2. Stroke
Alternative names: Cerebrovascular accident/
disease (CVA), Cerebral infarction, Cerebral
hemorrhage.
An ischemic stroke occurs when the blood supply to
part of the brain is blocked or reduced. This
prevents brain tissue from getting oxygen and
nutrients. Brain cells begin to die in minutes.
Another type of stroke is a hemorrhagic stroke. It
occurs when a blood vessel in the brain leaks or
bursts and causes bleeding in the brain. The blood
increases pressure on brain cells and damages
them.
3. SYMPTOMS
Symptoms of stroke include:
1. Trouble speaking and understanding what others
are saying. A person having a stroke may be confused,
slur words or may not be able to understand speech.
2. Numbness, weakness or paralysis in the face,
arm or leg. This often affects just one side of the body.
The person can try to raise both arms over the head. If
one arm begins to fall, it may be a sign of a stroke.
Also, one side of the mouth may droop when trying to
smile.
3. Problems seeing in one or both eyes. The person
may suddenly have blurred or blackened vision in one
or both eyes. Or the person may see double.
4. Headache
5. Trouble walking
4. CLASSIFICATION
STROKES CAN BE CLASSIFIED INTO 2 MAIN CATEGORIES:
ISCHEMIC STROKES. THESE ARE STROKES CAUSED BY BLOCKAGE
OF AN ARTERY (OR, IN RARE INSTANCES, A VEIN). ABOUT 87% OF
ALL STROKES ARE ISCHEMIC.
HEMORRHAGIC STROKE. THESE ARE STROKES CAUSED BY
BLEEDING. ABOUT 13% OF ALL STROKES ARE HEMORRHAGIC.
5. Ischemic strokes are further divided into 2 groups:
Thrombotic strokes. These are caused by a blood clot that develops in the
blood vessels inside the brain.
Embolic strokes. These are caused by a blood clot or plaque debris that
develops elsewhere in the body and then travels to one of the blood vessels
in the brain through the bloodstream.
6. Thrombotic stroke
Thrombotic strokes are strokes caused by a thrombus (blood clot) that develops
in the arteries supplying blood to the brain. This type of stroke is usually seen
in older persons, especially those with high cholesterol and atherosclerosis (a
buildup of fat and lipids inside the walls of blood vessels) or diabetes.
Sometimes, symptoms of a thrombotic stroke can occur suddenly and often
during sleep or in the early morning. At other times, it may occur gradually
over a period of hours or even days.
7. Embolic stroke
Embolic strokes are usually caused by a blood clot that forms elsewhere in the
body (embolus) and travels through the bloodstream to the brain. Embolic
strokes often result from heart disease or heart surgery and occur rapidly and
without any warning signs. About 15% of embolic strokes occur in people with
atrial fibrillation, a type of abnormal heart rhythm in which the upper
chambers of the heart do not beat effectively.
8. (A) Physical
Examination
Demographic
data
Vital signs
History taking
Crania
assessment
DIAGNOSIS
COMPUTED TOMOGRAPHY (CT) USES X-RAYS TO TAKE CLEAR, DETAILED
PICTURES OF YOUR BRAIN. IT IS OFTEN DONE RIGHT AFTER A SUSPECTED
STROKE. A BRAIN CT SCAN CAN SHOW WHETHER THERE IS BLEEDING IN THE
BRAIN OR DAMAGE TO THE BRAIN CELLS FROM A STROKE.
MAGNETIC RESONANCE IMAGING (MRI) USES MAGNETS AND RADIO WAVES
TO CREATE PICTURES OF YOUR BRAIN. AN MRI MAY BE USED INSTEAD OF —
OR IN ADDITION TO — A CT SCAN TO DIAGNOSE A STROKE. THIS TEST CAN
IDENTIFY CHANGES IN BRAIN TISSUE AND DAMAGE TO BRAIN CELLS.
OTHER IMAGING TESTS MAY INCLUDE DIGITAL SUBTRACTION ANGIOGRAPHY
(DSA) AND POSITRON EMISSION TOMOGRAPHY (PET) TO LOOK FOR
NARROWED BLOOD VESSELS IN THE NECK, AN ANEURYSMS , OR AN
ARTERIOVENOUS MALFORMATION (AVM, OR TANGLED BLOOD VESSELS) IN
THE BRAIN.
9. (A) MEDICATION
2.Anticoagulant 3. Statin
TREATMENT
ANTI-PLATELET DRUGS. Platelets are cells in the blood that form clots. Anti-platelet
medicines make these cells less sticky and less likely to clot. The most commonly
used anti-platelet medicine is aspirin. professional can recommend the right dose of
aspirin.
If TIA or minor stroke,take both an aspirin and an anti-platelet medicine such as
clopidogrel (Plavix). These medicines may be prescribed for a period of time to
reduce the risk of another stroke. If can't take aspirin, may be prescribed clopidogrel
alone. Ticagrelor (Brilinta) is another anti-platelet medicine that can be used for
strANTI-PLATELET oke prevention.
Blooding-thinning medicines, known as anticoagulants.
10. General Management of Patients with Acute Stroke
Blood glucose • Treat hypoglycemia with D5
• Treat hyperglycemia with insulin if
serum glucose >200 mg/dL
Blood pressure recommendations for thrombolysis
candidates and noncandidates
Cardiac monitor Continuous monitoring for ischemic
changes or atrial fibrillation
Intravenous fluids Avoid D5W and excessive fluid
administration
IV isotonic sodium chloride solution at
50 mL/h unless otherwise indicated
Oral intake NPO initially; aspiration risk is great,
avoid oral intake until swallowing
assessed
Oxygen Supplement if indicated (Sa02< 94%)
Temperature Avoid hyperthermia; use oral or rectal
acetaminophen and cooling blankets as
needed
