Stroke (Cerebrovascular Accident)

Stroke (Cerebrovascular Accident)

Stroke occurs when there is an ischemia (inadequate blood flow) to a part of the brain or hemorrhage into the brain that results in death of brain cells. Functions such as movement, sensation, or emotions that were controlled by the affected area of the brain are lost or impaired. The severity of the loss of function varies according to the location and extent of the brain involved. Following the onset of a stroke, immediate medical attention is crucial to reduce disability and death.

Definition

Stroke or Cardiovascular Accident (CVA) is the onset and persistence of neurologic dysfunction lasting longer than 24 hours and resulting from disruption of blood supply to the brain.

Types and Causes

Ischemic Stroke : About 80 percent of strokes are ischemic strokes. A stroke may be caused by a blocked artery (ischemic stroke)

Thrombotic stroke: A thrombotic stroke occurs when a blood clot (thrombus) forms in one of the arteries that supply blood to brain. A clot may be caused by fatty deposits (plaque) that build up in arteries and cause reduced blood flow (atherosclerosis) or other artery conditions.

An Embolic Stroke: Occurs when a blood clot or other debris forms away from the brain commonly in the heart and is swept through bloodstream to lodge in narrower brain arteries. This type of blood clot is called an embolus.

Haemorrhagic stroke

Haemorrhagic stroke occurs when a blood vessel in the brain leaks or ruptures. Brain haemorrhages can result from many conditions that affect the blood vessels. These include:

·              Uncontrolled high blood pressure (hypertension)

·              Over treatment with anticoagulants (blood thinners)

·              Weak spots in the blood vessel walls (aneurysms)

Types of haemorrhagic stroke include

Intracerebral hemorrhage. In an intracerebral hemorrhage, a blood vessel in the brain bursts and spills into the surrounding brain tissue, damaging brain cells.

Subarachnoid hemorrhage. In a subarachnoid hemorrhage, an artery on or near the surface of the brain bursts and spills into the space between the surface of your brain and the skull. This bleeding is often signaled by a sudden, severe headache.

Transient ischemic attack (TIA)

A transient ischemic attack (TIA) - sometimes known as a ministroke - is a temporary period of symptoms similar to stroke.

Risk Factors

Lifestyle risk factors : Being overweight or obese, Physical inactivity, Alcohol consumption, Use of illicit drugs such as cocaine and methamphetamines

Medical risk factors: Blood pressure readings higher than 140/90 millimeters of mercury, Cigarette smoking or exposure to secondhand smoke, High cholesterol, Diabetes, Obstructive sleep apnea, Cardiovascular disease, including heart failure, heart defects, heart infection or abnormal heart rhythm, Personal or family history of stroke, heart attack or transient ischemic attack.

Other factors associated with a higher risk of stroke include

Age - People age 55 or older, race, sex, men have a higher risk of stroke than women, Hormones- use of birth control pills or hormone therapies that include estrogen, as well as increased estrogen levels from pregnancy and childbirth.

Signs and Symptoms:

·              Sudden weakness, paralysis or numbness of the face, arm or leg especially on one side of the body.

·              Sudden dimness or loss of vision in one or both eyes.

·              Sudden loss of speech, confusion, or difficulty speaking or understanding speech.

·              Unexplained sudden dizziness, unsteadiness, loss of balance or coordination.

·              Sudden severe headache.

Diagnosis

·              Blood tests: blood sugar levels, platelet levels, Bleeding time and clotting time

·              Magnetic Resonance Imaging (MRI) scan

·               Computerized Tomography (CT) scan.

·              Electro cardio gram (ECG)

·              Cerebral angiography

·              Carotid ultrasound

·              Echocardiogram

·              Glasgow Coma Scale (GCS)

·              VSH/Doppler study of carotid arteries

Management

·              Anti-platelet drugs Anti-platelet drugs make these cells less sticky and less likely to clot.

·              Anticoagulants Reduce blood clotting

·              Physical therapy such as walking, eating and dressing.

·              Speech Therapy

Nursing Management

·              Vital Signs

·              Maintain neurologic flow sheet (Stroke scale)

·              Assess for voluntary or involuntary movement.

·              Monitor bowel and bladder function

·              Assess the skin care

·              Personal hygiene

·              Support of vital function- Maintain air way. Breathing oxygenation circulation

·              Assess the stroke scale

·              Intra venous fluids at maintenance until able to tolerate oral diet

·              Maintain Blood Pressure

·              Acces the level of conciousness by usingn (GCS)

·              Thrombolytic therapy - ischemic stroke

·              Maintain normal body temperature

·              Antispasmodic agents can be used for spastic paralysis

Surgical Treatment

·               Carotid Endarterectomy to treat carotid artery disease

·               Thrombectomy

·               Hemycraniaetomy

Prevention

·              Healthy diet

·              Controlling high blood pressure (Hypertension)

·              Quitting tobacco use

·              Controlling diabetes

·              Maintaining a healthy weight

·              Exercising regularly

·              Routine health assessment

Complications

·              Aspiration pneumonia

·              Dysphagia (Difficulty in swallowing)

·              Spasticity, Contractness

·              Brain stem herniation

·              Deep vein thrombosis, pulmonary embolism

·               Post stroke depression.