Stroke

Question 1

Definition of Stroke

Answer 1

Disruption in the blood supply to the brain, leading to the death of brain cells

Question 2

Types of Stroke

Answer 2

A) Ischemic Stroke: It occurs when a blood clot blocks an artery supplying blood to the brain. It is the most common type, accounting for about 85% of all strokes.

B) Hemorrhagic Stroke: This type of stroke occurs when a blood vessel in the brain ruptures, leading to bleeding within or around the brain.

C) Transient Ischemic Attack (TIA): Also known as a “mini-stroke,” it is a temporary interruption of blood flow to the brain, causing stroke-like symptoms. TIAs usually last only a few minutes and do not cause permanent damage.

Question 3

Causes of Stroke

Answer 3

A) Ischemic Stroke: Arterial thrombosis, cardioembolic, systemic hypoperfusion.

B)Hemorrhagic: intracerebral hemorrhage, subarachnoid hemorrhage, hypertension
(weakening the blood vessels, leading to their rupture).

C) Transient Ischemic Attack (TIA): TIAs are caused by a temporary disruption of blood flow, often due to a blood clot or narrowing of the blood vessels.

Question 4

Symptoms of Stroke

Answer 4

Numbness or weakness in the face, arm, or leg (often on one side of the body).

Confusion, trouble speaking, or understanding speech.

Severe headache with no known cause.

Difficulty walking, loss of balance, or coordination.

Blurred or double vision.

Question 5

Diagnosis of Stroke

Answer 5

Head + neck examination for S/S of trauma, infection and meningeal irritation.

Ocular exam (retinopathy, emboli, hemorrhage)

Heart (arrhythmias), peripheral vasculature (palpate carotids, radial, femoral pulses and auscultate for carotid bruits)

■ Neuro exams: cranial n.’s, motor, sensory and cerebellar function,
gait, language, mental status and level of consciousness

■ Important to reassess patient so you can compare if there has been
any improvements or sudden deteriorations (espesh in hemorrhagic)

Question 6

Treatment of Stroke

Answer 6

A) Ischemic Stroke: Tissue plasminogen activator (tPA) or mechanical removal of the clot (thrombectomy).

B) Hemorrhagic Stroke: Controlling bleeding, relieving pressure on the brain, and surgical interventions to repair or prevent bleeding.

C) Transient Ischemic Attack (TIA): Treatment focuses on addressing underlying risk factors, such as managing blood pressure, prescribing antiplatelet medications, and making lifestyle modifications.

Window for thrombolytic therapy: 4.5 hours

■ Acute stroke treatment:
(1) Thrombolysis; given within 4.5 hrs of ischemic stroke
(2) Anti-platelet; aspirin, 160 mg chewed, clopidogrel (300 mg)
(3) Anti-coagulant; if tPA not received give IV heparin
(4) Thrombectomy

■ Do not treat their hypertension, ONLY if systolic >220 mmHg, and if
diastolic > 120 mmHg