 Stroke

 This happens when blood flow to a part

of the brain is stopped either by a
blockage or a ruptured blood vessel
 Ischemic - blockage
 Hemorrhagic – rupture of a blood vessel

dead brain cells

 Most common  Occurs when a
 A blood vessel blood vessel
blocked by a blood ruptures, or
clot from: hemorrhages, and
* somewhere else in then prevents blood
the body then gets from getting to part
lodged in a blood of the brain
vessel in the brain –  Any blood vessel in
Embolic Stroke the brain, or in the
* a vessel within a membrane
brain – Thrombotic surrounding the
Stroke brain.
 High blood pressure. High blood pressure is the main risk factor
for stroke. Blood pressure is considered high if it stays at or
above 140/90 millimeters of mercury (mmHg) over time. If you
have diabetes or chronic kidney disease, high blood pressure
is defined as 130/80 mmHg or higher.
 Diabetes. Diabetes is a disease in which the blood sugar level
is high because the body doesn’t make enough insulin or
doesn’t use its insulin properly. Insulin is a hormone that helps
move blood sugar into cells where it’s used for energy.
 Heart diseases. Ischemic heart
disease, cardiomyopathy, heart failure, and atrial
fibrillation can cause blood clots that can lead to a stroke.
 Smoking. Smoking can damage blood vessels and raise blood
pressure. Smoking also may reduce the amount of oxygen that
reaches your body’s tissues. Exposure to secondhand smoke
also can damage the blood vessels.
 Age and gender. Your risk of stroke increases as you get older.
At younger ages, men are more likely than women to have
strokes. However, women are more likely to die from strokes.
Women who take birth control pills also are at slightly higher
risk of stroke.
 Race and ethnicity. Strokes occur more often in
African American, Alaska Native, and American
Indian adults than in white, Hispanic, or Asian
American adults.
 Personal or family history of stroke or TIA. If you’ve
had a stroke, you’re at higher risk for another one.
Your risk of having a repeat stroke is the highest
right after a stroke. A TIA also increases your risk of
having a stroke, as does having a family history of
stroke.
 Brain aneurysms or arteriovenous malformations
(AVMs). Aneurysms are balloon-like bulges in an
artery that can stretch and burst. AVMs are tangles
of faulty arteries and veins that can rupture (break
open) within the brain. AVMs may be present at
birth, but often aren’t diagnosed until they rupture.
 Alcohol and illegal drug use, including
cocaine, amphetamines, and other drugs
 Lack of physical activity
 Overweight and Obesity
 Stress and depression
 Unhealthy cholesterol levels
 Unhealthy diet
 Use of nonsteroidal anti-inflammatory drugs
(NSAIDs), but not aspirin, may increase the risk
of heart attack or stroke, particularly in patients
who have had a heart attack or cardiac
bypass surgery. The risk may increase the
longer NSAIDs are used. Common NSAIDs
include ibuprofen and naproxen.
https://www.slideshare.net/jofred/acute-biologic-crisis-lecture
 difficulty walking  numbness or
 dizziness paralysis in the face,
 loss of balance and leg, or arm, most
coordination likely on just one side
of the body
 difficulty speaking or
understanding others  blurred or darkened
who are speaking vision
 numbness or  a sudden
paralysis in the face, headache,
leg, or arm, most especially when
likely on just one side accompanied by
of the body nausea, vomiting, or
dizziness
https://www.slideshare.net/jofred/acute-biologic-crisis-lecture
https://www.slideshare.net/jofred/acute-biologic-crisis-lecture
https://www.slideshare.net/jofred/acute-biologic-crisis-lecture
 Face: Does one side of the face droop?
 Arm: If a person holds both arms out,
does one drift downward?
 Speech: Is their speech abnormal or
slurred?
 Time: It’s time to call 911 and get to the
hospital if any of these symptoms are
present.
 Be physically active. Physical activity can
improve your fitness level and health.
 Quit smoking.
 Aim for a healthy weight.
 Heart-healthy diet.
 Manage stress.
 Head CT or Head MRI - used to determine if the stroke was
caused by bleeding (hemorrhage) or other lesions and to define
the location and extent of the stroke.
 ECG (electrocardiogram) - used to diagnose underlying heart
disorders.
 Echocardiogram - used if the cause may be an embolus (blood
clot) from the heart.
 Carotid duplex - used if the cause may be carotid artery stenosis.
 Heart Monitor - worn while in the hospital or as an outpatient to
determine if a heart arrhythmia may be responsible for your
stroke.
 Cerebral Angiography - done to identify the blood vessel
responsible for the stroke. Mainly used if surgery is being
considered.
 Blood tests - to exclude immune conditions or abnormal clotting
of the blood that can lead to clot formation. (CBC, HGT, PT, PTT)
 Goal of treatment: restore
the blood flow
 clot-dissolving drug or a
blood thinner: alteplase -
tissue plasminogen activator
(tPA).
 Aspirin to prevent a second
stroke.
 Emergency treatment for this
type of stroke may include
injecting medicine into the
brain or removing a
blockage with a procedure
(carotid endarterectomy or
carotid artery angioplasty).
 Goal of treatment:
controlling the bleeding
 Drugs that lower the pressure
in the brain caused by
bleeding: anticonvulsants
such as diazepam, to
prevent seizure recurrence;
antihypertensive agents such
as labetalol, to reduce BP
and other risk factors for
heart disease; and osmotic
diuretics such as mannitol, to
decrease intracranial
pressure in the subarachnoid
space.
 Procedures done: aneurysm
clipping, coil embolization,
and arteriovenous
malformation (AVM) repair
 More than three quarters of people who
suffer a stroke survive for a year and over
half survive for more than five years. The
patient prognosis after an ischemic stroke
is much more positive than after a
hemorrhagic stroke. In addition to killing
off brain cells, hemorrhagic stroke
increases the risk of dangerous
complications such as increased
intracranial pressure or spasms in the
brain vasculature.
 Blood clots and muscle weakness. Being immobile
(unable to move around) for a long time can raise
the risk of developing blood clots in the deep veins
of the legs. Being immobile also can lead to
muscle weakness and decreased muscle flexibility.
 Problems swallowing and pneumonia. If a stroke
affects the muscles used for swallowing, having a
hard time eating or drinking is a possibility. The risk
of inhaling food or drink into your lungs is also high.
If this happens, pneumonia might develop.
 Loss of bladder control. Some strokes affect the
muscles used to urinate. A urinary catheter would
be needed until bladder control is present. Use of
these catheters can lead to urinary tract
infections. Loss of bowel control or constipation
also may occur after a stroke.
Thank you!