STROKEakaCVA - (damage to the brain from interruption of blood supply) Signs and symptomshemiparesis - weakness onone side of the bodyhemisensory lossaltered LOCheadache, dizziness, & anxiety vision loss (amaurosis fugax) visual field defects ataxia, vertigo, &incoordination dysarthria dysphasia dysphagia Pathophysiology –A sudden impairment of cerebral circulation in one or more blood vessels.Stroke interrupts or diminishes oxygensupply and commonly causes serious damage or necrosis in the brain tissues. No matter the cause, the underlying event is deprivation of oxygen and nutrients.Ischemiaandinfarctionare the result of atherosclerotic development of thrombi and emboli. Decreased and/or absent cerebral circulation causes neuronal cellular injury and death.Intracerebral hemorrhageoccurs from rupture of cerebral vessels often as the result of hypertension. Normally, if the arteries become blocked, autoregulatory mechanisms help maintain cerebral circulation until collateral circulation develops to deliver blood to the affected area.If the compensatory mechanisms become overworked, or if cerebral blood flow remains impaired for more than a few minutes, oxygen deprivation leads to infarction of brain tissue. A thrombotic or embolic stroke causes ischemia.Some of the neurons served by the occluded vessel die from lack of oxygen and nutrients, resulting in cerebral infarction.Injury to surrounding cells disrupt metabolism and leads to changes in ionic transport, localized acidosis, and free radical formation.Calcium, sodium, and water accumulate in injured cells and excitatory neurotransmitters are released.Consequent continued cellular injury and swelling may cause further damage.Risk factorshypertensiondiabetes high cholesterol physical inactivity, obesity family history, race, gender CAD, TIAs, AFib, prior strokes, or other heart diseases Certain blood disorders (ex. sickle cell anemia) Excessive Alcohol Illegal drug use Sleep Apnea How to change modifiable risk factors: Control/monitor B/P Control/monitor cholesterol Control/monitor diabetes Stop Smoking Lifestyle changes (diet & exercise) Regular Doctor Visits Treatments Treatment depends on the etiology of the stroke. Thrombolytic therapy is the mainstay of treatment for thrombotic and embolic events. Medical – Antihypertensive & Anticoagulants (Aspirin, warfarin, heparin) Carotid endarterectomyAngioplasty and stents Rationale for treatments Antihypertensive– lower BP by opening vessels and decreasing BV and Rate. Anticoagulants(warfarin, etc.) interfere with the body’s ability to clot (preventing strokes) Carotid endarterectomy-a procedure in which blood vessel blockage (fatty plaque) is surgically removed from the carotid artery.
