stroke concept map

Aetiology

Depletion of blood flow in a cerebral artery resulting from a thrombus or embolus. (1)

Pathogenesis

Occlusion of cerebral artery production of ATP failure of energy pumps influx of sodium and calcium ions and efflux of potassium passive inflow of water cytotoxic oedema destruction of cells in infarct core.

Membrane depolarisation release of glutamate excessive calcium influx into neurons destruction of cells by lipolysis, proteolysis and free radicals.

infarct core and ischaemic penumbra

necrotic tissue not able to conduct impulses interrupting normal function such as motor and sensory transmission and speech.

 

 

 

Risk factors

· Obesity

· Smoking

· Sedentary lifestyle

· Age 1.

· ageg

Clinical features

· Right-sided hemiplegia and weakness

· Sensory loss on right side

· Inability to see the right visual field of each eye

· Aphasia

· Apraxia

· Dysarthria

· Impaired reasoning

· Behavioural changes

· Problems with memory

 

Diagnosis

· Complete history

· Physical and neurological examination

· Brain MRI or CT scan –differentiate cerebral haemorrhage from ischaemic stroke

· Other tests for vascular imaging – CT angiography, magnetic resonance angiography

Primary prevention

· Don’t smoke

· Diet high in fruit and vegetables

· Diet low in fats and salt

· 30 minutes of exercise daily

· Limit alcohol

1,7

Treatment

Medical

· Reperfusion Thrombolytic (tPA )

Nursing acute phase

· Frequent evaluation of neurological status and vital signs

· Oxygen saturations – administer oxygen if required

· Screen for swallowing – manage hydration and nutrition

· Manage activities of daily living

· Address appropriate communication strategies

· Prevent complications

Rehabilitation

· Passive and active movement

· Encourage activities provided by physiotherapists, speech and occupational therapists e.g. mobility, speech, ADL

· Education-

Secondary prevention

· Neuroprotection – e.g, aspirin

Course of disease

With reperfusion – blood restored to area, many symptoms gradually resolve

Without treatment – ischaemia extends to penumbra –symptoms worsen. Recovery may continue 6 months to a year but left with disability. Requires rehabilitation to optimise function 8

Complications

· Contractures

· Incontinence

· Falls

· Mood disturbances

· Dysarthria and aphasia

·

·

Death of brain tissue resulting from an occluded cerebral artery in the left side of the brain.. 6.

Prognosis

One in five likely to die within one month.

Of those who recover about 90% will experience some impairment. 9

causes

Atherosclerosis

Prevents formation of

 

 

4,7

6,7

 

5

1,2,4

1,2,3

Leads to need for immediate

diagnoses

Diagnosed by

Results in