STROKE

Question 1

What is a stroke?

Answer 1

Brain basically lacks O2

Question 2

What are the 2 types of strokes?

Answer 2

Ischemic
Hemorrhagic

Question 3

What are the Risk factors?

Answer 3

Modifiable
HTN
Excessive alcohol
Diabetes
Hypercholesterol
Obesity
Smoking

NON
Advanced age
Male
Family HX
Previous TIA or stroke
AF

Question 4

S+S? DID FUC U
How to identify?

Answer 4

A sudden onset of:

Difficulty seeing, walking, hearing
Imbalance
Dizziness

Facial droop
Uncoordinated movement
Collapse

Uneven limb strength slurred speech.

Use FAST to identify
F = Face – Droop?
A = Arms - Can’t lift both arms?
S = Speech - Slurred? Can’t speak? Can’t understand me?
T = Time – Establish time

Question 5

What’s the difference between ischemic and hemorrhagic?

Answer 5

Ischemic happens when there is a narrowing or blockage of cerebral arteries. It’s similar to MI. When this happens, it results in tissue ischemia and subsequently tissue infarction if blood isn’t restored quickly. There are 2 types of ischemic.
Thrombotic = blockage forms in situ
Embolic = blockage originates anywhere and then gets stuck in cerebral vessels.
Atherosclerosis leads to these 2

Hemorrhagic is when the cerebral arteries ruptures resulting in bleeding and hematoma within brain and surround brain tissues. This will damage the tissue and reduce blood flow further downstream from rupture and the blood can damage neurons
Can increase ICP

Question 6

What happens from embolic ischemic stroke?

Answer 6

Embolic ischemic stroke is when the blockage originates anywhere in the body.
This impaired blood supply to different regions of the brain originated from an atherosclerotic plaque progressively breaking up.
So with this stroke there was blocking at the left cerebral hemisphere, brainstem and bilateral cerebellum. This results in blood supply to regions of the brain beyond the point being cut off resulting in tissue ischemia and hypoxia.
The hypoxic tissue to compensate resorts to anaerobic metabolism leading to cell death and functional loss if blood supply not restored.

Question 7

What does left brain control?

Answer 7

The L’s
Language and logic
Dysphasia
Reading or writing problem

Question 8

Right brain controls?

Answer 8

R for reckless and very creative
So lack of impulse control
Behavioural changes

Question 9

Complications? Examples?

Answer 9

Basically if the cerebral arteries in the left side of brain gets affected, causing death within the left brain, then it’ll lead to symptoms on there right side of the body vice versa

Eg = right hemiparesis
Right sensorial loss

Other complications
Expressive and receptive aphasia - speech disorder
Hemiparesis
Visual disturbances
Dysphagia - can’t swallow
Fatigue
Depresison

Question 10

Diagnostics?

Answer 10

GCS to evaluate LOC

Question 11

Management or treatment? What is plasmin?

Answer 11

Varies depending on type of stroke, timing and specific neurological impacts of stroke.
Medication:
rtPA = immediate treatment within few hours of ischemic stroke. Commonly used. Tissue plasminogen activator is a naturally occurring human protease enzyme that activates plasmin - converts plasminogen to plasmin. rtPA is made in a lab and it basically dissolves clots

Plasmin is a fibrinolytic which breaks down fibrin that holds clots together.

So it’s used to reperfuse the cerebral vessels and you need to be eligible with no risk factors like no recent major surgeries, MI or any other internal injuries. Required to have normal clotting function and sufficient number of platelets. NO significant HTN

Anti coagulation can be used with rtPA

Speech language therapy
Physio
Homecare