STROKE

DEFINITION
A stroke, previously known medically as a
cerebrovascular accident (CVA), is the
rapidly developing loss of brain function(s)
due to disturbance in the blood supply to the
brain. This can be due to ischemia (lack of
blood flow) caused by blockage (thrombosis,
arterial embolism), or a hemorrhage (leakage
of blood).
 As a result, the affected area of the brain is
unable to function, leading to
inability to move one or more limbs on one side of the
body
, inability to understand or formulate speech, or an
inability to see one side of the visual field.

A stroke is a medical emergency and can cause

permanent neurological damage, complications, and
lead to death. It is the leading cause of adult disability
PATHOPHYSIOLOGY
Hemorrhagic Ischemic

2
Types
of
Stroke
Ischemic Stroke
 Hemorrhagic stroke
Hemorrhagic strokes result in tissue injury by
causing compression of tissue from an expanding
hematoma or hematomas. This can distort and
injure tissue. In addition, the pressure may lead to
a loss of blood supply to affected tissue with
resulting infarction, and the blood released by
brain hemorrhage appears to have direct toxic
effects on brain tissue and vasculature.
 Head CT showing deep intracerebral hemorrhage due to

bleeding within the cerebellum, approximately 30 hours old.

MANIFESTATION
DIAGNOSIS
Stroke is diagnosed through several techniques: a
neurological examination (such as the Nihss), CT scans
(most often without contrast enhancements) or MRI scans,
Doppler ultrasound, and arteriography.

The diagnosis of stroke itself is clinical, with

assistance from the imaging techniques. Imaging
techniques also assist in determining the subtypes and
cause of stroke. There is yet no commonly used blood test
for the stroke diagnosis itself, though blood tests may be
of help in finding out the likely cause of stroke.
1) Physical examination
A physical examination, including taking
a medical history of the symptoms and a
neurological status, helps giving an
evaluation of the location and severity of a
stroke. It can give a standard score on e.g.
the NIH stroke scale.
2) Imaging
 CT Scan
 MRI Scan
What is the difference
between CT scan and
MRI scan?
Answer:

CT scans use specialized type of x-

ray while MRI scans use magnets and
radio waves to create the images.  No x-
rays are used in an MRI scanner. 
 TREATMENT
1) Stroke Unit

Ideally, people who have had a

stroke are admitted to a "stroke unit", a
ward or dedicated area in hospital staffed
by nurses and therapists with experience
in stroke treatment. It has been shown
that people admitted to a stroke unit have
a higher chance of surviving than those
admitted elsewhere in hospital, even if
they are being cared for by doctors
without experience in stroke.
for ischemic stroke:
2) Thrombolysis /
Thrombectomy
An ischemic stroke is caused by a thrombus
(blood clot) occluding blood flow to an artery
supplying the brain. Definitive therapy is aimed
at removing the blockage by breaking the clot
down (thrombolysis), or by removing it
mechanically (thrombectomy). The more rapidly
blood flow is restored to the brain, the fewer
brain cells die.
3) Medications

Other medical therapies

are aimed at minimizing clot
enlargement or preventing
new clots from forming. To
this end, treatment with
medications such as aspirin,
clopidogrel and dipyridamole
may be given to prevent
platelets from aggregating.
4) Management of acute stroke includes
control of blood sugars, ensuring the patient
has adequate oxygenation and adequate
intravenous fluids. Patients may be positioned
with their heads flat on the stretcher, rather
than sitting up, to increase blood flow to the
brain. It is common for the blood pressure to be
elevated immediately following a stroke.
Although high blood pressure may cause some
strokes, hypertension during acute stroke is
desirable to allow adequate blood flow to the
brain.
for hemorrhagic stroke:

5) Patients with intracerebral hemorrhage

require neurosurgical evaluation to detect and treat
the cause of the bleeding, although many may not
need surgery. Anticoagulants and antithrombotics,
key in treating ischemic stroke, can make bleeding
worse and cannot be used in intracerebral
hemorrhage. Patients are monitored for changes in
the level of consciousness, and their blood
pressure, blood sugar, and oxygenation are kept at
optimum levels.
END