Stroke

Question 1

What is a stroke?

Answer 1

• cerebrovascular accidents (CVA) also known as strokes result from cerebral infarction and are the most common brain disorder in the general population
• they occur when the flow of blood carrying essential oxygen to the brain is disrupted causing brain cells to die
• strokes are divided into three categories
  —> ischaemic - from decreased blood flow as a result of vascular occlusion by embolism or atherosclerosis within an artery
  —> thrombotic - a venous event - blood clot forms in one of the arteries
  —> haemorrhagic - subarachnoid haemorrhage due to a ruptured blood vessel in the brain
• CVA can vary in severity due to location and severity of damage - can range from mild strokes to severe brain damage or death

Question 2

What are the risk factors?

Answer 2

• hypertension (I, H)
• hypercholesterolaemia (I)
• heart disease (I)
• previous transient ischaemic attacks (I)
• diabetes (I)
• smoking (I, T)
• obesity (I)
• operative delivery (T)
• dehydration (T)
• infection (T)
• excessive alcohol intake (I)

Question 3

What are some of the complications?

Answer 3

- icahaemia resulting from a CVA may be experienced as 
       —> dizziness 
       —> weakness 
       —> numbness 
       —> paralysis in a limb or a side of the body 
       —> headache 
       —> slurred speech
       —> partial loss of vision 
       —> nausea and vomiting

Question 4

What are some of the issues in pregnancy?

Answer 4

• warfarin embryopathy may occur with exposure of the fetus to warfarin from 6-12 wks (prev CVA)
• risk factors identified and thromboprophylaxis commenced if necessary (at risk of CVA)
• pregnancy does not appear to increase the incidence of SAH although the changes in pregnancy may result in the vasodilation of an already abnormal vessel and precipitate it
• SAH is often associated with pre-eclampsia and eclampsia