STROKE

Stroke



Table of Content

INTRODUCTION1

PART 1: RATIONALE1

PART 2: PATHOPHYSIOLOGY OF CARE1

Causes and Risk Factors3

Blockage of an artery3

Embolic stroke3

Cerebral hemorrhage4

Subarachnoid hemorrhage4

Vasculitis4

Migraine headache5

Symptoms5

Diagnosis5

Treatment6

Tissue plasminogen activator (TPA)6

Heparin and aspirin6

Managing other Medical Problems7

Rehabilitation7

PART 3: EVIDENCED BASED ANALYSIS7

CONCLUSION8

REFERENCES10

INTRODUCTION

A stroke, or cerebrovascular accident (CVA), occurs when blood supply to part of the brain is disrupted, causing brain cells to die. When blood flow to the brain is impaired, oxygen and glucose cannot be delivered to the brain. Blood flow can be compromised by a variety of mechanisms. (Wang 2007, 82)

 

PART 1: RATIONALE

Stroke is life-threatening, but Edwin wasn't thinking about dying in the hours following his stroke. The nighttime fears that drove him to the edge of despair were those that "painted pictures in my mind that my stroke might advance to the point where I could not speak nor see nor hear nor move, and still be alive." (Hebert 2005, 5)

Stroke is the third leading cause of death and the leading cause of serious long-term disability in the United States. Approximately 700,000 people suffer a new or recurrent stroke every year -- 1 every 45 seconds. That means that at about the time you finish reading this paragraph, another American will have suffered a stroke. Fifteen percent of stroke victims will die shortly after their stroke, and only 10% will have near full recovery. Most strokes (87%) are ischemic in nature; intracerebral and subarachnoid hemorrhagic strokes account for the remainder. Racial and ethnic disparities persist in both the incidence and outcomes of stroke. Blacks are more likely to die from stroke regardless of age at occurrence.

PART 2: PATHOPHYSIOLOGY OF CARE

This brief presentation of pathophysiology of stroke reviews conditions that influence ischemic injury, mechanisms of death of neurons (coagulation necrosis vs apoptosis), cerebral blood flow and survival of brain tissue and features of hypotensive stroke. Ischemic penumbra and viability of brain tissue, and re-perfusion hemorrhage (O'Regan 2008, 24)a complication of restoration of cerebral blood flow to injured brain tissue are also explained.

Understanding of the pathogenesis of stroke is to understand how ischemia and hemorrhage cause injury. An ischemic stroke deprives neurons of oxygen and nourishment. Accumulation of noxious metabolites in the brain tissue originating from the injured or dying neurons increases with time, which then results in injury to the surrounding healthy neurons. This process can be halted or even reversed in the ischemic penumbral brain tissue if restoration of blood flow occurs within a critical time period. In hemorrhagic stroke, extra vascular release of blood causes damage by cutting off connecting pathways, resulting in local or generalized pressure injury. (Kidwell 2003, 29)

Two major types of “strokes” cause brain damage: ischemic and hemorrhagic stroke. In ischemic stroke, which represents about 80% of total strokes, lack of circulating blood deprives neurons of oxygen and nourishment. The effects are fairly rapid because the brain does not store glucose and is incapable of anaerobic metabolism 1 . Hemorrhagic stroke causes damage to brain tissue by disrupting connecting pathways resulting in local or generalized tissue ...