• Stroke also called – cerebral vascular accident ( CVA )

• Brain attack
• Cerebral hemorrhage.

• Stock is a medical emergency.
• Stroke occurs when a part of the brain loses function due to an interruption of blood flow to the brain.

Definition of stroke

• Brain stroke is a sudden onset and persistent loss of neurological and brain functions, resulting from disruption of blood supply to the brain.

Types of stroke

1. transient ischemic attack

• Ischemic stroke is the most common type of stroke.
• Ischemic stroke occurs due to arteries in the brain being obstructed or blocked and causing ischemia and necrosis.

Ischemic stroke is divided into –

1. Thrombotic stroke
2. Embolic stroke.

1. Thrombotic stroke

• Thrombotic strokes occur due to thrombus formation in the brain arteries.
• Arteries can narrow, because cholesterol builds up the plague formation that prevents blood supply to the brain and decreases the oxygen supply.

2. Embolic stroke

• A stroke occurs due to a clot in the brain’s blood supply.
• Generally, symbolize a blood clot arises from the heart.
• Arrhythmia is a common cause of blood clots.

2.hemorrhagic stroke

• Hemorrhagic stroke due to bleeding hemorrhage.
• Brain blood vessels lead blood into brain tissue and result in brain cell dysfunction.
• Generally bleeding due to high blood pressure and weak artery wall.

Stroke forms –

1. Transient ischemic attack ( TIA )

• Also called a mini-stroke.
• TIA is a short time episode of temporary loss of brain functions.
• Reversible ( resolve spontaneously )
• TIA is a warning sign of compromise blood circulation.
• Many patients referred to a TIA as a mini stroke.

2. Brain attack

• Brain attack is a permanent loss of brain function due to cessation of brain blood supply and causes necrosis.

Cause of stroke

• Thrombosis ( most common cause )
• Cerebral embolism
• Atherosclerosis
• Rapture brain blood vessels
• Ischemia and necrosis
• Vascular compression
• Arterial spasm.

Risk factors of stroke

• Hypertension
• High cholesterol diet
• Diabetes mellitus
• Smoking and tobacco use
• Stress ( emotional )
• Family history
• Obesity
• Oral contraceptive pills ( OCP )
• Bleeding disorder
• Heart disorder
• Increased age
• Aneurysm formation in the brain.

Pathophysiology of stroke

Cause / risk factors

↓

Compromise the brain circulation

↓

Interruption blood flow to the brain

↓

Ischemia and necrosis

↓

Oedema and congestion in the brain is tissue

↓

Focal neurological deficit

↓

Temporary and permanent loss of brain functions.

Sign/Symptoms of a stroke

stroke symptoms

• Hemiplegia – paralysis of one side of the body.
• Agnosia – unable to recognize objects.
• Ataxia – is a gait disturbance.
• Dysphagia – difficulty in swallowing.
• Aphasia – patient unable to speech and communicate.
• Dyspraxia – difficulty to perform skilled movement.
• Dysarthria – difficulty in articulation of words into sentences.
• Hemianopsia – half vision loss.
• Homonymous hemianopsia – is a half vision loss in both eyes on the same side.
• Kinaesthesia – alteration in sensation.
• Neglect syndrome – patients cannot pay attention to particular portions.
• Paraesthesia – abnormal tingling sensation.
• Neurological function deficit.
• Increased ICP.
• Nausea, vomiting.
• Headache.
• Meningeal irritation.
• Nuchal rigidity.
• Epistaxis ( nose bleeding ).
• Memory impairment.
• Bounding pulse.
• Increase pulse pressure.
• Loss of consciousness.
• Cheyne stoke breathing.
• Numbness.
• Fever, vertigo, confusion.
• Seizures.
• Disorientation.
• Retinal haemorrhage.
• Language disorder.
• Altered bowel and bladder pattern.
• Cranial nerves affect.
• Reflexes change.
• Memory impairment.
• Loss of motor and sensory function.

Note

If the left side brain hemisphere is affected – the right side area of the body is paralyzed.

Diagnostic examination of stroke

• History collection and physical examination.
• Positron emission tomography scan (PET – scan).
• CT scan and MRI.
• Cerebral angiography.
• EEG.
• CSF culture test.
• Blood test.
• Urine examination test.

Medical management of stroke

• Pharmacological –

  • Mild analgesics – to control pain.
  • Thrombolytic therapy – plasminogen activator.
  • Anticoagulant – Heparin – to dissolve blood clots.
  • Diuretics – osmotic diuretics – mannitol.
  • Antihypertensive agents – Verapamil.
  • Antiemetic – Emset.
  • Anti-seizure drugs – phenytoin.
  • Antiplatelets – decrease thrombus formation.

Surgical management of stroke

For hemorrhagic stroke – craniotomy.

For thrombotic and embolic stroke –

• Intravascular procedure
• Open procedure.

Nursing management of stroke

• Nurses monitor patient airways and general appearance.
• Remove airway secretion and administer oxygen therapy.
• Provide a head 15 – 30° elevated position to control ICP.
• Monitor patient vital signs and other physical examinations.
• Nurses observe neurological assessment and level of consciousness.
• Assess sign and symptom and brain blood supply.
• If the right side brain affects, the nurse observes the left side of body dysfunctions, and if the left side brain affects, nurses observe right side body dysfunctions.
• The Administrator prescribed medication and IV fluids.
• Maintain seizures precautions.
• Administer NG tube and catheterization.
• Provide a calm, quiet and non stimulating environment.
• Maintain patient hygiene conditions and conduct daily baths.
• A nurse prepares the patient for the surgical procedure.
• Maintain patient skin integrity and posture.
• Nurses start bladder sphincter control training.
• Nurses help patients to mobilize the patient with support.
• Nursing encourages patients to speak, try to understand, perform the activity, and use affected areas in activity and passive exercise.
• Provide health education.

Stroke FAQ.