3. INTRODUCTION
The brain receives about 25% of the body's
oxygen, but it cannot store it. Brain cells
require a constant supply of oxygen to stay
healthy and function properly. Therefore,
blood needs to be supplied continuously
to the brain through two main arterial
systems:
CAROTID ARTERY
BASILAR ARTERY
4. CONT..
The carotid arteries come up
through either side of the front of
the neck.
The basilar artery forms at the base
of the skull from the vertebral
arteries, which run up along the
spine, join, and come up through
the rear of the neck.
5. Definition:
Stroke occurs when there is
ischemia (inadequate blood
flow) to a part of the brain or
hemorrhage into the brain
that results in death of brain
cells.
6.
7. RISK FACTORS
RISK FACTORS ARE DIVIDED INTO :
NON MODIFIABLE
MODIFIABLE
NONMODIFIABLE RISK FACTORS INCLUDE:
AGE- Stroke increase with age
GENDER- Equal in men and women
RACE-
HEREDITY- a family history of stroke
10. TYPES OF STROKE
Strokes can be divided into two major
categories:
ISCHEMIC(85%)- Stroke in which
vascular occlusion and significant
hypoperfusion occur.
HEMORRHAGIC (15%)- in which
there is extravasation of blood into
the brain
11.
12. Ischemic stroke
Ischemic stroke results from
inadequate blood flow to the brain
from partial or complete occlusion of an
artery. It is further divided into:
Thrombotic stroke.
Embolic stroke.
13. THROMBOTIC
Thrombotic strokes are due to atherosclerotic
plaques in the large blood vessels of the brain.
Thrombus formation and occlusion at the site
of the atherosclerosis result in ischemia and
infarction. Thrombotic strokes have been
preceded by TIA (transient ischemic attack ).
TIA is a temporary loss of neurologic function
caused by ischemia of one of the vascular
territories of the brain due to micro emboli
that temporarily block the blood flow.
14.
15. EMBOLIC STROKE
An embolus is a blood clot or
other debris circulating in the
blood. When it reaches an
artery in the brain that is too
narrow to pass through, it
lodges there and blocks the flow
of blood.
16.
17. Hemorrhagic Stroke
A burst of blood vessel may allow
blood to seep into and damage the
brain tissues until clotting shuts off
the leak. It is further divided into two.
Intra-cerebral hemorrhage(intra-
parenchymal)
Subarachnoid hemorrhage (intra-
ventricular )
18. Intra-cerebral hemorrhage
It is the bleeding within the brain caused
by a rupture of a vessel. Hypertension is
the most important cause of intra-
cerebral hemorrhage. There is most often
a sudden onset of symptoms, with
progression over minutes to hours
because of ongoing bleeding. Symptoms
include neurologic deficits, headache,
nausea, vomiting, decreased level of
consciousness and hypertension.
19. Subarachnoid hemorrhage
It occurs when there is intracranial
bleeding into cerebrospinal fluid filled
space between the arachnoid and pia
mater membranes on the surface of the
brain. It commonly caused by rupture of a
cerebral aneurysm. Common symptoms
includes severe headache, sudden
comatose, focal neurologic deficits,
nausea, vomiting, seizures and stiff neck
21. Obstruction of blood vessel
Disrupted cerebral blood flow
Ischemia
Neurons shift from aerobic respiration to anaerobic respiration
Generates large amount of lactic acid (pH increases)
Electrolyte balance fails
Increases intracellular calcium and glutamate release
Cell membranes and proteins brake down
Cell injury and cell death
22. Ischemia
Energy Failure
Ion imbalance
Cell Injury & Death
Cell membranes & proteins breakdown
Formation of free Radicals
Protein production decreased
Pathophysiology
Intracellular calcium
increased
Depolarization
Increased
Glutamate
Hemorrhage
Acidosis
23. CLINICAL MANIFESTATIONS
• A stroke can cause a wide variety of
neurologic deficits ,depending on the
location of the lesion (which vessels
are obstructed),the size of the area of
inadequate perfusion, and the amount
of secondary or accessory blood
flow. Ischemia or haemorrhage to one
side of the brain can often result in
signs and symptoms on the opposite
side of the body.
24. THE PATIENT MAY PRESENT WITH ANY OF THE
FOLLOWING SIGNS OR SYMPTOMS:
• Numbness or weakness of the face, arm, or
leg, especially on one side of the body
• Confusion or change in mental status
• Trouble speaking or understanding speech
• Visual disturbances
• Difficulty walking, dizziness, or loss of
balance or coordination
• Sudden severe headache
25. VISUAL FIELD DEFICITS
• Hemianopsia -Loss of half of the visual
field
• Loss of peripheral vision - Difficulty seeing
at night. Unaware of objects or the borders
of objects
• Diplopia - Double vision
28. MOTOR DEFICITS
• Hemiparesis –Weakness of the face, arm, and leg
on the same side (due to a lesion in the opposite
hemisphere)
• Hemiplegia – Paralysis of the face, arm, and leg on
the same side (due to a lesion in the opposite
hemisphere).
• Ataxia - Staggering, unsteady gait .Unable to keep
feet together; needs a broad base to stand
• Dysarthria - Difficulty in forming words
• Dysphagia- Difficulty in swallowing.
30. VERBAL DEFICITS ( APHASIA)
• Expressive aphasia - Unable to form words
that are understandable; may be able to
speak in single-word responses
• Receptive aphasia -Unable to comprehend
the spoken word; can speak but may not
make sense
• Global (mixed) aphasia -Combination of
both receptive and expressive aphasia
31. COGNITIVE DEFICITS
• Short- and long-term memory loss
• Decreased attention span
• Impaired ability to concentrate
• Poor abstract reasoning
• Altered judgment
• Apraxia
32. EMOTIONAL DEFICITS
• Loss of self-control
• Emotional liability
• Decreased tolerance to stressful situations
• Depression
• Withdrawal
• Fear, hostility, and anger
• Feelings of isolation
33. • Paralysis or weakness on left
side of body
• Left visual field deficit
• Spatial-perceptual deficits
• Increased distractibility
• Impulsive behavior and poor
judgment
• Lack of awareness of deficits
• Paralysis or weakness on
right side of body
• Right visual field deficit
• Aphasia (expressive,
receptive, or global)
• Altered intellectual ability
• Slow, cautious behavior
COMPARISON OF LEFT AND RIGHT
HEMISPHERIC STROKES
LEFT HEMISPHERIC STROKE RIGHT HEMISPHERIC STROKE
36. DIAGNOSIS STUDIES
Diagnostic studies are done to:
•Diagnosis of stroke ,including
extent of involvement
•To measure cerebral blood flow
• To assess cardiac involvement
42. PHARMACOLOGICAL MANAGEMENT
• ANTI PLATELET DRUG
e.g.: ASPIRIN,CLOPIDOGREL (dose:81-325
mg/day).
• ANTICOAGULANT
E.g.: warfarin
• THROMBOLYTIC THERAPY
Recombinant t-PA thrombolytic substance made
naturally by the body works by binding to fibrin
and converting plasminogen to plasmin, which
stimulates fibrinolysis of the atherosclerotic
lesion.
43. Cont..
• CALCIUM CHANNEL BLOCKER
Nimodipine is given to patients with
subarachnoid hemorrhage to decrease the
effects of vasospasm and minimize cerebral
damage.
• ANTISEIZURE DRUGS
Phenytoin is given if seizure occurs.
• ANALGESICS
• codeine, acetaminophen may be prescribed
for head and neck pain.
44. Cont…
• DIURETIC DRUGS
it is used to reduce cerebral edema and it also
helps in lowering ICP
E.g.: MANNITOL , FUROSEMIDE.
45. NON-PHARMACOLOGICAL MANAGEMENT
•Maintain ABC.
•Reduce salt and sodium intake
•Maintain a normal body weight
•Maintain a normal blood pressure
•Increase level of physical exercise
•Avoid cigarette smoking or tobacco
products
46. Cont…
•Limit consumption of alcohol to
moderate levels
•Use a diet that is low in saturated fat
and dietary cholesterol and high in
fruits and vegetables.
•The patient is fitted with elastic
compression stockings to prevent
deep vein thrombosis, a threat to any
patient on bed rest.
47. SURGICAL MANAGEMENT
• Carotid endarterectomy
The artheromatous lesion is removed from the
carotid artery and to improve blood flow.
• Transluminal angioplasty -
It is the insertion of a balloon to open a
stenosed artery and improve blood flow.
• EC-IC bypass
It involves anastomosing a branch of an
extracranial artery to an intracranial artery beyond
the area of obstruction with the goal of increasing
cerebral perfusion.
Merci retriever-it removes the blood clots by going
into the artery that is blocked and pulls the clot out.
50. For aneurysm and hemorrhage
• CLIPPING AND WRAPPING.
It’s a traditional method to prevent rebleeding.
• COILING
It’s a endovascular procedure done by inserting a
metal coil (GDC’S) into the lumen and thus
provides immediate protection against bleeding
and reduce the pulsation within the aneurysm.
54. a. Nursing Responsibilities
The role of a nurse in taking care of a
patient with CVA are:
1. Improve physical mobility and prevent
joint deformities by providing correct
positioning and assist the patient in
maintain good body alignment.
2. The arm of the patient is slightly flexed
with a pillow under the arm where elbow
is positioned higher than shoulder and the
wrist higher than elbow to prevent edema.
55. Cont…
3.Change the position of the
patient every 2 hours to
prevent pressure sores.
4.Provide passive exercises to
affected extremities four or five
times a day to maintain
mobility, motor control which
helps in preventing venous
stasis.
57. Cont..
5. Ambulate the patient as soon as
possible when the patient can be
assisted out of bed.
6. The nurse should never lift or
pull the patient by the affected
shoulder . The proper positioning
and range of exercise reduce
shoulder pain.
58. Cont..
7.The nurse should encourage the
patient to do self care activities.
8.The role of a nurse is to support
the client in improving thought
process in collaboration with
primary care physician
neuropsychologist and other
professionals.
59. Cont..
9. The patient skin must be kept
clean and dry .Maintain
normal skin and tissue
integrity by providing
adequate nutrition.
10.Educate and counsel the
family members who play an
important role in the patients
recovery.
61. CVA diagnosis are:
1. Ineffective cerebral tissue
perfusion related to decreased
cerebral blood flow as evidenced
by decreased GCS.
2. Impaired physical mobility
related to hemiparesis, loss of
balance and co-ordination and
brain injury as evidenced by
limited ability to perform
activities.
62. Cont..
3. Impaired verbal
communication related to
brain damage as evidenced
by inability to speak or find
words.
4. Self care deficit related to
stroke squeals as evidenced
by inability in performing
daily course.
