Professional Documents
Culture Documents
Family history of stroke Precipitating factors: 1.Hypertension 2. Heart disease (atrial fibrillation) 3. Diabetes mellitus 4. Sleep apnea 5. Blood cholesterol levels 6. Smoking 7. Sickle cell disease 8. Substance abuse 9. Living in the stroke belt 10. Prior stroke, carotid stenosis, and a history of TIA 11.Heavy alcohol consumption 12. Obesity 13. Specific to women: oral contraceptive use, pregnancy, childbirth,menopause, migraine headaches with aura, autoimmune d/os (diabetes and lupus), clotting factor disorders
Atherosclerosis
Atherosclerotic plaques
STENOSIS
THROMBUS FORMS
CAN DEVELOP ANYWHERE small, deep penetrating arteries( lenticulostriate arteries) from the middle cerebral artery LACUNAR STROKE OCCLUSION thrombus may remain in place and continue to enlarge
common site: internal carotid artery, vertebral arteries and the junction of the vertebral and basilar arteries
INFARCTION
DIE
only minor deficits are seen since these areas are very small
more severe manifestations may develop including paralysis and sensory loss
EMBOLUS
carried through the arterial system ISCHEMIC CASCADE Brain BEGINS WHEN
lodged in a vessel too narrow to permit further movement (most common site: left middle cerebral artery)
neurons can no longer maintain aerobic respiration Mitochondria switch Anaerobic respiration
not absorbed by the body large amounts of lactic acid manifestations will persist change in the pH level >drowsiness, stupor, coma RENDERS >contralateral hemiplegia of the arm and face neuron incapable of producing >contralateral sensory sufficient quantities of deficits of the arm and face adenosine triphosphate >global aphasia (if dominant (ATP) hemisphere is involved) >homonymous hemianopia NA- K pump fails
release of glutamate
IF CONTINUED
generation of free radicals, vasoconstriction, release of more calcium and glutamate, destruction of the cell membrane
MINI STROKE/ TRANSIENT ISCHEMIC If managed: tPA, ATTACK
displaces brain tissue Inflammatory reaction impairing absorption and circulation of CSF decreases cerebral blood flow
infarction
>contralateral numbness or weakness of the leg, hand, forearm and corner of the mouth( middle cerebral artery involvement) >aphasia (ischemia of the left hemisphere); >visual disturbances such as blurring (posterior cerebral artery involvement) IF NOT MANAGED
>weakness of one side (including the face, arm and leg) Putaminal & >slurred speech Internal >deviation of the capsule eyes
SEVERE HEMORRHAGE >hemiplegia >fixed and dilated pupils >abnormal body posturing >coma
Hemiplegia with more thalamus sensory than motor loss release of metalloprotease (zinc & calcium- dependent enzymes)
severe headache, vomiting, loss of ability to walk, dysphagia, dysarthria, cerebellum eye movement disturbances
CEREBRAL EDEMA
VASCULAR CONGESTION
Compression of tissue
Middle Cerebral Artery Lateral hemisphere, Frontal, parietal And temporal Lobes, basal ganglia
Occipital lobe; Branches into opthalmic, Anterior & medial PCA, anterior Portion of temporal Choroidal,ACA, MCA lobe
Contralateral hemiparesis or hemiplegia, unilateral Neglect, altered consciousness, homonymous anopsia, inability to turn eyes toward affected side, Vision changes, dyslexia, Dysgraphia, Aphasia, agnosia, Memory deficits, vomiting
Contralateral Alternating motor Hemiparesis, Weaknesses, Mild contralateral Foot and leg deficits Contralateral Ataxic gait, Hemiparesis, greater than the arm, Hemiparesis w/ dysmetria, Intention tremor, foot drop, Contralateral Facial asymmetry, Diffuse sensory gait disturbances, Hemisensory Contralateral Loss, Contralateral Impairments, Sensory Pupillary dysfunction, Hemisensory Double vision, Alterations, Loss of conjugate Alterations, Homonymous Homonymous Gaze, nystagmus, Deviation of Hemianopia, Hemianopsia, Loss of depth Eyes toward Nystagmus, Perception, Ipisilateral periods Conjugate gaze, Affected side, Cortical blindness, Expressive of blindness, Paralysis, Homonymous Aphasia, aphasia Dysarthria, Hemianopsia, Confusion, If dominant Memory loss, Perseveration, Amnesia, Hemisphere Disorientation, dyslexia, Flat affect, Tinnitus, is involved, Memory deficits, Apathy, shortened Hearing loss, Horner's Visual hallucinations Attention span, dysphagia, syndrome Incontinence, acuity vertigo,coma Carotid bruits Apraxia, acuity
Ipsilateral Ataxia, facial Paralysis, Ipsilateral loss of sensation in face, Sensation changes on Trunk and limbs, Nystagmus, Horner's syndrome, Tinnitus, hearing loss
Ataxia, paralysis Of the larynx And soft palate, Ipsilateral Loss of sensation In face, Contralateral on Body, Nystagmus, dysarthria, Horner's Syndrome, Hiccups And coughing, Vertigo, Nausea And vomting
If managed: Palliative care- monitoring v/s and neurovital signs, intubation, ICP monitoring, intubation, Mechnical ventilation, vasodilators, Osmotic, diuretics, ventriculostomy
If not managed
Cardiovascula r system
Pulmonary system
GIT
GUT
Other systems
Neurogenic bladder
Bradycardia
Restlessness, abnormal Thermoregulation, Mental Confusion, Increase Secretions, Decreased urinary output
Systemic failure
DEATH