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© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 3 Pathophysiology Injury to brain tissue caused by disruption of blood flow Also called a cerebrovascular accident (CVA) Results in loss of body function
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Chapter 31Stroke
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© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
Overview
Pathophysiology Types of Stroke Risk Factors Assessment Management
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© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
Pathophysiology
Injury to brain tissue caused by disruption of blood flow
Also called a cerebrovascular accident (CVA) Results in loss of body function
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© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
Pathophysiology
Advances in treatment Time-sensitive condition
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© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
Types of Stroke
Brain cells depend on oxygen Two types of stroke
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© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
Types of Stroke
Ischemic stroke– Blockage of blood supply– 85% of strokes
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© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
Types of Stroke
Ischemic stroke– Blood vessels narrow– Platelets accumulate– Vessel is blocked
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© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
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© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
Types of Stroke
Ischemic stroke– Embolus can also form elsewhere
and travel to the brain
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© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
Types of Stroke
Ischemic stroke– Severe shock can cause very low
blood pressure– Brain receives no oxygen
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© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
Types of Stroke
Ischemic stroke– Brain cells deprived of oxygen will die in a very
short time– A group of cells that have died is called an infarct– The tissue around an infarct is the penumbra– The penumbra may recover
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© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
Types of Stroke
Transient ischemic attack– Stroke symptoms that resolve spontaneously– Caused by a thrombus– High risk of a stroke
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© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
Types of Stroke
Hemorrhagic stroke– Caused by rupture of a blood vessel in brain– May be from high blood pressure or aneurysm– 15% of strokes
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© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
Types of Stroke
Hemorrhagic stroke– Leaking blood can injure brain tissue– Intracranial pressure may become elevated
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© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
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© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
Risk Factors
Vascular disease Diabetes Irregular heart rhythms High blood pressure Previous stroke
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© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
Assessment
Signs and symptoms– Depend on the affected area of brain– Middle cerebral artery is most common
vessel affected– Dysarthria
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© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
Assessment
Signs and symptoms– Headache and ICP– Early diagnosis improves outlook
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© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
Symptoms associated with stroke – Generalized or focal weakness– Paralysis on one side of the body– Paresthesias on one side of the body– Difficulty in speaking
Assessment
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© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
Assessment
Symptoms associated with stroke– Headache– Vomiting– Visual changes– Dizziness
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© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
Assessment
Assess for life threats History Focused neurologic examination
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© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
Assessment
Initial assessment– Assess ABCs– Identify potential life threatening
issues at that point
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© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
Assessment
Focused history– Past medical history– Allergies– Medications taken
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© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
Assessment
Focused history– Obtain history from family, if necessary– The management of stroke is very time sensitive
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© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
Assessment
Focused physical exam– Patient’s mental status– Pupils – Assess for pronator drift– Assess for facial droop– Assess for dysarthria
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© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
Assessment
Focused physical exam– Patient’s mental status– Assess pupils
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© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
Assessment
Focused physical exam– Pronator drift
• A useful way to test for arm weakness
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© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
Assessment
Focused physical exam– Facial droop
• Facial droop indicates facial muscle weakness
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© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
Assessment
Focused physical exam– Dysarthria
• Garbled speech
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© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
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© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
Assessment
Focused physical exam– Expressive aphasia– Receptive aphasia– No speech
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© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
Assessment
Focused physical exam– Cincinnati Prehospital Stroke Scale– Other stroke scales
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© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
Assessment
Baseline vital signs– May have high blood pressure
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Management
Recognize and transport Every minute counts
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© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
Management
Hospital management– Diagnosis– Therapy
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© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
Management
Hemorrhagic stroke– Control blood pressure
Ischemic stroke– Medications
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© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
Management
Stroke centers Timely transport
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© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
Management
Specific management of all stroke patients includes:– ABCs– High-flow 100% oxygen– Support blood pressure– Elevate head of bed
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© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
Other diagnoses to consider in presence of stroke-like symptoms:– Hypoglycemia– Bell’s palsy– Traumatic brain injury
Management
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© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
Management
Other diagnoses to consider in presence of stroke-like symptoms:– Seizure– Migraine– Drug toxicity
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© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
Transport– To most appropriate hospital– ALS intercept– Notify hospital
Management
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© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
Management
Ongoing assessment– Note carefully any changes
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Stop and Review
Describe the pathophysiology of ischemic stroke.
Describe the pathophysiology of hemorrhagic stroke.
Identify several conditions that might mimic stroke.
