STROKE IN ENGLISH

                                               

                                           STROKE IN ENGLISH

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STROKE-

Ø Stroke is defined as functional abnormality of the central nervous system (CNS) that occurs when the normal blood supply to the brain is disrupted. stroke is a leading cause of serious, long-term disability. Strokes can be divided into two major types-

Ø Ischemic stroke

Ø Hemorrhagic stroke

Ø Ischemic stroke- In this type of stroke there is reduced blood supply to the brain causing ischemia of brain cells, due to occlusion in the arteries which supply oxygenated blood to the brain. It accounts for 85% of total stroke cases.

Ø Hemorrhagic stroke- In this type of stroke there is reduced blood supply to the brain due extravasation of blood into the brain or hemorrhage. It accounts for 15% of total stroke cases.

 

CAUSES OF STROKE-

Ø Ischemic stroke is mainly caused by atherosclerosis and thrombus formation. Large artery thrombotic strokes are caused by atherosclerotic plaques in the large blood vessels of the brain.  Due to atherosclerosis plaque and thrombus lumen of arteries supplying oxygenated blood to brain becomes narrow and blood supply/oxygen supply is reduced to the brain tissues.

Ø Ischemic stroke may also be caused by embolism. Emboli originate from the heart and circulate to the cerebral vasculature, most commonly the left middle cerebral artery, resulting in a stroke.

Ø Hemorrhagic stroke may be caused by intracerebral hemorrhage, subdural hemorrhage, aneurysms or arterio-venous malformations (AVM) . Due to bleeding, blood supply/oxygen supply to the brain tissues is reduced.

CLINICAL MANIFESTATIONS-

Ø Clinical manifestations of an ischemic stroke depend upon the location of the lesion, the size of the area of inadequate perfusion, and the amount of collateral  blood flow. The patient may present with any of the following signs or symptoms:

Ø Numbness or weakness of the face, arm, or leg, specially on one side of the body (hemiparesis)

Ø Confusion or change in mental status

Ø Difficulty in speaking or understanding speech

Ø Visual disturbances such as diplopia

Ø Difficulty in walking,

Ø Dizziness, depression and withdrawal symptoms.

Ø Loss of balance or coordination of muscles

Ø Sudden severe headache

Ø  Paralysis of one side of the body (hemiplegia)

Ø  Loss of or decreased deep tendon reflexes.

Ø Apraxia (inability to perform a previously learned action)

Ø Homonymous hemianopsia (loss of half of the visual field)

Ø difficulty in interpreting visual, tactile, and auditory stimuli.

Ø The patient with a hemorrhagic stroke may have clinical manifestations similar to the patient with ischemic stroke.

Ø Other symptoms that may be observed more frequently in patients with acute hemorrhagic stroke are

Ø vomiting, sudden change in level of consciousness, and possibly focal seizures due to frequent brain stem involvement.

Ø The patient with an intracranial aneurysm or arterio-venous malformations (AVM) may have some unique clinical manifestations. such as

Ø Severe headache and often loss of consciousness for a variable period of time.

Ø There may be pain and rigidity of the back of the neck (nuchal rigidity) and spine due to meningeal irritation

DIAGNOSTIC INVESTIGATIONS-

Ø History taking and Physical and neurologic examination.

Ø CT scan and MRI to confirm the type of stroke, the size and location of the hematoma

Ø Cerebral angiography to confirms the diagnosis of an intracranial aneurysm or AVM.

Ø Lumber puncture to check ICP

Ø ECG

TREATMENT –

Ø Medical management of ischemic stroke includes use of Platelet-inhibiting medications, including aspirin, extended- release dipyridamole plus aspirin, clopidogrel  and ticlopidine to prevent further thrombus and embolism formation

Ø Thrombolytic agent t-PA (Tissue plasminogen activator)  isused to treat ischemic stroke by dissolving the blood clot that is blocking blood flow to the brain.

Ø Surgical management includes carotid endarterectomy. It is performed by removal of an atherosclerotic plaque or thrombus from the carotid artery.

Ø Carotid stenting, with or without angioplasty, is a less invasive procedure that may be used for ischemic strokes.

Ø Management of hemorrhagic stroke may consist of bed rest with sedation to prevent agitation and stress, management of vasospasm, and surgical or medical treatment to prevent re-bleeding.

Ø Antiseizure agents are often administered prophylactically for a brief period of time.

Ø Analgesic agents may be prescribed for head and neck pain.

Ø Surgical management may be needed for large hematomas and aneurysms.

NURSING MANAGEMENT-

Ø Proper assessment is done by health history, and physical examination and a nursing care plan is prepared.

Ø The nurse should also assess  mental status, sensation, perception , motor control,  swallowing ability, nutritional and hydration status, skin integrity, activity tolerance and bowel and bladder function

Ø A patient with hemiplegia has unilateral paralysis have chances of developing contractures. The nurse uses correct positioning for patient to prevent contractures.

Ø  Nurse assist in maintaining good body alignment, and prevent compressive neuropathies, especially of the ulnar and peroneal nerves neuropathies.

Ø To prevent adduction contracture of the affected shoulder while the patient is in bed  during sleep, a pillow is placed in the axilla.

Ø The fingers are positioned in such a way that they are slightly flexed. The hand is placed in slight supination which is its most functional and natural anatomical position.

Ø The nurse encourages the patient and assist to stretch the muscles of hand and fingers because spasticity of hands can be prevented by stretching and splinting.

Ø  As soon as possible, the patient is assisted out of bed and an active rehabilitation program is started.

Ø When the patient is able to sit up, the nurse should encourage him/her for personal hygiene activities .

Ø Patients with a decreased field of vision should be approached on the side where visual perception is intact.

Ø The patient can be taught to turn the head in the direction of the defective visual field to compensate for this loss.

Ø Increasing the natural or artificial lighting in the room and providing eyeglasses help to increase vision.

Ø After a stroke, the patient may have transient urinary incontinence due to confusion, inability to  communicate needs, so the nurse should use intermittent catheterization with sterile technique.

Ø The voiding pattern is analyzed, and the urinal or bedpan is offered on this pattern or schedule.

Ø A regular turning schedule is adhered to even if pressure-relieving devices are used to prevent tissue and skin breakdown

Ø Family members play an important role in the patient’s recovery. Family members are encouraged to participate in counseling and to use support systems to help the patient in emotional and physical stress

Ø Patient and family education is a fundamental component of rehabilitation. The nurse provides teaching about stroke, its causes and prevention, and the rehabilitation process during discharge planning.