RECOGNITION

 AND  TREATMENT  

MARIA KRISTINA D. GARCIA, M.D., F.P.N.A.

STROKE  IS…  
•  an  emergency  
•  treatable  
•  preventable  

Guidelines  for  the  preven?on,  treatment,  &  rehabilita?on  of  stroke  by  the    
Stroke  Society  of  the  Philippines,  6th  ed.  
 STROKE  BURDEN  
•  2nd  leading  cause  of  
death  
•  Neurologist  to  pa?ent  
ra?o  is  1:330,000  
•  67%  of  neurologists  
prac?ce  in  urban  
centers  

The  Real  Stroke  Burden  in  the  Philippines.  Navarro  JC,  Baroque  AC  2nd,  Lokin  JK,  Venketasubramanian  N.  
Interna'onal  Journal  of  Stroke,  July  2014.  9(5):640-­‐641.  
 STROKE  
•  A  complex  disease  that  requires  the  efforts  
and  skills  of  all  members  of  the  
mul?disciplinary  team  
•  Nurses  play  a  pivotal  role  in  all  phases  of  care  
of  the  stroke  pa?ent  

Comprehensive  Overview  of  Nursing  and  Interdisciplinary  Care  of  the  Acute  Ischemic  Stroke  Pa?ent.    
Stroke.  2009;40:2911-­‐2944.  
 Stroke:  Early  Recogni?on  
•  A  local  study  on  the  reasons  for  delays  in  the  
care  of  acute  stroke  pa?ents  included  failure  
to  recognize  symptoms  as  serious  and  stroke-­‐
related  
•  Longer  delays  arise  from  healthcare-­‐related  
factors  such  as  delays  in  Neurology  referral  
and  Neuro-­‐radiologic  diagnosis  

Guidelines  for  the  preven?on,  treatment,  &  rehabilita?on  of  stroke  by  the    
Stroke  Society  of  the  Philippines,  6th  ed.  
 STROKE  DEFINITION  
•  Rela?vely  sudden  
occurrence  of  a  focal  
neurologic  deficit  

Adams  and  Victor’s  Principles  of  Neurology  10th  edi?on  2014  

 Anyone  should  consider  stroke  if  they  
have  any  of  these  symptoms:  
•  Sudden  numbness  or  weakness  of  the  face,  
arm  or  leg,  especially  on  one  side  of  the  body  
•  Sudden  confusion,  trouble  speaking,  or  
understanding  
•  Sudden  trouble  seeing  in  one  or  both  eyes  
•  Sudden  trouble  walking,  dizziness,  loss  of  
balance  or  coordina?on  
•  Sudden  severe  headache  with  no  known  
cause  
Guidelines  for  the  preven?on,  treatment,  &  rehabilita?on  of  stroke  by  the    
Stroke  Society  of  the  Philippines,  6th  ed.  
 Cincinna?  Pre-­‐hospital  Stroke  Scale:  
“FAST”  
•  Facial  asymmetry  
–  Have  the  person  smile  or  show  his  or  her  teeth  
•  Arm  drif  
–  Have  the  person  close  his  or  her  eyes  &  hold  his  or  her  
arms  straight  out  in  front  for  about  10  seconds  
•  Slurred  speech  
–  Have  the  person  say  some  simple  familiar  saying  
•  Time  
–  If  any  of  the  above  3  is  present,  refer  immediately  
Guidelines  for  the  preven?on,  treatment,  &  rehabilita?on  of  stroke  by  the    
Stroke  Society  of  the  Philippines,  6th  ed.  
WHAT  IS  STROKE?  
 THROMBOTIC  STROKE  
•  An  artery  becomes  
blocked  by  the  
forma?on  of  a  blood  
clot  within  it  
•  The  clot  may  be  caused  
by  fajy  deposits  
(atherosclero?c  plaque)  
that  build  up  in  arteries  
and  compromise  blood  
flow  
De  Silva  D,  Venketasubramanian  N,  Roxas  Jr.  A,  Kee  LP,  Lampl  Y.  Understanding  Stroke:  A  Guide  for  Stroke  
Survivors  and  Their  Families.  2014  
 EMBOLIC  STROKE  
•  A  blood  clot  forms  away  
from  the  brain  –  
commonly  the  heart  –  
and  is  swept  through  
the  bloodstream  to  
lodge  in  the  narrower  
brain  arteries  

De  Silva  D,  Venketasubramanian  N,  Roxas  Jr.  A,  Kee  LP,  Lampl  Y.  Understanding  Stroke:  A  Guide  for  Stroke  
Survivors  and  Their  Families.  2014  
WHAT  IS  STROKE?  
INTRACEREBRAL  HEMORRHAGE  
SUBARACHNOID  HEMORRHAGE  
 TRANSIENT  ISCHEMIC  ATTACK  
•  Are  “mini-­‐strokes”  
•  Old  defini?on:  temporary  loss  of  func?on  of  a  
part  of  the  brain  caused  by  brief  interrup?on  
of  local  cerebral  blood  flow  las?ng  less  than  
24  hours  

Guidelines  for  the  Preven?on  of  Stroke  in  Pa?ents  With  Stroke  and  Transient  Ischemic  Ajack:    
A  Guideline  for  Healthcare  Professionals  From  the  American  Heart  Associa?on/American  Stroke  Associa?on.  
Stroke.  2014;45:2160-­‐2236.  
 TRANSIENT  ISCHEMIC  ATTACK  
•  Tissue-­‐based  defini?on  of  TIA  
•  Transient  episode  of  neurological  dysfunc?on  
caused  by  focal  brain,  spinal  cord,  or  re?nal  
ischemia,  without  acute  infarc?on    

Guidelines  for  the  Preven?on  of  Stroke  in  Pa?ents  With  Stroke  and  Transient  Ischemic  Ajack:    
A  Guideline  for  Healthcare  Professionals  From  the  American  Heart  Associa?on/American  Stroke  Associa?on.  
Stroke.  2014;45:2160-­‐2236.  
 CAUSES  OF  STROKE  
•  Atherosclero?c  thrombosis  
•  Embolism  
•  Hypertension  
•  Ruptured  saccular  aneurysm  
•  Arteri?s  
•  Hematologic  disorders  
•  Trauma  and  dissec?on  of  caro?d  and  basilar  arteries  
•  Amyloid  angiopathy  
•  Dissec?ng  aor?c  aneurysm  
•  Complex  migraine  
•  Gene?c  

Guidelines  for  the  preven?on,  treatment,  &  rehabilita?on  of  stroke  by  the    
Stroke  Society  of  the  Philippines,  6th  ed.  
 Condi?ons  that  can  mimic  stroke:  
•  Seizures   •  Herpes  encephali?s  
•  Systemic  infec?on   •  Transient  global  amnesia  
•  Brain  tumor   •  Demen?a  
•  Toxic-­‐metabolic   •  Demyelina?ng  disease  
•  Posi?onal  ver?go   •  Cervical  spine  fracture  
•  Cardiac   •  Myasthenia  gravis  
•  Syncope   •  Parkinsonism  
•  Trauma   •  Hypertensive  
•  Subdural  hematoma   encephalopathy  
•  Conversion  disorder  
Guidelines  for  the  preven?on,  treatment,  &  rehabilita?on  of  stroke  by  the    
Stroke  Society  of  the  Philippines,  6th  ed.  
 NON-­‐MODIFIABLE  RISK  FACTORS  
•  Age  
•  Gender  
•  Previous  stroke  
•  Ethnicity  
•  Heredity    

Guidelines  for  the  preven?on,  treatment,  &  rehabilita?on  of  stroke  by  the    
Stroke  Society  of  the  Philippines,  6th  ed.  
 MODIFIABLE  RISK  FACTORS  
•  Hypertension  
•  Diabetes  mellitus  
•  Heart  disease  
•  Atrial  fibrilla?on  
•  Hypercholesterolemia    

Guidelines  for  the  preven?on,  treatment,  &  rehabilita?on  of  stroke  by  the    
Stroke  Society  of  the  Philippines,  6th  ed.  
MODIFIABLE  RISK  FACTORS  
•  Smoking  
•  Heavy  alcohol  intake  
•  Obesity  
•  Physical  inac?vity  
•  Stress  
•  Illicit  drug  use  

Guidelines  for  the  preven?on,  treatment,  &  rehabilita?on  of  stroke  by  the    
Stroke  Society  of  the  Philippines,  6th  ed.  
STROKE  IS  AN  
CLOT  BUSTER!  
 ACTILYSE  
•  Tissue  plasminogen  ac?vator  (TPA)  
•  Dissolves  blood  clots  
•  Reestablishes  blood  supply  to  the  affected  
brain  region  
ACTILYSE  
 ACTILYSE  
•  Within  3  to  4.5  hours  of  onset  
•  Given  intravenously  
•  30%  more  likely  to  have  minimal  or  no  
disability  at  3  months  

Guidelines  for  the  preven?on,  treatment,  &  rehabilita?on  of  stroke  by  the    
Stroke  Society  of  the  Philippines,  6th  ed.  
 MANAGEMENT  OF  ACUTE  STROKE  
•  Determine  the  cause  of  stroke!  
•  Individualize  treatment!  
•  Tissue  plasminogen  ac?vator  (TPA)  
•  An?platelets  
•  An?coagulants  
•  Surgery  
•  Physical  therapy  
•  Occupa?onal  therapy  
 THANK YOU!

“When you know better, you do better.”

Maya Angelou