Cerebrovascular Accidents/Stroke

• Stroke


  Caused by disruption of blood supply to the brain, causing neurologic deficit.
• Stroke; Pathophysiology

  Obstruction or bleeding - decreased blood flow - cerebral hypoxia - headache (initial manifestation)
• Stroke; Pathophysiology

  Obstruction or bleeding - decreased blood flow - cerebral hypoxia - frontal - decreased motor function - anosmia (smell); paresis (muscle weakness); plegia (paralysis); aphasia (slurred); dysphagia (swallowing)
• Stroke; Pathophysiology

  Obstruction or bleeding - decreased blood flow - cerebral hypoxia - parietal - aguesia (gustatory); decreased sensation (tactile) behavioral changes
• Stroke; Pathophysiology

  Obstruction or bleeding - decreased blood flow - cerebral hypoxia - temporal - amnesia
• Stroke; Pathophysiology

  Obstruction or bleeding - decreased blood flow - cerebral hypoxia - occipital - vision loss - hemianopsia
• Hemianopsia

  1/2 vision loss
• Stroke Manifestations:

  Contralateral except from eyes to mouth. Because of the medulla oblongata. If above - ipsilateral. If below - contralateral. Medulla oblongata is level with the mouth.
• Stroke: Dx

  Cranial CT / MRI (Plain) = Obstruction
• Stroke: Management

  Emergent:

  • position: Semi fowlers
  • NPO - NGT
  • NVS q 1 to 2 hours
  • O2 support; if desat = mechanical ventilation
• Stroke: Pharma

  Ischemic Stroke

  1. Anti-platelet (ASA / Epidogrel)
  2. Anti- coagulants (warfarin / heparin)
  3. Thrombolytics (urokinase, streptokinase, tpa)
  4. Antilipemic (- statin) - for hyperlipidemia
• Stroke: Pharma

  Ischemic Stroke

  1. Anti-platelet - prevents further clogging
• Stroke: Pharma

  Ischemic Stroke

  1. Thrombolytics - dissolves clots
• Stroke: Surgical

  1. Craniotomy - surgical opening of a portion of the skull to gain access to the intracranial structures 
  2. Craniectomy - surgical removal of a portion of the skull
• Stroke: Surgery

  2 types of Craniotomy:

  1. Supratentorial (ibabaw) - postop position: semi fowlers
  2. Infratentorial (likod) - postop position: side lying