University of Kirkuk By: Dr.

Abd Kumet
College of nursing Dr. Youes Kheder
2019-2020 / 4th class Dr. Yousif Salih
Critical care nursing (8)

Neurological disorder
Stroke and Gillian barre syndrome
Stroke:
Blood Supply to the Brain

What is a stroke?
Stroke is a sudden interruption of the blood supply to the brain. Most strokes are caused by
an abrupt blockage of an artery (ischemic stroke). Other strokes are caused by bleeding into brain
tissue when a blood vessel bursts (hemorrhagic stroke). The effects of a stroke depend on the

severity and which area of the brain is injured.

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University of Kirkuk By: Dr. Abd Kumet
College of nursing Dr. Youes Kheder
2019-2020 / 4th class Dr. Yousif Salih
Critical care nursing (8)

Types of Stroke
1- Ischemic Stroke: (most common - 87% of cases)
Ischemic stroke is the most common type of stroke. An ischemic stroke happens when
an artery in the brain is blocked. There are two types of ischemic stroke:
a- Embolic Stroke: In an embolic stroke, a blood clot or plaque fragment forms, usually
in the heart or the large arteries leading to the brain, and then moves through the arteries
to the brain. In the brain, the clot blocks a blood vessel and leads to a stroke.
b- Thrombotic Stroke: (less common - 13% of cases) a thrombotic stroke is a blood
clot that forms inside an artery that supplies blood to the brain. The clot interrupts blood
flow and causes a stroke.
2- Hemorrhagic stroke: A hemorrhagic stroke happens when a blood vessel in the
brain bursts and spills blood into or around the brain. There are different types of
hemorrhagic stroke, including intracerebral hemorrhage and subarachnoid hemorrhage.

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University of Kirkuk By: Dr. Abd Kumet
College of nursing Dr. Youes Kheder
2019-2020 / 4th class Dr. Yousif Salih
Critical care nursing (8)

Stroke Risk Factors That Cannot Be Treated

1- Age
2-Sex
3- Race
4- Prior stroke
5- Family history
Stroke Risk Factors That Can Be Treated
1-Hypertension/High Blood Pressure
2-Heart Disease
3- Cigarette Smoking
4- Transient Ischemic Attacks

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University of Kirkuk By: Dr. Abd Kumet
College of nursing Dr. Youes Kheder
2019-2020 / 4th class Dr. Yousif Salih
Critical care nursing (8)

5- Diabetes
6- Elevated Blood Cholesterol/Lipids
7-Asymptomatic Carotid Bruits

What are the symptoms?

Stroke symptoms may occur alone or in a combination and may last a few minutes or
several hours.
1-Sudden weakness or numbness of the face, arm or leg, usually on one side
2-Difficulty speaking or understanding language
3-Decreased or blurred vision in one or both eyes
4-Sudden, severe headache
5-Unexplained loss of balance or dizziness

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University of Kirkuk By: Dr. Abd Kumet
College of nursing Dr. Youes Kheder
2019-2020 / 4th class Dr. Yousif Salih
Critical care nursing (8)

How Are Strokes Treated?

1- Ischemic Stroke
• Clot-busters e.g., t-PA
• Anticoagulants – warfarin
• Carotid Endarterectomy
• Angioplasty/Stents
2- Hemorrhagic Stroke
• Surgical Intervention
• Endovascular Procedures, e.g., “coils”
3- Rehabilitation

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University of Kirkuk By: Dr. Abd Kumet
College of nursing Dr. Youes Kheder
2019-2020 / 4th class Dr. Yousif Salih
Critical care nursing (8)

Guillain-Barre syndrome:
Guillain-Barre (gee-YAH-buh-RAY) syndrome is a rare disorder in which your body's
immune system attacks your nerves. Weakness and tingling in your extremities are
usually the first symptoms.
These sensations can quickly spread, eventually paralyzing your whole body.

The exact cause of Guillain-Barre syndrome is unknown. But it is often preceded by an

infectious illness such as a respiratory infection or the stomach flu.

There's no known cure for Guillain-Barre syndrome, but several treatments can ease
symptoms and reduce the duration of the illness.
Symptoms
Signs and symptoms of Guillain-Barre syndrome may include:

1- Prickling, pins and needles sensations in your fingers, toes, ankles or wrists
2- Weakness in your legs that spreads to your upper body
3- Unsteady walking or inability to walk or climb stairs
4- Difficulty with eye or facial movements, including speaking, chewing or swallowing
5-Severe pain that may feel achy or cramplike and may be worse at night
6- Difficulty with bladder control or bowel function
7- Rapid heart rate
8- Low or high blood pressure
9-Difficulty breathing

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University of Kirkuk By: Dr. Abd Kumet
College of nursing Dr. Youes Kheder
2019-2020 / 4th class Dr. Yousif Salih
Critical care nursing (8)

Types
1- Acute inflammatory demyelinating polyradiculoneuropathy (AIDP), the most
common sign of AIDP is muscle weakness that starts in the lower part of your
body and spreads upward.
2- Miller Fisher syndrome (MFS), in which paralysis starts in the eyes. MFS is also
associated with unsteady gait.
3- Acute motor axonal neuropathy (AMAN) and acute motor-sensory axonal
neuropathy (AMSAN)
Risk factors
Guillain-Barre syndrome can affect all age groups. But you're at slightly greater risk
if:You're a man,You're a young adult
Guillain-Barre syndrome may be triggered by:

a- Most commonly, infection with campylobacter, a type of bacteria often found in

undercooked poultry
b- Influenza virus
c- Cytomegalovirus
d- Epstein-Barr virus
e- Zika virus
f- Hepatitis A, B, C and E
g- HIV, the virus that causes AIDS
h- Mycoplasma pneumonia
i- Surgery
j- Hodgkin's lymphoma
k- Rarely, influenza vaccinations or childhood vaccinations
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University of Kirkuk By: Dr. Abd Kumet
College of nursing Dr. Youes Kheder
2019-2020 / 4th class Dr. Yousif Salih
Critical care nursing (8)

Complications: -
1- Breathing difficulties.
2- Residual numbness or other sensations.
3- Heart and blood pressure problems.
4- Pain.
5- Bowel and bladder function problems.
6- Blood clots.
7- Pressure Sores.
8- Relapse
Diagnosis
1- Spinal tap (lumbar puncture).
2- Electromyography.
3- Nerve conduction studies.
Treatment
There's no cure for Guillain-Barre syndrome. But many of treatments can speed
recovery and reduce the severity of the illness:
a- Plasma exchange (plasmapheresis). The liquid portion of part of your blood
(plasma) is removed and separated from your blood cells.
b- Immunoglobulin therapy. Immunoglobulin containing healthy antibodies from
blood donors is given through a vein (intravenously).
c- given medication to Relieve pain
d- Prevent blood clots
e- Physical help and therapy before and during recovery.