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Stroke. Presented by Chris Fernandez, Naseem Mazlaghani, Ashley Thoreson, and Mary Wuest. Quick Facts. CVA’s are leading cause of disability and third leading cause of death in US Tends to run in families; More common in men

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Stroke l.jpg

Stroke

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


Quick facts l.jpg
Quick Facts

  • CVA’s 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


Pathophysiology l.jpg
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


  • Pathophysiology cont l.jpg
    Pathophysiology (cont.)

    Cerebral infarction

    3 major causes:

    • sudden vascular blockage

    • ongoing vascular blockage

    • narrowing of blood vessel

      2 major types:

    • Ischemic—area is slightly discolored, softens immediately (6-12 hrs after blockage), necrosis occurs within 48-72 hrs

    • Hemorrhagic—affected 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)


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    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


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    Cerebral infarction:

    Ischemic vs. Hemorrhagic


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    Cerebral Hemorrhage

    Agamanolis, D (2008). Neuropathology. Retrieved March 30, 2009, Web site: http://neuropathology.neoucom.edu/chapter2/images2/2-15l.jpg

    About Stroke Genetics. Retrieved March 30, 2009, from Rosand Lab Web site: http://www.strokegenomics.org/img/stroke_isc_web.jpg


    Etiology l.jpg
    Etiology

    • 4 Classifications of Stroke based on Pathophysiology

      • Thrombotic Stroke

      • Embolic Stroke

      • Lacunar Stroke

      • Hemorrhagic Stroke


    Etiology cont l.jpg
    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


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    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.


    Etiology cont11 l.jpg
    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.


    Etiology cont12 l.jpg
    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 (>2cm)

      • Small (1-2cm)

      • Slit (resides in subcortical area)

      • Petechial (pinhead).


    Slide13 l.jpg

    CLINICAL MANIFESTATIONS

    • MOTOR & SENSORY

    • Consciousness

    • Vision

    • Hearing

    • Vertigo

    • LANGUAGE

    • Speech


    Slide14 l.jpg

    Physiological

    • Headache

    • Nausea/vomiting

    • Seizure

    • Paralysis

      Psychological

    • Emotional

      -Client

      -Family

    • Psychiatric

      Labs

    • Glucose

    • Cardiac Enzymes

    • Drug Screens

    • CBC/Platelets


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    Stroke Treatment

    Ischemic Stroke

    • Clot-busters, e.g., tPA

      • Only given within 3 hours after diagnosed with stroke to dissolve clot.


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    Stroke Treatment cont’d

    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.


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    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.


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    Preventative Treatment cont’d

    • Angioplasty/Stents

      • Performed to improve blood flow in the body’s arteries and veins.


    Works cited l.jpg

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

    Works Cited


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