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Cerebrovascular accident (Stroke); essentials about stroke

A stroke occurs when the blood supply to the parts of brain is interrupted or reduced depriving brain tissue of oxygen and nutrients. Brain cells begin to die early action can minimize brain damage and potential complications.

Stroke is a condition in which the neurologic deficit result from decreased blood flow to a localized area of the brain. It interrupts or diminishes oxygen supply, causing serious damage or necrosis in brain tissues.

Types Of Stroke

1. Ischemic Stroke:Blood supply to a part of the Brian is suddenly interrupted due to either a THROMBUA, EMBOLUS, SYSTEMIC OR METABOLIC DISEASE.

2. Hemorrhagic Stroke:This occurs when a blood vessel breaks open, spilling blood into spaces surrounding neurons.

3. Transient Ischemic Attack (Tia): Brief episode, less than 24hours of neurological dysfunction, it's a warning for impending stroke. Neurological Dysfunction is present for minutes to hours but no permanent neurological deficit remains.

4 Neuromuscular deficits: these are due to damage of motor neurons of the pyramidal tracts.

5. Right And Left Stroke: Damage to either the left or right side of the brain will result in paralysis of either the right or left side of the body (HEMIPLEGIA) OR vise versa.

Causes Or Risk Factors

Hypertension

Diabetes Mellitus

Heart disease

Obesity

Smoking

Atherosclerosis

High Serum Triglyceride level

Oral Contraceptives.

Aging

Family History Of Cerebrovascular disease.

Note: Stroke is commoner in males than in female.

PATHOPHYSIOLOGY

In stroke, there is reduced blood and oxygen supply to a particular area of the brain this could result from obstruction or rupturing of the tiny blood vessels. The impaired brain tissue perfusion will result result in speech defect, dysphagia, visual problems, sensory losses such as touch and auditory stimuli, impaired mental activity if the frontal lobes is affected e.g. reduced comprehension forgetfulness, loss of control of the external sphincter resulting in incontinence depending on the side that is affected.

Note: HEMIPLEGIA is one of the most common symptoms. Left HEMIPLEGIA results from effect on the right side of the Brain.

Clinical Manifestations

It depends on the affected artery

1. Hemiplegia/paralysis

2. Sensory Defects e.g. loss of tactile and auditory stimuli.

3. Aphasia (speech defect)

4. Unilateral neglect of paralysed side.

5. Bladder impairment (Urinary incontinence)

6. Respiratory impairment

7. Cranial nerve impairment

8. Dysphagia, impaired tongue movement

9. Dyslexia (Reading problem)

10.Dysgrahia (inability to write).

DIAGNOSTIC EVALUATION

1. MRI to evaluate lesion location and size

2. EEG will detect reduced electrical activity in an area of infarction.

3. Cerebra Angiography details disruption or displacement of the cerebra circulation by occlusion or haemorrhagic.

4. Lumber puncture.

Medical Management

Medical Management of stroke commonly includes the following;

Physical Rehabilitation

Pharmacotherapy which includes Anticonvulsant e.g. Phenobarbital.

Corticosteroids e.g. dexamethasone.

Diuretics e.g. Lasix

Aspirin and Anti-hypertensives e.g. Vasoprin

Anticoagulant e.g. Warfarin e.t.c

Surgery: depending on the CVA cause and extent. The patient may also undergo surgery example Craniotomy.

Nursing Diagnosis

1. Ineffective air way clearance related to altered level of consciousness

2. Impaired physical mobility related to the function of neurological damage

3. Ineffective cerebra tissue perfusion related to interruption of blood flow, occlusion, disorder haemorrhage, cerebral oedema

Complications

Cerebral swelling (edema)

Increased intracranial pressure (ICP)

Intracerebral hemorrhage

Seizures

Warning signs of stroke

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

Sudden confusion, trouble speaking S

Suddentrouble seeing in one or both eyes.

Sudden trouble walking

Sudden severe headache without known cause

Content created and supplied by: The_Don (via Opera News )

Brian Hemorrhagic Ischemic Stroke

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