STROKE

Ratheesh R.L

IInd year MSc(N)

SGNC

THE NORMAL BRAIN

BLOOD SUPPLY TO BRAIN

DEFINITION

It is a sudden loss of function resulting from disruption of

the blood supply to the part of the brain. The C.V.A is also

termed as “Brain attack”. This event is usually result of

long standing cerebro vascular disease.

CAUSES

• Hypertension

• Heart disease

• DM

• Sleep apnea

• Increased blood cholesterol level

• Smoking

• Sickle cell disease

• Substance abuse

• Living in the stroke belt

ISCHEMIA

↓

ENERGY FAILURE

↓

ACIDOSIS↔ION IMBALANCE

↓

↑ GLUTAMATE ↔ DEPOLARIZATION

↓ ↓

INTRACELLULAR CALCIUM INCREASED

↓

CELL MEMBRANE AND PROTEINS BREAK DOWN

FORMATION OF FREE RADICALS PROTEIN

PRODUCTION DECREASED

↓

CELL INJURY AND DEATH

CLINICAL MANIFESTATIONS

1. Weakness of the face, arm, leg, especially on one side of the

body.

2. Confusion or Mental changes.

3. Trouble Speaking.

4. Visual disturbances.

5. Difficulty in walking, dizziness, or loss of balance or

coordination.

6. Sudden severe headache.

1. MOTOR LOSS:-

A). Hemiplegia (paralysis of one side of the body)

B). Hemiparesis (weakness of one side of the body)

2. COMMUNICATION LOSS:-

A). Dysarthria (difficulty in speaking)

B). Aphasia (loss of speech)

C). Apraxia (inability to perform previously learned

actions)

3. PERCEPTUAL DISTURBANCES:-

A).Hemianopsia (loss of half of the visual field)

4. SENSORY LOSS:-

A). Loss of proprioception( ability to perceive the position

and motion of the body parts)

B). Difficulty in interpreting visual,tactile,and auditory

stimuli.

(A) Physical Examination

Demographic data

Vital signs

History taking

Motor assessment

Sensory assessment

Cranial assessment

DIAGNOSIS

(B) Lab & radiological investigation

1. Blood test

2. Brain imaging test

3. Heart & Blood vessel

test5. Electrocardiogram

4. Leg ultrasound

6. Transcranial Doppler (TCD)

• High cholesterol, sugar level, blood clotting time

1.Blood test

• CT Scan - detect bleeding in brain (hemorrhagic stroke)

• MRI – detect damaged brain tissue

• MRA (Magnetic Resonance Angiography) –visualize narrowing blood vessel

2. Brain Imaging Test

• Carotid ultrasonography- clotting in arteries leading to brain

• Catheter angiography (arteriography)

3. Heart & Blood Vessel Test

CT Scan result

(a) Carotid Ultrasound

(b) Result(normal)

(c) Result (narrowing)

(a) (b)

(c)

• Identify problem with electrical conduction of heart

• Regular heart beat rhythmic pattern smooth blood flow

• Defect arrhythmia form blood clot stroke

5. Electrocardiogram (ECG)

• Detect blood clot in deep vein in legs

• Clot movement to brain leads to stroke

4. Leg Ultrasound

• Sound waves – measure blood flow blood vessel of hemorrhagic area

6. Transcranial Doppler (TCD)

(a) Leg Ultrasound

(b)Result

Result of Electrocardiogram (ECG)

TREATMENT

Pharmacological Therapy

Stroke with Cardiogenic cause should treat promptly with

warfarin sodium, Platelet inhibiting drugs (aspirin, clopidogrel,

ticlopidine) can decrease the incidence of cerebral infarction.

(A) MEDICATION

1. Alteplase (tissue plasminogen

activator- TPA)

Injected to vein in arm

Given 4½ hour after onset of symptoms

Dissolve blood clot –restore blood flow

2. Anticoagulant

Drugs to thin blood

Ex: Aspirin, Heparin, Warfarin

3. Statin

Block enzyme in liver

Reduce cholesterol in

blood

TREATMENT

(B) SURGERY

1. Carotid endarterectomy

Incision in neck

open carotid artery

remove fatty acids

2. Craniotomy

Small section of skull cut away

Remove blood clot / repair burst in blood vessel

Carotid Endarterectomy

Craniotomy

Steps

Diet

(low fat, high fiber)

Quit smoking & alcohol intake

Controlling diabetes

Maintain healthy weight

Exercise

Avoiding illicit drugs

PREVENTION

Nursing Management

1. Improving Mobility.

2. Preventing Joint deformity.

3. Changing Position.

4. Establishing Exercise Programme.

5. Improving Communication.

6. Improving Thought Process.

7. Improving Skin Integrity.

8. Improving Family coping.

NURSING DIAGNOSIS

• Ineffective cerebral tissue perfusion related to decreased

cerebral blood flow.

• Impaired physical mobility related to hemiparesis

• Self care deficit related to loss of ability to use extrimities

• Disturbed sensory perception related to changes in visual

field

• Impaired verbal communication related to cerebral injury

• Impaired swallowing related to weakness or loss of

coordination of the tongue

• Impaired urinary elimination related to neurological

deficits