T. Stroke

Question 1

Stroke

Answer 1

• Stroke occurs when ischemia or hemorrhage into the brain results in death of brain cells.
• Physical, cognitive, and emotional impact

Question 2

Ischemic Stroke

Answer 2

• inadequate blood flow to the brain from partial or complete occlusion of an artery.
• A Transient Ischemic Attack (TIA) is usually a precursor to ischemic stroke.
• About 80% of all strokes are ischemic in nature.
• Blood flow must be maintained at 750 to 1000 mL/min (55 mL/100 g of brain tissue), or 20% of the cardiac output, for optimal brain functioning.
• 87% of all strokes

It can be either:
Thrombotic or embolic

Question 3

Thrombolytic stroke

Answer 3

• the process of clot formation results in a narrowing of the lumen, which blocks the passage of blood through the artery
• Thrombosis occurs in relation to injury to a blood vessel wall and formation of a blood clot.
• Result of thrombosis or narrowing of the blood vessel
• Most common cause of stroke
• Lacunar strokes are typically asymptomatic.

Question 4

Embolic stroke

Answer 4

• an embolus is a blood clot or other debris circulating in the blood. When it reaches an artery in the brain that is too narrow to pass through it lodges there and blocks the flow of blood
• Occurs when an embolus lodges in and occludes a cerebral artery
• Results in infarction and edema of the area supplied by the involved vessel
• Second most common cause of stroke
• Warning signs are less common with embolic than with thrombotic stroke.

Question 5

Hemorrhagic stroke

Answer 5

• a burst blood vessel may allow blood to seep into and damage brain tissues until clotting shuts off the leak
• Account for approximately 15% of all strokes
• Result from bleeding into the brain tissue itself or into the subarachnoid space or ventricles

Question 6

Transient ischemic attack

Answer 6

• Transient episode of neurological dysfunction caused by focal brain, spinal cord, or retinal ischemia, without acute infarction of the brain
• is usually a precursor to ischemic stroke.
• Symptoms last <1 hour.
• a temporary period of symptoms similar to those of a stroke

Question 7

Intracerebral hemorrhage

Answer 7

• Bleeding within the brain caused by rupture of a vessel
• Hypertension is the most important cause.
• Hemorrhage commonly occurs during periods of activity.
• Often a sudden onset of symptoms, with progression over minutes to hours because of ongoing bleeding

Question 8

Subarachnoid hemorrhage

Answer 8

• Intracranial bleeding into cerebro-spinal fluid–filled space between the arachnoid and pia mater
• Commonly caused by rupture of a cerebral aneurysm
• An aneurysm may be saccular or berry.
• Majority of aneurysms are in the circle of Willis.
• “Worst headache of one’s life”
• Surgical treatment to prevent rebleeding.

Question 9

Right-Brain and Left-Brain Stroke

Answer 9

Right-Brain Stroke

• paralyzed left side
• left side neglect
• impaired judgements, time concepts, safety, impulsive
• rapid attention span
• Respond best to directions given verbally
• Difficulty in judging position, distance, and movement
• Impulsive, impatient, and denying problems related to stroke

Left-Brain Stroke
- right paralysis
- aphasia
- impaired l/r discrimination
 cautions, slow performance, 
- aware of defects, depression
- impaired language comprehension
- Respond well to nonverbal cues
-Slower in organization and performance of tasks
- Impaired spatial discrimination
- Have fearful, anxious response to stroke

Question 10

Aphasia

Answer 10

is the total loss of comprehension and use of language.

occurs when a stroke damages the dominant hemisphere of the brain.

Question 11

Dysphasia

Answer 11

refers to difficulty related to the comprehension or use of language and is due to partial disruption or loss.

Question 12

Global Aphasia

Answer 12

all communication and receptive function are lost.

Question 13

dysarthria

Answer 13

Disturbance in the muscular control of speech

Impairments may involve

• pronunciation
• articulation
• phonation

Question 14

anosognosia

Answer 14

Deny illness or own body parts

a symptom of severe mental illness experienced by some that impairs a person’s ability to understand and perceive his or her illness.

Question 15

agnosia

Answer 15

inability to recognize an object by sight, touch, or hearing

Question 16

apraxia

Answer 16

Inability to carry out learned sequential movements on command

Question 17

How do you know it’s a stroke?

Answer 17

• Altered level of consciousness
• Weakness, numbness, or paralysis
• Speech or visual disturbances
• Severe headache
• ↑ or ↓ heart rate
• Respiratory distress
• Unequal pupils
• Hypertension
• Facial drooping on affected side
• Difficulty swallowing
• Seizures
• Bladder or bowel incontinence
• Nausea and vomiting
• Vertigo

Question 18

Recombinant tissue plasminogen activator (tPA)

Answer 18

• “clot buster”
• Used to reestablish blood flow through a blocked artery to prevent cell death in clients with acute onset of ischemic stroke symptoms
• Must be administered within 3–4.5 hours of onset of clinical signs of ischemic stroke

Question 19

12–72 hours Post stroke

Answer 19

After stroke has stabilized for 12–72 hours, collaborative care shifts from preserving life to lessening disability and attaining optimal functioning.
Client may be transferred to a rehabilitation unit, outpatient therapy, or home care-based rehabilitation.
After stroke, client is at risk for deep vein thrombosis.

Question 20

homonymous hemianopsia

Answer 20

Blindness in same half of each visual field is a common problem after stroke

Question 21

Expressive aphasia

Answer 21

Broca’s aphasia, is a type of aphasia characterized by partial loss of the ability to produce language (spoken, manual, or written), although comprehension generally remains intact

Question 22

Receptive aphasia

Answer 22

Wernicke’s aphasia or receptive aphasia is when someone is able to speak well and use long sentences, but what they say may not make sense.

Question 23

Anomic/amnesic aphasia

Answer 23

a language disorder that leads to trouble naming objects when speaking and writing

Question 24

If blood flow to the brain is totally interrupted

Answer 24

neurologic metabolism is altered in 30 seconds
metabolism stops in 2 minutes
cellular death occurs in 5 minutes.

Question 25

Lacunar strokes

Answer 25

a type of ischemic stroke that occurs when blood flow to one of the small arteries deep within the brain becomes blocked.

Question 26

ipsilateral v. contralateral

Answer 26

ipsilateral - belonging to or occurring on the same side of the body. contralateral - relating to or denoting the side of the body opposite to that on which a particular structure or condition occurs.

Question 27

FAST for strokes

Answer 27

``` F = facial drooping A = arms weakness S = speech difficulties T = timing ```