Stroke

by Pelison Matuguinas SN,

 Condition in which neurologic deficits result from sudden decrease in blood flow to a localized area of brain. ISCHEMIC : Blood supply to a part of the brain is suddenly interrupted by a blood clot or embolus STENOSIS : Narrowing of Blood vessel Hemorrhagic : Blood vessels breaks open

Risk Factors
Hpn due to systolic and diastolic Bp are associated w/ damage to all Blood vessel. Heart Dse such as atrial fibrilation. Diabetes Mellitus It leads to vascular changes in both systemic and cerebral circulation. Sleep Apnea - bp and causes O2 and CDO in blood Smoking can trigger ischemic stroke.

Pathophysiology
The Brain = 2% TBW; 20% Cardiac Output/Min (750ml)
Cerebral Blood Flow Largely self-regulated by the brain to meet metabolic needs(autoregulation) It is not effective when systemic BP is <50mmHg or > 160mmHg in cerebral Blood flow Cardiac Output Oxygenation of cerebral neurons are decreased Changes at cellular level take place in 4 to 5mins(glucose,glycogen,ATP are and the NaK pump fails) Sodium into cell Cerebral Blood vessel also swell Blood flow

 The neurologic deficits that occur as a result of a stroke can often be used to identify its location > Motor pathways cross at junction of the medulla and spinal cord ( Decussation ) > Strokes lead to loss/impairment of sensori motor functions on the side of the brain that is damaged ( Contralateral Deficit)

Types of Stroke
Ischemic Stroke- Blockage of cerebral artery ,

blood flow. a) Transient Ischemic Attack (TIA) (Mini-stroke) - Brief period of localized cerebral ischemia that causes neurologic deficits( <24hrs) - A warning sign for ischemic thrombotic.

Manifestation have sudden onset - Middle Cerebral Artery Weakness of leg, hand, forearm. - Left Hemisphere Aphasia - Posterior Cerebral Artery Visual Disturbances. Amaurosis Fugax Fleeting blindness of one eye, desribe as a shyade coming down over vision with the affected eye.

 Thrombotic Stroke- Occlusion

of a large cerebral vessel by a thrombosis(blood Clot). - Common in adult during Sleep coz BP is lowered down.
Thrombi in large arteries
Narrowed lumens Deposits of atherosclerosic plaque

It involves the intima of the artery To become thin Platelets adhere it that releases ADP Thrombus form

Remain in place and cont. to enlarge

If removed became an embolus.

Complication
It may be transient or permanent depending on the damaged as well as the treatment. SENSORI PERCEPTUAL DEFICIT - Hemianopia loss of half of the visual of one or both eye.

field

- Agnosia- the inability to recognize one or more subjects were previously familiar. -Apraxia- inability to carry out some motor pattern. Bitemporal hemianopia Homonymous Hemianopia - Proprioception the body sense of its position.

 COMMUNICATION DISORDER - Aphasia- Inability to use/ understand language a) Expressive motor speech prob which can understand but respond in short phases. b) Receptive- which one cannot understand the spoken/written. c) Mixed/Global- Language dysfunction in both understanding and expressive.

MOTOR DEFICITS
- Hemiplegia- paralysis of the left /right half of the body. - Hemiparesis- Weakness of the left/right of the body. -Flaccidity Absence of muscle tone. - Spasticity- Increase muscle tone.

MEDICATION
- Anti-platelet Aspirin, clopidogrel(plavix), dipyridamole(persantine), ticlopidine(ticlid). - Anticoagulant- Warfarin.

Diagnostic Test
- CT scan - Lumbar puncture

Nursing Intervention
ADL ROM Nutrition Hollistic Care v/s (pulse rate) LOC