Stroke

1
Stroke

• Presented by Chris Fernandez, Naseem Mazlaghani,
  Ashley Thoreson, and Mary Wuest

2
Quick Facts

• CVAs are leading cause of disability and third
  leading cause of death in US
• Tends to run in families More common in men
• Persons with Hypertension and type 2 diabetes
  mellitus are at 4x risk of CVA

3
Pathophysiology

• 2 types of stroke
• (1) cerebral infarction
• (2) cerebral hemorrhage
• Cerebral infarction occurs as a result of lack
  of blood supply due to a blockage in a blood
  vessel
• Cerebral hemorrhage caused by hypertension

4
Pathophysiology (cont.)

• Cerebral infarction
• 3 major causes
• sudden vascular blockage
• ongoing vascular blockage
• narrowing of blood vessel
• 2 major types
• Ischemicarea is slightly discolored, softens
  immediately (6-12 hrs after blockage), necrosis
  occurs within 48-72 hrs
• Hemorrhagicaffected area bleeds excessively
  after blood flow has been restored (blood flow
  can be reestablished if the original cause of
  lack of blood supply is removed/changed)

5
Pathophysiology (cont.)

• Cerebral hemorrhage
• Major cause Hypertension
• Increased pressure? brain tissue is shifted?
• ischemia
• edema
• increased intracranial pressure
• at times, blood leaks into the ventricular system
• Resolved through reabsorption by macrophages and
  astrocytes
• Following removal of blood, a cavity forms

6
Cerebral infarction Ischemic vs. Hemorrhagic
7
Cerebral Hemorrhage

• Agamanolis, D (2008). Neuropathology. Retrieved
  March 30, 2009, Web site http//neuropathology.ne
  oucom.edu/chapter2/images2/2-15l.jpg
• About Stroke Genetics. Retrieved March 30, 2009,
  from Rosand Lab Web site http//www.strokegenomic
  s.org/img/stroke_isc_web.jpg

8
Etiology

• 4 Classifications of Stroke based on
  Pathophysiology
• Thrombotic Stroke
• Embolic Stroke
• Lacunar Stroke
• Hemorrhagic Stroke

9
Etiology (cont.)

• Thrombotic Stroke
• Atherosclerosis, vasoconstriction , various
  inflammatory diseases of the blood vessel wall,
  noninflammatory vasculopathy, and fibromuscular
  dysplasia.
• Over 20 to 30 years plaque (stenotic lesion) can
  form at branching and curves in the arteries,
  eventually forming a clot

10
Etiology (cont.)

• Embolic Stroke
• Most commonly an occlusion from fragments of
  thrombus formed outside the brain, in the heart,
  aorta or common carotid.
• Less common causative agents of stroke are air,
  fat, clumps of bacteria and tumors.

11
Etiology (cont.)

• Lacunar Stroke
• Fibrinoid degeneration
• Involve small perforating arteries in basal
  ganglia, internal capsules, and pons. Usually
  smaller than 1cm.
• Pure motor and sensory deficits.

12
Etiology (cont.)

• Hemorrhagic Stroke
• Hemorrhage of cranial arteries. Common causes
  include Hypertension, Ruptured aneurysms,
  bleeding into a tumor, hemorrhage due to bleeding
  disorders, anticoagulation, head trauma, and
  illicit drug use.
• Classified as
• Massive (gt2cm)
• Small (1-2cm)
• Slit (resides in subcortical area)
• Petechial (pinhead).

13
CLINICAL MANIFESTATIONS

• MOTOR SENSORY
• Consciousness
• Vision
• Hearing
• Vertigo
• LANGUAGE
• Speech

14

• Physiological
• Headache
• Nausea/vomiting
• Seizure
• Paralysis
• Psychological
• Emotional
• -Client
• -Family
• Psychiatric
• Labs
• Glucose
• Cardiac Enzymes
• Drug Screens
• CBC/Platelets

15
Stroke Treatment

• Ischemic Stroke
• Clot-busters, e.g., tPA  
• Only given within 3 hours after diagnosed with
  stroke to dissolve clot.

16
Stroke Treatment contd

• Hemorrhagic Stroke
• Aneurysm clipping
• A surgical intervention performed to isolate an
  aneurysm from the normal blood circulation.
• Endovascular coiling
• Less invasive procedure in which an aneurysm is
  filled with a substance to block it off.

17
Preventative Treatment

• Anticoagulants/Antiplatelets
• Anticoagulants such as aspirin thin the blood and
  prevent clotting.
• Antiplatelets such as warfarin prevent platelet
  aggregation.
• Carotid endarterectomy 
• Procedure in which plaque is surgically removed
  from the lining of the carotid artery.

18
Preventative Treatment contd

• Angioplasty/Stents
• Performed to improve blood flow in the bodys
  arteries and veins.

19
Works Cited

• Huether, Sue, and Kathryn McCance. Understanding
  Pathophysiology. 4th ed. St. Louis Mosby, 2008.