Stroke

STROKE

Stroke, also known as cerebrovascular accident (CVA) is a disruption in cerebral perfusion causing neurological deficit.

Types of strokes

Thrombotic ischemic stroke: When cerebral arteries are blocked by blood clot.

Embolic stroke: Impaired cerebral perfusion due to embolism,

vasospasm or atherosclerotic plaque.

Hemorrhagic stroke

• Due to ruptured or leaking aneurysm, intravenous

malformation, bleeding disorder, arterial rupture or trauma.

• Most of the intracerebral hemorrhages are arterial in

origin.

。 Severe explosive headache is the characteristic of

hemorrhagic shock.

Signs and symptoms depend on the affected artery and severity

of the damage.

■Motor symptoms

• Hemiplegia: Paralysis of one side of the body.

• Hemiparesis: Weakness in one side of the body

• Paraplegia: Paralysis of lower extremities

• Quadriplegia: Paralysis of all four limbs of the body

Ataxia: Unsteady gait

Communication disturbance

Dysarthria: Difficulty in speaking

• Dysphasia or aphasia: Defective speech or loss of speech.

It can be expressive, receptive or mixed • Expressive aphasia: It is due to damage to brocca's area of speech, here client can understand what others are communicating but can't communicate back.

• Receptive aphasia: Wernicke's area in the temporal lobe is affected. In this condition, client is unable to understand spoken or written word.

Apraxia: It is the inability to perform previously learned

activities.

Perceptual problems

o Hemianopsia: Loss of half of the visual filed

o Diplopia: Double vision

Agnosia: Inability to recognize familiar object or person.

• Treatment

Anticoagulants are contraindicated in patients with

hemorrhagic stroke but useful in nonhemorrhagic stroke. The only fibrinolytic agent that has been shown benefit in selected patients with acute ischemic stroke is tissue

plasminogen activator (t-PA). NIH stroke scale/score (NIHSS) is done to ascertain the need of thrombolysis.

Surgical evacuation of clot or hematoma relieves increased ICP.

■ Carotid endarterectomy remove plaques. Anticonvulsants to prevent seizure. Analgesics to control pain.

*Key nursing interventions*

■ Assess LOC

■ Monitor ICP and vital signs

Bleeding is the most common side effect of t-PA. So closely monitor the client.

■Speak slowly and simply to patient.

■ Monitor fluid input and output hourly.

■ Positioning of the patient to prevent deformity.

■ Physical therapy to prevent contractures.Unilateral neglect or neglect syndrome: Seen in stroke patient who is unaware about the existence of paralyzed part.

Care provided by Hope of life at Home