Haider Badr Stroke Fourth Stage

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A stroke occurs when a blood vessel in the brain ruptures and bleeds, or when
there’s a blockage in the blood supply to the brain. The rupture or blockage
prevents blood and oxygen from reaching the brain’s tissues.

There are three primary types of strokes:

 Ischemic stroke involves a blockage caused by either a clot or plaque in the

artery. The symptoms and complications of ischemic stroke can last longer
than those of a TIA, or may become permanent.
 Transient ischemic attack (TIA) involves a blood clot that typically
reverses on its own.
 Hemorrhagic stroke is caused by either a burst or leaking blood vessel that
seeps into the brain.
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Transient ischemic attack (TIA)

A transient ischemic attack, often called a TIA or ministroke, occurs when blood
flow to the brain is blocked temporarily.

Embolism and Thrombosis

 There are two types of blockagesTrusted Source that can lead to ischemic
stroke: a cerebral embolism and cerebral thrombosis.
 A cerebral embolism (often referred to as embolic stroke) occurs when a
blood clot forms in another part of the body — often the heart or arteries in
the upper chest and neck — and moves through the bloodstream until it hits
an artery too narrow to let it pass.
 The clot gets stuck, and stops the flow of blood and causes a stroke.
 Cerebral thrombosis (often referred to as thrombotic stoke) occurs when a
blood clot develops at the fatty plaque within the blood vessel.

Risk Factors

The following are the nonmodifiable and modifiable risk factors of

Cerebrovascular accident:

Nonmodifiable risk factors

 Advanced age (older than 55 years)

 Gender (Male)
 Race (African American)

Modifiable risk factors

 Hypertension
 Atrial fibrillation
 Hyperlipidemia
 Obesity
 Smoking
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 Diabetes
 Asymptomatic carotid stenosis and valvular heart disease (eg, endocarditis,
prosthetic heart valves)
 Periodontal disease

Pathophysiology

The disruption in the blood flow initiates a complex series of cellular metabolic
events.

Cerebrovascular accident (CVA)

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 Decreased cerebral blood flow. The ischemic cascade begins when
cerebral blood flow decreases to less than 25 mL per 100g of blood per
minute.
 Aerobic respiration. At this point, neurons are unable to maintain aerobic
respiration.
 Anaerobic respiration. The mitochondria would need to switch to
anaerobic respiration, which generates large amounts of lactic acid, causing
a change in pH and rendering the neurons incapable of producing sufficient
quantities of ATP.
 Loss of function. The membrane pumps that maintain electrolyte balances
fail and the cells cease to function.

Assessment and Diagnostic Findings

Ask patient or a family member about symptoms and what him \ here doing when
they arose. take medical history to find out stroke risk factors. also:

 ask what medications him \ here take

 check patient blood pressure
 listen to patient heart sound

during physical examination will evaluate patient for:

 balance
 coordination
 weakness
 numbness in arms, face, or legs
 signs of confusion
 vision issues
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others diagnostic procedures

 Carotid ultrasound: also called a carotid duplex scan, can show fatty
deposits (plaque) in carotid arteries, which supply the blood to face,
neck, and brain.

 CT scan.
 MRI. Shows areas of infarction, hemorrhage, AV malformations, and areas
of ischemia.
 Cerebral angiography.
 Lumbar puncture.
 Transcranial Doppler ultrasonography. Evaluates the velocity of blood
flow through major intracranial vessels;
 EEG.
 Skull x-ray. May show a shift of pineal gland to the opposite side from an
expanding mass;
 ECG and echocardiography. To rule out cardiac origin as source of
embolus (20% of strokes are the result of blood or vegetative emboli
associated with valvular disease, dysrhythmias, or endocarditis).
 Laboratory studies to rule out systemic causes: CBC, platelet
and clotting studies, VDRL/RPR, erythrocyte sedimentation rate (ESR),
chemistries (glucose, sodium).

Signs & Symptoms of Ischemic Stroke

 Severe headache without a known cause

 Numbness or weakness of the face, arm or leg, especially on one side of
the body
 Confusion
 Trouble walking, dizziness, loss of balance or coordination
 paralysis
 trouble speaking or understanding others
 slurred speech
 disorientation, or lack of responsiveness
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 sudden behavioral changes, especially increased agitation
 vision problems, such as trouble seeing in one or both eyes with vision
blackened or blurred, or double vision
 trouble walking
 loss of balance or coordination
 seizures
 nausea or vomiting

Treatment of ischemic stroke

 Thrombolytic drugs can break up blood clots in brain’s arteries, which still
stop the stroke and reduce damage to the brain.

One such drug, tissue plasminogen activator (tPA), or Alteplase IV r-tPA, is

considered the gold standard Trusted Source in ischemic stroke treatment.

This drug works by dissolving blood clots quickly.

 Mechanical thrombectomy

During this procedure, a doctor inserts a catheter into a large blood vessel inside
your head. They then use a device to pull the clot out of the vessel. This surgery is
most successful if it’s performed 6 to 24 hoursTrusted Source after the stroke
begins.

 Stents

If a doctor finds where artery walls have weakened, they may perform a procedure
to inflate the narrowed artery and support the walls of the artery with a stent.

Other Medical Management

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Patients who have experienced TIA or stroke should have medical management for
secondary prevention.

 Increased ICP. Management of increased ICP includes osmotic diuretics,

maintenance of PaCO2 at 30-35 mmHg, and positioning to avoid hypoxia
through elevation of the head of the bed.
 Endotracheal Tube. There is a possibility of intubation to establish patent
airway if necessary.
 Hemodynamic monitoring. Continuous hemodynamic monitoring should
be implemented to avoid an increase in blood pressure.
 Neurologic assessment to determine if the stroke is evolving and if other
acute complications are developing
 carotid endarterectomy: This traditional treatment is used to remove
atherosclerotic plaque from the carotid artery when the vessel is narrowed or
blocked. The surgeon makes an incision in the neck, the artery is opened and
the plaque is removed. It has recently been proven that for certain patients
with minor strokes or TIAs, carotid endarterectomy is highly beneficial in
preventing future strokes. This procedure is also beneficial for some patients
with blockage of the carotid arteries who have not had previous symptoms.
 Revascularization (bypass): This technique is used to establish a new route
for blood to reach the brain, usually by grafting another vessel to a cerebral
artery.