Strokes

Morgann Loaec and Laila Siddique MS2

Blood Supply to the Brain

Blood Supply of the Brain

What is a stroke?

Poor blood flow to the brain resulting in cell death

What can cause poor blood flow to the brain?

Types of Strokes

Hemorrhagic - due to bleeding

10-15% of strokes

Ischemic - due to lack of blood flow, usually from a blood clot

85-90% of strokes

Risk Factors for Stroke Family History

Hypertension (high blood pressure)

Smoking

Alcohol Intake

Obesity

High cholesterol

Diabetes

Atrial fibrillation

Aneurysm

What do all of these factors put you at risk for that increases your risk of having a stroke?

Clinical Presentation of a Stroke Inability to move or feel one side of the body

Problems understanding or speaking

Feeling like the world is spinning

Loss of vision to one side

severe headache with no known cause

dizziness and lightheadedness

weakness of any kind

confusion, trouble speaking/understanding

numbness of face arm or leg especially on one side of body

passing out or fainting

NIH Stroke Scale Level of Consciousness

LOC Responsiveness

LOC Questions

LOC Commands

Horizontal Eye Movement

Visual field test

Facial Palsy

Motor Arm

Motor Leg

Limb Ataxia

Sensory

language

Speech

Extinction and Inattention

Pathophysiology of Strokes

https://www.youtube.com/watch?v=pcmrgwNCPwM

Main points

Ischemic strokes are formed by blockage of blood vessels that starve brain tissue of oxygen and nutrients

Clots can either form in the unhealthy vessel within the brain = thrombus

Or clots can form somewhere else and travel to the brain = embolism (This is why atrial fibrillation is a risk factor for strokes)

Hemorrhagic strokes are caused by a rupture of a blood vessel within the brain or from the rupture of an aneurysm

Hemorrhagic strokes destroy brain tissue directly with the leak of blood on to brain tissue and indirectly by cutting off the blood supply to brain tissue

Treatment of Strokes

tPA = Gold standard for ischemic stroke treatment

tissue plasminogen activator = breaks down clots

Endovascular procedures to remove the clot is your next option

Mechanical thrombectomy using a stent retriever

Hemorrhagic strokes are treated with endovascular procedures or surgical procedures

Catheter procedure to prevent rupture of aneurysm or AVM

Surgical repair of burst aneurysm or AVM using metal clips

Natural HistoryDisability after a stroke correlates with the amount of time between the stroke onset and treatment.

The longer a patient’s brain is deprived of blood supply, the more it will start to die.

If treatment is started early, within the first few hours, many of the stroke symptoms will not be permanent; but if treatment is delayed, the brain damage may be permanent and symptoms can persist.

75% of patients experience some kind of disability after their stroke:- muscle weakness- numbness- loss of speech- loss of vision- pain

This is a traumatic experience for all patients and support is imperative for their recovery

Life After Stroke

Stroke patients often need rehabilitation to regain function after a stroke

They work with OT and PT to regain skills such as:

Self-care skills such as feeding, grooming, bathing, toileting and dressingMobility skills such as transferring, walking or self-propelling a wheelchair Communication skills in speech and language Cognitive skills such as memory or problem solving Social skills for interacting with other people

This often takes place in a variety of settingsAcute care in the hospital Long term care facilities Home health care

Prevention

Prevention includes:

- Decreasing the risk factors we discussed earlier (high blood pressure, diabetes, obesity, smoking, alcohol consumption, high cholesterol etc)

- Aspirin (blood thinner to break down clots or prevent formation)

- Statins (helps to lower high cholesterol levels)

- Surgery to open up the arteries to the brain in those with problematic narrowing

- Warfarin (another blood thinner) in those with atrial fibrillation