Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
Accident
STROKE
Age- incidence
with age until age
75.
Race- higher in
African Americans
Gender- higher in
men
Heredity- family
history increases risk
Potentially
Modifiable
Lifestyle- excessive
alcohol, cigarette
smoking, obesity, high
fat diet, drug abuse.
Pathologic conditionscardiac disease, DM,
HTN, migraine
headaches,
hypercoagulability
states.
INTRACRANIAL FACTORS
A.
Metabolic factors
Blood vessels
Intracranial pressure
Atherosclerosis
An
TYPES OF STROKE
Ischemic:
Thrombotic stroke
Most
Thrombotic Stroke
Thrombotic
Thrombotic stroke
The
Thrombotic stroke
Symptoms
EMBOLIC STROKE
Cerebral
Embolic Stroke
Emboli
A fib
MI
Infective endocarditis
Rheumatic heart disease
Valvular prostheses
ASD
Embolic stroke
Less
Air
Fat from long bone fracture
Amniotic fluid postpartum
tumors
Embolic stroke
Prodromal
events
sudden onset
Most commonly related to head
trauma
High rate of re-occurrence if cause is
not treated.
Hemorrhagic stroke
Intracerebral
hemorrhage is bleeding
within the brain caused by rupture of a
blood vessel that lasts from minutes to
days.
Most commonly caused by HTN
May be caused by brain tumors,
trauma, thrombolytic drugs, and
ruptured aneurysms.
Hemorrhagic stroke
Blood
Subarachnoid stroke
Caused
by aneurysms, AV malformations,
trauma, and HTN.
May have prodromal symptoms if
ballooning or dilation applies pressure to
brain tissue.
May suddenly rupture, causing neuro
changes
Majority of aneurysms are in the Circle of
Willis
Subarachnoid hemorrhage,
contd
If
Temporal Development of
CVA
Transient
TIAs
s/s
Completed Stroke
Neuro
days.
Usually embolic in nature
Also called stable stroke.
Signals readiness for aggressive rehab
therapy. (unless an aneurysm is
involved).
Clinical Manifestations
All
See
Neuromotor Function
Destruction
Mobility
Respiratory function
Swallowing and speech
Gag reflex
Self-care abilities
Motor deficits
Loss
Patterns of deficits
Contralateral
deficits
The
Communication
Aphasia-
Communication
Conductive
Communication, contd
Wernickes
area damage
Affect
May
Intellectual Function
Memory
Spatial-Perceptual Alterations
Right
Elimination
Most
Diagnostic Studies
CT
Diagnostics
PET
Collaborative care
PREVENTION
Healthy diet
Weight control
Regular exercise
No SMOKING
Limiting alcohol
Routine health assessment
DRUG THERAPY
Prophylactic
Surgical Therapy
Carotid
Transluminal Angioplasty
Insertion
EC-IC BYPASS
Extracranial-intracranial
bypass
ACUTE CARE
Table
dentures
Acute Care
Establish
Acute Care
Maintain
patient warmth
Reassure patient and family
Ischemic Cascade
Series
of events in response to
thrombotic and embolic strokes.
Ischemic area becomes discolored and
soft, initially. However, around the border
there is an area of perfusion called the
ischemic penumbra that maintains
perfusion for 3 to 6 hours post stroke.
If adequate blood flow is reinitiated during
this period, less neuro damage results
Treatment
Control
Treatment
IV
Elevating HOB
Maintain head and neck in alignment
Avoidance of hip flexion
Limit cerebral tissue metabolism and
vasodilation by:
avoiding hyperthermia, avoiding
hypervolemia, manage constipation
Medications
Diuretics
Mannitol (Osmitrol)
Lasix, (Furosemide)
Dexamethasone for patients with
vasogenic edema
Drug Therapy
Thrombolytic
therapy
t-PA
Clot specific
Less likely to cause hemorrhage as
compared to streptokinase or
urokinase.
Single most important factor is
timing!!!
t-PA
Patients
Platelet inhibition/anticoagulant
therapy
Heparin,
Drug therapy
Calcium
Drug therapy
Tylenol
treats hyperthermia
Dilantin may be given for seizures