Stroke
Ischemia to part of brain that results in death of brain cells
- neuro metabolism altered in 30 sec
- metabolism stops in 2 minutes
- cell death in 5 minutes
Ischemic stroke
Ischemia to brain from partial or complete artery occlusion
- most strokes
- transient, thrombotic, embolic
Thrombotic stroke
Injury to blood vessel wall and formation of clot (most common cause)
- narrowing of blood vessel
- most associated with HTN and DM
- preceded by TIA
Embolic Stroke
Embolus lodges in and occluded in a cerebral artery
- infarction and edema
- rapid occurrence of severe symptoms
- usually remain conscious but might have headache
Transient ischemic attack
Temporary focal loss of neuro function by ischemia
- most resolve in 3 hours
- may be due to microemboli
- warning sign of progressive cerebrovascular disease
- Dx: CT without contrast
Hemorrhagic stroke
Bleeding into the brain tissue or subarachnoid space or ventricles
- inter cerebral: HTN is most likely cause, occurs during periods of activity
- sudden onset of symptoms with progression over minutes to hrs
- neuro deficits, headache, NV, decreased LOC, HTN
Risk factors
- age, gender, race, family
- HTN
- metabolic syndrome
- heart disease
- alcohol consumption, poor diet
Right CVA
Paralyzed left side
Spatial perceptual and visual field deficits
Tends to minimize problems
Short attention span
Impaired judgement: impulsive, impaired time concept
Left CVA
Paralyzed right side hemiplegia Impaired speech and language Slow performance Visual field deficits Aware of deficits: depression, anxiety Impaired comprehension: math and language
Motor function
Impairment of respiratory function, swallowing/speech, gag reflex
-initial period of flaccidity followed by the spasticity
Broca’s Aphasia
Nonfluent Aphasia
- damage to frontal lobe
- speak in short phrase, omit small words
- understand speech
Wernicke’s aphasia
Fluent aphasia
- damage in left temporal lobe
- speak in long sentences that have no meaning
- often unaware of their mistakes
Agnosia
Inability to use an object correctly
Apraxia
Inability to carry out a purposeful activity
Ataxia
Inability to coordinate muscle activity during voluntary movement
Hemianospia
Blindness in half visual field
Homonymous hemianopsia
Blindness in same half of the visual field of both eyes
Neglect
Visual change that often occurs after a stroke in the right hemisphere of the brain
Hemiplegia
Paralysis on one side of the body
Hemiparesis
Weakness on one side of the body
Primary Dx
CT scan within 25 minutes and read within 45 minutes of arrival at ER
- indicates size and location of lesion
- differentiate between ischemic and hemorrhage stroke
Prevention of stroke
- reduce salt and sodium intake
- maintain of normal body weight
- normal BP
- increase exercise
- avoid cigarettes and tobacco
- limit alcohol to moderate levels
- low in saturated fats, total fat, and cholesterol
Primary prevention
Control BP
Treat hyperlipidemia
Secondary Prevention
Antiplatelet drugs
- aspirin
- clopidogrel
