Definition of stroke/cardiovascular accident
Acute neurologic injury that occurs as a result of ischemic infarction or bleeding into part of the brain manifested by rapid onset of focal CNS signs and symptoms with or without a focal higher cerebral dysfunction (e.g. aphasia, hemisensory loss, visual defect) lasting >24 hours.
The standard definition of TIA requires that all neurologic signs and symptoms resolve within 24 hours regardless of whether there is imaging evidence of new permanent brain injury.
2)Hemorrhagic strokes (15%)which can occurs in following areas;
Ischemic stroke: Thrombosis
Large vessels include both the extracranial (common and internal carotids, vertebral). And intracranial arterial system (Circle of Willis and proximal branches)
Note – atherosclerosis is most commonest in both.
Extracranial large vessels
Small vessel disease (30%): affect the intra cerebral arterial system, specifically the penetrating arteries of the vertebral, basilar and arteries of circle of Willis.
a.) lipohyalinosis : lipid hyaline built up distally due to hypertension & fibrinoid degeneration
b.) atheroma formation at their origin or in the parent large artery, extending into the orifices of the small arteries (atheromatous branch disease).
Less frequent causes: bleeding into tumor, aneurysmal rupture & Vasculitis
Symptoms include the following:
Establish the time the patient was last normal is especially critical when thrombolytic therapy is an option.
Rule out risk factors for atherosclerosis and CVS D’SES e.g. hypertension and diabetes( DM).
Also rule out history of smoking, alcohol, high cholesterol levels. History of drugs, trauma.
Physical examination is directed toward 5 major areas:
The neurologic examination must be thorough; able to localise which site has been affected based on neurological deficits.
CT angiography can demonstrate the vascular occlusion and areas of perfusion deficits .
Diffusion-weighted MRI (DW-MRI) can detect areas of ischemic brain injury earlier in the evolution of ischemia than standard T1/T2-weighted MRI images or CT scan by detecting changes in water molecule mobility
1)Do Blood glucose levels
2)Correct BP- see below.
3)Cardiac monitor- continuous monitoring for ischemic changes or Atrial fibrillation.
4)Hydration; intravenous fluids- avoid D5W and excess fluid admin- use normal saline ( not >50ml/h).
Nil per oral initially due to risk of aspiration; avoid oral intake until swallowing is assessed because dysphagia is common after stroke.
6) Oxygen therapy if SaO2 <90% or patient is hypotensive.
7) Temp- ensure normothermia-use acetaminophen intravenous. Raised temp increase infarct volume.
9) Catheterization –to prevent urinary tract infection
10) Fibrinolytics within 3 hrs of ischaemic stroke, antiplatelets, anticoagulants for Ischaemic strokes
10) Surgical intervention – Craniotomy, surgical evacuation, Neurosurgical decompression
Physical Therapy (PT)
Occupational Therapy (OT)
Speech Language Therapy
Written by Doc Bob
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