurred speech for 14 hours. His medical history included hypertension. Examination found left-sided motor weakness and deviated eyes and mouth. A CT scan showed an infarction in the right middle cerebral artery. The patient was diagnosed with an ischemic stroke. The goals of management were to ensure medical stability, determine eligibility for thrombolysis, and uncover the cause of symptoms. Treatment included monitoring blood pressure, glucose, swallowing function, and fever. Intravenous thrombolysis within 4.5 hours or mechanical thrombectomy within 24 hours were recommended treatment options.
1. An ischemic stroke occurs when a blood clot or fat deposit blocks an artery in the brain, cutting off blood flow and oxygen to brain cells.
2. There are two main types - arterial thrombosis where a clot forms in the brain artery, and cerebral embolism where a clot forms elsewhere and travels to the brain.
3. Risk factors include age, gender, medical conditions like high blood pressure, smoking, high cholesterol, prior transient ischemic attacks, and family history.
The document provides information about cerebrovascular accidents (strokes) including:
1) Strokes occur when blood supply to the brain is disrupted, depriving brain cells of oxygen. India has high stroke prevalence, with risk factors like hypertension.
2) Strokes are either ischemic (caused by clot) or hemorrhagic (caused by bleed). Diagnosis involves CT/MRI and management focuses on restoring blood flow through thrombolysis or surgery.
3) Post-stroke care aims to prevent complications, maximize function through rehabilitation, and reduce risk of recurrence through lifestyle changes and medication compliance. Nurses monitor for complications and support recovery.
Guidelines for management of acute strokesankalpgmc8
This document provides an overview of stroke types, pathophysiology, investigations, and management guidelines. It discusses the three main types of stroke: ischemic, intracerebral hemorrhage, and subarachnoid hemorrhage. For ischemic stroke, it describes the ischemic core and penumbra. It outlines the emergency evaluation of acute ischemic stroke including vital signs, blood tests, imaging, and scales like the NIH Stroke Scale. Management strategies discussed include thrombolysis, antiplatelet/anticoagulation drugs, neuroprotective agents, and surgical interventions. Complications like cerebral edema and their management are also summarized.
A 76-year-old male is admitted to the ICU for recovery after lung surgery. His BP is 168/96 mmHg without end-organ damage, so this represents a hypertensive urgency rather than emergency. Fundoscopic exam is not needed for this transient postoperative hypertension. Starting IV antihypertensives or consulting a hypertension specialist are not necessary actions at this time. The patient should be reassessed later since there is no end-organ damage currently.
A 76-year-old male is admitted to the ICU for recovery after lung surgery. His BP is 168/96 mmHg without end-organ damage, so this represents a hypertensive urgency rather than emergency. Fundoscopic exam is not needed for this transient postoperative hypertension. Starting IV antihypertensives or consulting a hypertension specialist are not necessary actions at this time. The patient should be reassessed later since there is no end-organ damage currently.
This document discusses the management of stroke. It begins by defining stroke as a clinical syndrome caused by vascular issues leading to neurological deficits lasting more than 24 hours. It emphasizes the importance of specialized care in a stroke unit and assessing patients immediately to determine if they are eligible for time-sensitive treatments like thrombolysis. The main types of stroke are ischemic and hemorrhagic. Secondary prevention focuses on controlling risk factors like high blood pressure, smoking, diabetes, and atrial fibrillation through medications and lifestyle changes to reduce the risk of recurrent strokes.
Dr Avinash.KM is a Neurosurgeon with advanced training in Interventional vascular Neurosurgery(FINR) from Zurich, Switzerland, and FMINS-Fellowship in minimally invasive and Endoscopic Neurosurgery from Germany.
He is presently working in Columbia asia hospitals, Bangalore.
His main areas of interest are Vascular Neurosurgery, Stroke specialist, interventional neuroradiology, Endovascular Neurosurgery, Endoscopic and minimally invasive Neurosurgery, Endoscopic spine surgery.He has advanced training in both Brain Aneurysm coiling and clipping, Brain AVM embolizations and its surgical removal, carotid artery stenting and carotid endarterectomy. Since he is trained both in open microvascular Neurosurgery and in Interventional Neurosurgery he helps patients in choosing the right treatment options for brain vascular diseases with out any bias of one treatment over the other.
1. The document discusses nervous system disorders including intracranial pressure, components of the brain, causes of increased ICP, signs and symptoms, investigations, and management of increased ICP including drug therapy and nursing care.
2. It also covers topics such as stroke, including types, signs and symptoms, diagnosis using FAST test, treatment including thrombolysis and antiplatelet/anticoagulant drugs, and nursing care to monitor patients and prevent complications.
3. Finally, it briefly discusses meningitis as an inflammation of the lining around the brain and spinal cord often caused by bacteria or viruses.
Stroke occurs when blood flow to the brain is interrupted, depriving brain tissue of oxygen and nutrients. The main types of stroke are ischemic (caused by blockage) and hemorrhagic (caused by bleeding). Risk factors include high blood pressure, diabetes, smoking, high cholesterol, obesity, heart disease, age, gender, family history, and prior vascular events. Treatment depends on the type of stroke but may involve clot-busting drugs, surgery, rehabilitation, and managing risk factors to prevent future strokes. Lifestyle changes like quitting smoking, losing weight, exercising, and following a healthy diet can significantly reduce the risk of having a stroke.
This document defines stroke and its two main types - ischemic and hemorrhagic. It describes risk factors like hypertension, atrial fibrillation, and smoking. For evaluation, a neurologic exam and CT scan are important. Ischemic stroke is initially managed with permissive hypertension and aspirin, while hemorrhagic stroke requires urgent blood pressure control. Identifying and treating risk factors can help prevent future strokes.
This document discusses supportive management strategies for patients experiencing acute stroke. It covers positioning, monitoring and treatment of cerebral edema, management of seizures, blood pressure control, glucose control, potential cardiac issues, the role of hypothermia and neuroprotective agents, prevention of venous thromboembolism, and monitoring for infections. Key recommendations include maintaining normothermia, blood sugars between 140-180 mg/dL, treating cerebral edema with osmotic therapies like mannitol if indicated, and early mobilization to prevent complications like DVT.
acute stroke for rehab physician - dr trilochan shrivastavamrinal joshi
1. The document discusses acute management and rehabilitation of stroke, providing information on types of strokes, risk factors, signs and symptoms, investigations, treatments, and rehabilitation approaches.
2. It covers diagnostic testing including imaging, medications, and interventional procedures for ischemic and hemorrhagic strokes.
3. Rehabilitation services are described including physical, occupational and speech therapy in various settings from inpatient to home-based care with the goal of improving functional abilities and outcomes for stroke patients.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
2. CEREBROVASCULAR ACCIDENT
• Medical term for a stroke, also called “brain attack”
• The sudden death of some brain cells due to lack of
oxygen
3. •It occurs when blood flow to a part of your brain is
stopped either by a blockage such as a floating clot or
a stationary clot , or a rupture of a blood vessel, or
compression.
CEREBROVASCULAR ACCIDENT
6. SYMPTOMS
• Symptoms of a stroke depend on the area of
the brain affected.
• Stroke symptoms signify a medical
emergency.
7.
8. Definition of Stroke Severity
• MILD STROKE:
– Alert patients with any or combinations of
symptoms such as:
• mild motor weakness of one side of the body,
• sensory deficit,
• slurred speech,
• vertigo with incoordination
• visual field defects alone
– NIHSS score= 0-5
9. Definition of Stroke Severity
• MODERATE SROKE:
– Awake patient with significant motor and /or
sensory and /or visual deficit, or
– Disoriented, drowsy, or light stupor with purposeful
response to painful stimuli, or
– NIHSS Score= 6-21
10. Definition of Stroke Severity
• SEVERE STROKE:
– Deep stupor or comatose patient with non-
purposeful response, decorticate, or decerebrate
posturing to painful stimuli, or
– Comatose patient with no response to painful
stimuli , or
– NIHSS Score= >22
11. Stages of CVA
• Transient ischemic attack (TIA) – sudden and
short-lived attack
• Reversible ischemic neurologic deficit (RIND)
similar to TIA, but symptoms can last up to a
week
• Stroke in evolution (SIE) - gradual worsening
of symptoms of brain ischemia
• Completed stroke (CS) – symptoms of stroke
stable over a period and rehab can begin
12. CLASSIFICATION OF STROKE
Stroke
Primary Hemorrhagic
(20% of Strokes)
Primary Ischemic
(80% of Strokes)
Thrombotic
50%
Embolic
30%
Intracerebral
Hemorrhage 15%
Subarachnoid
Hemorrhage 5%
12
14. Transient Ischemic Attack
• TIA was traditionally defined as a neurological deficit,
the symptoms of which are defined CURED
completely within 24 hours
• The current definition of TIA is
• Acute onset neurological dysfunction, due to focal
brain ischemia, which completely resolves within 60
minutes
• No evidence of cerebral ischemia
15. ISCHEMIC STROKE PATHOPHYSIOLOGY:
The First Few Hours
Penumbra
Core
Clot in
Artery
“TIME IS BRAIN:
SAVE THE PENUMBRA”
Penumbra is zone of
reversible ischemia around
core of irreversible
infarction—salvageable in
first few hours after
ischemic stroke onset
Penumbra damaged by:
• Hypoperfusion
• Hyperglycemia
• Fever
• Seizure
16. What are the risks factors?
• Modifiable Risks
– HTN
– CAD/Carotid Disease/PVD
– Atrial Fibrillation
– Diabetes
– Weight
– High Cholesterol/Diet
– Lack of exercise
– ETOH/Drug abuse
– Coagulopathy- Cancer,
Sickle Cell Anemia
– PFO- Patent Foramen
Ovale
• Non-Modifiable Risks
– Age->55
– Race- African Americans
have 2x the risk of death
and disability. Asians
have 1.4x the risk of
death and disability.
– Sex- 9% greater chance
in men. (61% of stroke
deaths occur in women)
– Previous Stroke or TIA
– Family History of Stroke
17. Signs and Symptoms
In embolism
Usually occurs without warning
Client often with history of cardiovascular disease
In thrombosis
Dizzy spells or sudden memory loss
No pain, and client may ignore symptoms
In cerebral hemorrhage
May have warning like dizziness and ringing in the
ears (tinnitus)
Violent headache, with nausea and vomiting
18. Signs and Symptoms
• Sudden-onset CVA
– Usually most severe
– Loss of consciousness
– Face becomes red
– Breathing is noisy and strained
– Pulse is slow but full and bounding
– Elevated BP
– May be in a deep coma
19. Time is Critical!
• The longer the time period that the
person remains unresponsive, the less
likely it is that the person will recover.
• The first few days after onset is critical.
• The responsive person may:
– Show signs of memory loss or inconsistent
behavior
– May be easily fatigued, lose bowel and bladder
control, or have poor balance.
21. Stroke Awareness
The Cincinnati Prehospital Stroke Scale using the acronym "FAST"
Facial Asymmetry Have the person smile or show his or her teeth. If one side doesn't
move as well as the other or it seems to droop, that could be sign
of a stroke.
Arm Drift Have the person close his or her eyes and hold his or her arms
straight out in front for about 10 seconds. Look for weakness or
drift.
Slurred Speech Have the person say, "You can't teach an old dog new tricks," or
some other simple, familiar saying. If the person slurs the words,
gets some words wrong, or is unable to speak, that could be sign
of stroke.
Time If any of the above 3 is present then patients are advised to seek
immediate hospital consultation.
22. Stroke Test or FAST test
A local version of "FAST" is "KAMBIO --
Sambitin at Gawin Upang Stroke ay Alamin"
KAmay Itaas ang kamay at obserbahan
kung may panghihina o "drift"
Mukha Ipakita ang ngipin o mag-Smile.
Tingnan kung may kaibahan ang
kaliwa sa kanang mukha.
Bigkas Bigkasin at ulitin "Kumukutikutitap
ang lampara". Obserbahan kung
may mali sa pananalita
Oras Kapag may nakitang mali, huwag
magpatumpiktumpik at humarurot
sa ospital.
27. INVESTIGATIONS
• full blood count, serum electrolytes, renal function
tests, cardiac enzymes, and coagulation studies
• Blood sugar is mandatory to exclude hypoglycemia or
diagnose diabetes mellitus
• Full blood count to detect Polycythaemia,ESR for
endocarditis,
• clotting studies for Hypercoagulable States
• An electrocardiogram (ECG) : arrhythmias and
myocardial infarction. Baseline ECG is recommended
in all patients with stroke(AHA/ASA Guidelines)
• Echocardiography : valve disease and intra-cardiac
clot
28. NEUROIMAGING
• Brain CT scan: CT is sensitive to the intracranial
blood and is readily available.
Normal early CT therefore rules out haemorrhagic
stroke. CT Scan changes in ischemic stroke may
take several days to develop.
• MRI: MRI is better at detecting posterior fossa
lesions especially in posterior circulation stroke
such as Pons or cerebellum
• It is also recommended that all patients with
transient neurologic symptoms have a
neuroimaging within 24 hours or as soon as
possible.(Class 1,LOE B)
30. Stroke management algorithm
Symptoms & signs suggestive of
Stroke
Symptoms & signs persist > 1 hour
Acute Care
Urgent Clinical Evaluation
Urgent brain CT
Blood tests
ECG
Ischaemic Stroke
Brain CT normal or shows
acute infarction
Haemorrhagic Stroke
( ICH / SAH )
Brain CT shows haemorhage
Specific Stroke therapy
Thrombolytic therapy ( if no
contraindications ,
Antiplatelet therapy
Neurosurgical
Evaluation & Treatment
31. Acute Stroke Care
Stroke Unit ( if available )
Airway , Breathing , Circulation
Hydration.
Blood Pressure monitoring
Neurological Status monitoring
Anticipate & treat complications
Begin rehabilitation
Neurorehabilitation
Multidisciplinary Team Approach
Proper Positioning
Early mobilization
Physiotherapy
Occupational therapy
Speech therapy
Treat spasticity
Treat depression
Further Investigations
Establish Stroke
subtype and underlying
cause
Cardio &
Cerebrovascular Risk
Assessment
Education
Patient &
Caregiver
Secondary Prevention
Antiplatelet therapy
Treat risk factors
Treat specific underlying cause
32. Primary Prevention
Factors recommendation
Hypertension Treat medically if BP>140mmHg systolic
and/or>90mmHg diastolic.
Lifestyle changes if BP between 130-139mmHg systolic
and/or 80-89mmHg diastolic.
Target BP for diabetics is <130mmHg systolic and
<80mmHg diastolic.
Hypertension should be treated in the very elderly(age
>70yrs) to reduce risk of stroke.
Diabetes mellitus Strict blood pressure control is important in diabetics.
Maintain tight glycaemic control.
Hyperlipidaemia High risk group keep LDL<2.6mmol/l.
1 or more risk factors: keep LDL<3.4mmol/l.
No risk faktor: keep LDL<4.2mmol/l.
Smoking Cessation of smoking.
33. Aspirin therapy 100mg aspirin every other day may be useful in women
above the age of 65
Post menopausal
Hormone
Replacement
therapy
Oestrogen based HRT is not recommended for primary
stroke prevention
Alcohol Avoid heavy alcohol consumption.
34. General Management of Acute Ischaemic
Stroke
Factors Recommendation
Airway &Breathing Ensure clear airway and adequate oxygenation.
Elective intubation may help some patients with severely
increased ICP.
Mobilization Mobilize early to prevent complications
Blood Pressure Do not treat hypertension if<220mmHg systolic
or<120mmHg diastolic. Mild hypertension is desirable at
160-180/90-100mmHg.
Blood pressure reduction should not be drastic.
Proposed substances: Labetolol 10-20 mg boluses at 10
minute intervals up to 150-300 mg or 1 mg/ml infusion, 1-
3 mg/min or Captopril 6.25-12.25 mg orally.
Blood Glucose Treat hyperglycaemia (Random blood glucose>11mmol/l)
with insulin.
Treat hypoglycaemia (Random blood glucose<3mmol/l)
with glucose infusion.
35. Nutrition Perform a water swallow test.
Insert a nasogastric tube if the patient fails the swallow test.
PEG is superior to nasogastric feeding only if prolonged
enteral feeding is required.
Infection Search for infection if fever appears and treat with
appropriate antibiotics early.
Fever Use anti-pyretics to control elevated temperatures.
Raised
Intracranial
Pressure
Hyperventilate to lower intracranial pressure.
Mannitoll (0.25 to 0.5 g/kg) intravenously administered over
20 minutes lowers intracranial pressure and can be given
every 6 hours.
If hydrocephalus is present, drainage of cerebrospinal fluid
via an intraventicular catheter can rapidly lower intracranial
pressure.
Hemicraniectomy and temporal lobe resection have been
used to control intracranial pressure and prevent herniation
among those patients with very large infarctions of cerebral
hemisphere.
Ventriculostomy and suboccipital craniectomy is effective in
relieving hydrocephalus and brain stem compression
caused large cerebellar infarctions.
36. Acute Stroke therapy
Treatment Recommendations
rt-Pa In selected patients presenting within 3 hours: IV rt-Pa
(0.9mg/kg, maximum 90mg ) with 10% given as a bolus
followed by an infusion over one hour.
Aspirin Start aspirin within 48 hours of stroke onset.
Use of aspirin within 24 hours of rt-Pa is not recommended
Anticoagulants The use of heparins (unfractionated heparin, low molecular
weight heparin or heparinoids) is not routinely
recommended as it does not reduce the mortality in
patients with acute ischaemic stroke.
Neuroprotective
Agents
A large number of clinical trials testing a variety of
neuroprotective agents have been completed. These trials
have thus far produced negative results.
To date, no agent with neuroprotective effects can be
recommended for the treatment of patient with acute
ischaemic stroke at this time.
37. Anti Coagulation following Acute
Cardioembolic Stroke
Treatment Recommendations
Aspirin All patients should be commenced on aspirin within 48 hours
of ischaemic stroke
Warfarin Adjusted-dose warfarin may be commenced within 2-4 days
after the patient is both neurologically and medically stable.
Heparin
(unfractionated)
Adjusted-dose unfractionated heparin may be sterted
concurrently for patients at very high risk of embolism.
Anticoagulation Anticoagulation may be delayed for 1-2 weeks if there has
been substantial haemorrhage.
Urgent routine anticoagulation with the goal of improving
neurological outcomes or preventing early recurrent stroke is
not recommended.
Urgent anticoagulation is not recommended for treatment of
patients with moderate-to-large cerebral infarcts because of a
high risk of intracranial bleeding complications
38. Secondary Prevention
Factors
Treatment
Recommendations
Antiplatelets
Single agent
Aspirin
Alternatives:
Clopidogrel
Ticlopidine
Double therapy
Aspirin+clopidogrel
The recommended dose of aspirin is 75mg to 325mg
daily.
The recommended dose is 75mg daily.
The recommended dose is 250mg twice a day.
In selected high risk patients only when benefit
outweighs risk
Anti-hypertensive
treatment
ACE-inhibitor based therapy should be used to
reduce recurrent stroke in normotensive and
hypertensive patients.
ARB-based therapy may benefit selected high risk
populations.
39. Lipid lowering Lipid reduction should be considered in
all subjects with previous ischaemic
strokes.
Diabetic control All diabetic patients with previous stroke
should improve glycaemic control.
Cigarette
smoking
All smokers should stop smoking.
40. Stroke in special circumstances
Treatment Recommendations
Aspirin Young Ischaemic stroke
If the cause is not identified, aspirin is usually given.
There are currently no guidelines on the appropriate
duration of treatment.
Heparin
Warfarin
Endovascular
thrombolysis
Cerebral Venous thrombosis
Anticoagulation appears to be safe, and cerebral
haemoffhage is not a contra-indication for
anticoagulation.
Simultaneous oral warfarin should be commenced.
The appropriate length of treatment is unknown.
It is currently considered for patients with extensive
disease and clinical deterioration
41. SURGICAL TREATMENT
• Surgical removal of hemorrhage with
cerebellar decompression for patients with
cerebellar hemorrhages, or with brainstem
compression
• Standard Craniotomy for patients with
supratentorial ICH,
42. PREVENTION AND MANAGEMENT OF
COMPLICATIONS
• Management of complications improves both
short-term and long-term prognosis.
• Complications of stroke can be divided into
General medical and Neurological
complications.
• They can also be divided into Acute(<7 days)
or subacute(>7days) based on time of
occurrence.
44. Key points
• Young stroke patients
• Time is at premium
• Early identification
• Early institution of Rx
• Good and very satisfying result
• Drug available ,Neuro-imaging available
• Previous cases encouraging result
Cerebrovascular accident: is the medical term for a stroke, also called “brain attack”. A stroke occurs when blood flow to a part of your brain is stopped either by a blockage or a rupture of a blood vessel. Thus, there would be sudden death of some brain cells due to lack of oxygen due to the blockage of the brain's blood flow.
A stroke is a medical emergency. Anyone suspected of having a stroke should be taken immediately to a medical facility for diagnosis and treatment.
-As mentioned, it occurs when blood flow to a part of your brain is stopped either by a blockage such as a floating clot (embolus) or a stationary clot (Thrombosis), or a rupture of a blood vessel(Hemorrhage), or compression.
. Symptoms of a stroke depend on the area of the brain affected.
-The most common symptom is weakness or paralysis of one side of the body with partial or complete loss of voluntary movement or sensation in a leg or arm. There can be speech problems and weak face muscles, causing drooling.
-Numbness or tingling is very common. A stroke involving the base of the brain can affect balance, vision, swallowing, breathing and even unconsciousness.
. The most common symptom is weakness or paralysis of one side of the body with partial or complete loss of voluntary movement or sensation in a leg or arm. There can be speech problems and weak face muscles, causing drooling. Numbness or tingling is very common. A stroke involving the base of the brain can affect balance, vision, swallowing, breathing and even unconsciousness.
Stroke symptoms (for example, loss of arm or leg function or slurred speech) signify a medical emergency because without treatment, blood deprived brain cells quickly become damaged or die resulting in brain injury, serious disability, or death.
-Stroke symptoms (for example, loss of arm or leg function or slurred speech) signify a medical emergency because without treatment, blood deprived brain cells quickly become damaged or die resulting in brain injury, serious disability, or death.
Anyone should consider stroke if they experience any of these symptoms:
1. Sudden N\numbness or weakness of the face, arms or leg, especially on one side of the body
2. Sudden Confusion, trouble speaking or understanding
3. Sudden trouble seeing in one or both eyes
4. Sudden trouble walking, dizziness, loss of balance or coordination
5.Sudden, severe headache with no known cause
-Similarly, it is important that the public are made aware on how to perform the Cincinnati Prehospital Stroke Scale which tests three signs that can indicate that the patient may be having stroke. If anyone of the three tests show an abnormal finding, the patient maybe having a stroke
MILD STROKE:
-Alert patients with any or combinations of symptoms such as:
-mild motor weakness of one side of the body, defined as:
>able to raise arm above shoulder
>has clumsy hand or
>can ambulate without assistance
-sensory deficit,
-slurred but intelligible speech,
-vertigo with incoordination (e.g. gait disturbances, unsteadiness or clumsy hand)
-visual field defects alone
- NIHSS score= 0-5
MODERATE SROKE:
-Awake patient with significant motor and /or sensory and /or visual deficit, or
-Disoriented, drowsy, or light stupor with purposeful response to painful stimuli, or
-NIHSS Score= 6-21
SEVERE STROKE:
- Deep stupor or comatose patient with non-purposeful response, decorticate, or decerebrate posturing to painful stimuli, or
- Comatose patient with no response to painful stimuli , or
-NIHSS Score= >22
Stroke Test or FAST test : Smile, Wave, Talk The F.A.S.T. test helps spot symptoms. It stands for: F means face: If one side of the face droops, it’s a sign of a possible stroke A means arms: If the person cannot hold both arms out, it’s another possible stroke sign S means speech: Slurring words and poor understanding of simple sentences is another possible stroke sign T means time: If any of the FAS signs are positive, it’s Time to call 9-1-1 immediately
This is the Philippine version of FAST.
Stroke: Time = Brain Damage, that is why it important to remember the FAST test for stroke; the T in FAST also means the longer time the blockage of blood (usually due to clot formation) to the brain, the more damage to the brain can occur. In some qualified patients, the use of a clot-busting drug may be used to dissolve the clot and restore blood flow. For many patients, the time span to diagnose and treat such a clot is usually 3 hours (some clinicians suggest a bit longer time). Often, patients do not qualify for this treatment. There are also some risks like bleeding associated with this treatment that may cause problems. Because treatments are sometimes difficult to qualify for and because damage to brain cells can happen quickly, strokes are a leading cause of long-term disability in people.
The NIHSS has a Total Score=42;
Mild Stroke: 0-5
Moderate Stroke: 6-21
Severe Stroke:>22
Aphasia: ask the patient to describe what is happening on the picture and name items.
Dysarthria : Ask the patient to read or repeat words from the list.
Modified Rankin Scale: measures independence rather than performance of specific tasks.
Scale consists of six grades from 0-5; 0 denotes no symptoms and 5 indicates severe disability.
For clinical purpose, mild disability range is from 0-2; moderate disability ranges from 3-4 and 5 indicates severe disabilityModified Rankin Scale
MANAGEMENT OF SAH
Bed rest Analgesic
Blood pressure control
TRIPLE – H therapy(hypervolemia , induced hypertension, hemodilution )
Oral nimodipine 60mg q6hx21 days
Angiography for localization of bleeding
If aneurysm
Immediate surgical clipping for
Grade 1-3 patient without contraindication
Grade 4-5 with intracerebral clot and deterioratio
Secondary prevention of stroke
Management of hypertension (goal <140/85 mm Hg)
Diabetes control (goal<126 mg/dL)
Lipid management: Statins (goal cholesterol<200 mg/dL, LDL<100 mg/dL)
Anticoagulants: Warfarin (target INR 2 to 3); esp. recommended in patients with cardioembolic stroke
Appropriate life style modification (cessation of smoking, exercise, diet etc)
Antiplatelet agents:Antiplatelet agents such as aspirin(300mg) reduce the risk of recurence of all ischaemic stroke & for patients with TIAs.
Aspirin is not useful for preventing a first stroke in persons at low risk (Class III; Level of Evidence A).
Secondary prevention of stroke
Management of hypertension (goal <140/85 mm Hg)
Diabetes control (goal<126 mg/dL)
Lipid management: Statins (goal cholesterol<200 mg/dL, LDL<100 mg/dL)
Anticoagulants: Warfarin (target INR 2 to 3); esp. recommended in patients with cardioembolic stroke
Appropriate life style modification (cessation of smoking, exercise, diet etc)
Antiplatelet agents:Antiplatelet agents such as aspirin(300mg) reduce the risk of recurence of all ischaemic stroke & for patients with TIAs.
Aspirin is not useful for preventing a first stroke in persons at low risk (Class III; Level of Evidence A).
Surgical removal of hemorrhage with cerebellar decompression should be performed for patients with cerebellar hemorrhages greater than 3 cm in diameter who are deteriorating, or who have brainstem compression and/or hydrocephalus due to ventricular obstruction
For patients with supratentorial ICH, current guidelines suggest consideration of standard craniotomy only for those who have lobar clots >30 mL within 1 cm of the surface.
Mortality at 30 days in general compared with conservative management is not different.