Ischemic strokes
-2 pathos
Thrombotic Stroke
-atherosclerosis in the cerebral arteries
-plaque forms clot
Embolic Stroke
-a blood clot from somewhere between the Left side of the heart and the brain gets stuck in the brain arteries and causes a stroke
Hemorrhagic stroke
-patho
A burst blood vessel in the brain causes bleeding into the brain tissues
-pressure/force of blood damages the brain cells
From severe HTN, could be from an aneurysm
Transient Ischemic Attack
(TIA)
A temporary focal, mini ischemic stroke
Microemboli are small enough for body to fix it without help
-no lasting damage
-temporary
-puts them at a higher risk for an ischemic stroke later on
How does a hemorrhagic stroke present?
Sudden onset with a progression from minutes to hours due to ongoing bleeding
Neurologic deficits
Headache, N/V
Decreased LOC
HTN
What are risk factors for strokes?
Same as cardiac risk factors
-HTN, metabolic syndrome. heart disease, heavy alcohol, poor diet, drug abuse, sleep apnea, obesity, inactivity, smoking
How does right-sided brain damage present? (R-sided stroke)
Left-sided hemiplegia (paralysis)
Very impulsive, poor judgement, poor short term memory, no regard for personal safety, poor attention span, impaired time concepts, does everything really fast, denies that there is anything wrong with them
Crazy patient that you can’t trust
How does left-sided brain damage present? (L-sided stroke)
R-sided hemiplegia
Slow patient, overly cautious, struggles to understand high-level concepts, knows things are wrong, anxiety, everything slowed down or impaired
How can motor function be affected by a stroke?
Initially: flaccidity
Later on: muscle spasticity
Broca’s Aphasia
nonfluent aphasia
Damage to frontal lobe
Short phrases, no filler words, takes great effort and time to get words out
“Walk….dog” instead of “I’m going to walk the dog”
Typically understands other’s speech well
Aware of their difficulties, frustrated
Wernicke’s Aphasia
Fluent aphasia
Damage to either temporal lobe
Long sentences with no meaning, add unnecessary words, made-up words
-absolute gibberish sometimes
May or may not understand other’s speech
Often unaware of their mistakes- think they’re communicating exactly what they mean- Frustrated
How can a stroke impact a patient’s affect?
Difficulty controlling emotions- big swings of anger for small issues
Personality changes
Educate family/caretakers, be patient
How can a stroke affect spacial perception?
Impacts depth perception- difficulty moving through space- huge fall risk
Homonymous hemianopsia
Blindness in the same half of each eye- half of visual field is gone
-impacts eating food- half of plate isn’t in visual field
How does a stroke affect elimination?
Since the spinal cord controls elimination, a stroke doesn’t typically have lasting impacts
Most problems would be initial and temporary
What is the gold standard for a stroke diagnosis?
CT!
Identifies if the stroke is ischemic or hemorrhagic (bleeding would be visible for hemorrhagic)
CT must be done within 25 mins and read within 45 minutes of arrival
How can a stroke be prevented?
Same as atherosclerosis/CAD prevention
-reduce salt intake
-normal BP
-increase exercise
-No smoking, limit alcohol
-low fat, high produce foods
Describe primary prevention of strokes
Control BP
Treat hyperlipidemia
Describe secondary prevention of strokes
Preventing a stroke after a TIA
-antiplatelets- Aspirin or clopidogrel
What 3 things are important the second a patient presents with a possible stroke?
Airway
Stroke code
IV access
CT scan ASAP
If a CT scan shows bleeding and therefore a hemorrhagic stroke, what do you do?
Consult neurosurgery
If a CT scan shows no bleeding and therefore an ischemic stroke, what do you do?
Determine if fibrinolytic therapy is appropriate- assess onset of symptoms
-within 3 hours of onset- you can use thrombolytics
tPA
Type of thrombolytic
Breaks up every clot in body- must be given within 3 hours of onset- patient must be certain about onset of symptoms
What are the 3 conditions to be a candidate for tPA?
18+ years
Ischemic stroke diagnosis
Onset within 3 hours ago
What are contraindications for tPA/thrombolytic therapy?
Recent surgery, recent bleeding disorders/injuries, bleeding risks, severe HTN
