Acute Stroke

Acute Stroke

A stroke occurs when the blood supply to your brain is interrupted or reduced. This deprives your brain of oxygen and nutrients, which can cause your brain cells to die.

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Causes

1. A blocked artery (ischemic stroke) - Thrombotic stroke. A thrombotic stroke occurs when a blood clot (thrombus) forms in one of the arteries that supply blood to your brain.

                                                        -  Embolic stroke. An embolic stroke occurs when a blood clot or other debris forms away from your brain,commonly in your heart and is swept through your bloodstream to lodge in narrower brain arteries.

     2. The leaking or bursting of a blood vessel (hemorrhagic stroke) - Hemorrhagic stroke occurs when a blood vessel in your brain leaks or ruptures. There are two types of hemorrhagic stroke including Subarachnoid hemorrhage and Intracerebral hemorrhage.

     3. Temporary disruption of blood flow to their brain (transient ischemic attack, or TIA) - A temporary decrease in blood supply to part of your brain causes TIAs, which often last less than five minutes.

(Myoclinic, 2015)

Signs and symptoms

1. Abrupt onset of hemiparesis, monoparesis, or (rarely) quadriparesis.

2. Hemisensory deficits.

3. Monocular or binocular visual loss.

4. Visual field deficits.

5. Diplopia.

6. Dysarthria.

7. Facial droop.

8. Ataxia.

9. Vertigo (rarely in isolation).

10. Nystagmus.

11. Aphasia.

12.Sudden decrease in level of consciousness. (E.C.Jauch, H.L. Lutsep, 2015)

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Investigations

• CT angiography and CT perfusion scanning.

• Magnetic resonance imaging (MRI).

• Carotid duplex scanning.

• Digital subtraction angiography.

• Complete blood count (CBC).

• Cardiac biomarkers: Important because of the association of cerebral vascular disease and coronary artery disease.

• Toxicology screening: May assist in identifying intoxicated patients with symptoms/behavior mimicking stroke syndromes.

• Arterial blood gas analysis: In selected patients with suspected hypoxemia, arterial blood gas defines the severity of hypoxemia and may be used to detect acid-base disturbances.

Treatments

1. Therapy with clot-busting drugs must start within 3 hours if they are given into the vein.

2. Aspirin. Aspirin is an immediate treatment given in the emergency room to reduce the likelihood of having another stroke.

3. Intravenous injection of tissue plasminogen activator (TPA). Some people can benefit from an injection of a recombinant tissue plasminogen activator (TPA), also called alteplase. An injection of TPA is usually given through a vein in the arm. TPA restores blood flow by dissolving the blood clot causing your stroke, and it may help people who have had strokes recover more fully.

4. Medications delivered directly to the brain -  using catheter.

5. Mechanical clot removal.

6. Oxygen - Supplement if indicated (Sa02 < 94%) (T. I. A. ACUTE STROKE MANAGEMENT GUIDELINE ).

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REFERENCES

• E.C.Jauch, H.L. Lutsep. (2015, January 20). Ischemic Stroke . Retrieved May 7, 2015, from medscape: http://emedicine.medscape.com/article/1916852-overview

• Myoclinic. (2015, april 28). Stroke. Retrieved May 07, 2015, from www.mayoclinic.org: http://www.mayoclinic.org/diseases-conditions/stroke/symptoms-causes/dxc-20117265