![]() ![]() Medical Management Warfarin Sodium (Coumadin) Platelet-inhibiting medication Aspirin - most cost effective - 50 mg/d Dipyridamole (Persantine) - 400 mg/d Clopidogrel (Plavix) Ticlopidine (Ticlid) Thrombolytic Therapy Therapy for patients with ischemic stroke not receiving t-PA Endarterectomy Ĭriteria for t-PA Administration 18 years of age or older NIH stroke scale of 22 Time of onset of stroke known and is 3 hours or less BP systolic Not a minor stroke or rapidly resolving stroke No seizure at onset of stroke Not taking warfarin Prothrombine time Not receiving heparin during the past 48 hours with elevated partial thromboplastin time Platelet count of > 100,000 Blood glucose level between 50 and 400 mg/dL No acute myocardial infarction No prior intracranial hemorrhage, neoplasm, arteriovenous malformation, or aneurysm No major surgical procedures within 14 days No stroke or serious head injury within 3 months No gastrointestinal or urinary bleeding within last 21 days Not lactating or postpartum within last 30 days. Pathophysiology Open Ca channels Inc Ca, Na and Cl Dec K Inc cell death Inc glutamine and aspartateĪssessment Motor Loss Communication Loss Perceptual Disturbances Sensory Loss Cognitive Impairment and Psychological Effects - Cognitive impairment - Psychological problems Ĭooperation of Left and Right Hemispheric Stroke Lack of awareness of deficits Impulsive behavior and poor judgment Slow, cautions behavior Increase distractibility Altered intellectual ability Spatial-perceptual deficits Aphasia (expressive, receptive, or global) Left visual field loss Right visual field deficit Paralysis or weakness on left side of the body Paralysis or weakness on right side of the body Right Hemispheric Stroke Left Hemispheric Strokeĭiagnostic Examination Non Contrast Computed Tomography scan 12-lead electrocardiogram –standard test Carotid ultrasound – standard test Cerebral angiography Transcranial Doppler flow studies Transthoracic or transesophageal echocardiography Magnetic resonance imaging Xenon CT Single photon emission CT Carotid phonoangiography Oculoplethysmography Carotid angiography Digital subtraction angiography Pathophysiology Occlusion of artery Dec blood flow Dec oxygenation and nutrition of brain Dec energy stores Hypertension Uncontrollable Risk Factors Controllable Risk Factors Progressing stroke Complete Stroke - stabilization of the neurologic signs and symptoms - indicates no further progression of hypoxic insult to the brain from this particular ischemic event. Stroke in Evolution - worsening of neurologic sign and symptoms over several minutes or hours. Reversible Ischemic Neurologic Deficit - sign and symptoms are consistent but more distinct than a TIA - last for more than 24 hours - symptoms revolve in days without permanent neurologic deficits. ![]() last for a few seconds or minutes but no longer than 24 hours. ![]() temporary episodes of neurologic dysfunction manifested by a sudden loss of motor, sensory, or visual function. Stroke Continuum: Time Course Classification Transient Ischemic Attack - may serve as a warning of approaching strokes - greatest incidence is in the first month following the first attack. other strokes – from the use of cocaine, coagulopathies, migraine, and spontaneous dissection of the carotid or vertebral arteries. Emboli stroke may be prevented by the use of anticoagulant therapy in patients with atrial fibrillation. Emboli originate from the heart and circulate to the cerebral vasculature, most commonly the left middle cerebral artery, resulting in a stroke. Cardiogenic embolic strokes – are associated with cardiac dysrhythmias, usually atrial fibrillation. also known as Lacunar strokes because of the cavity that is created once the infracted brain tissue disintegrates. Small penetrating artery thrombosis – affects one or more vessels and are the most common type of ischemic stroke. Thrombus formation and occlusion at the site of the atherosclerosis result in ischemia and infarction. įive Types according to causes: Large artery thrombosis – are due to atherosclerotic plaques in the large blood vessels of the brain. ISCHEMIC STROKE Also known as brain attack is a abrupt loss of function resulting from disrupted blood supply to a part of the brain. Cerebrovascular Disease Ischemic Stroke Hemorrhagic Stroke ![]()
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