Stroke | ischemic and hemorrhagic stroke

What is stroke?

Stroke is a damage to the brain part as a result of interruption of nutrients and blood supply to brain. So, function loss of that particular area occurs.

Example:

If a patient is having stroke of occipital cortex. He would get blind. if cerebellum stroke occurs the body would not be able to maintain balance. Broca’s area controls speaking, if patient is having stroke of Broca’s area speaking becomes difficult. In case of damage to Wernicke’s area of brain, the patients ability to perceive deteriorates.

Mechanism of muscle contraction:

Brain controls the muscles of whole body. Muscle fibers emerging from brain enters the spinal cord. Nerves originating from spinal cord attach with muscles. Signal moves from brain to spinal cord and then from nerves to muscles as a result muscle contraction occurs and we move. Our brain needs high level of glucose, oxygen and blood supply. If the arteries like the major carotid artery in neck gets blocked blood do not reaches the brain. Area supplied by this particular nerve will get damage and pathology occurs there.

Types:

ischemic stroke

Due to blood clot formation (atherosclerosis), Blood do not reaches the brain, and neuronal or cell death due to this clot formation or lack of blood is called ischemic stroke. Antiplatelet medications, antilipidemic drugs and for rehabilitation we will suggest physiotherapy for that limb. If physiotherapy is not done at that stage. Due to immobilization there might be DVT, clot, ulcer or bed sore formation. Treatment plan is suggested according to the symptoms. Thinning of blood is required.

hemorrhagic stroke

Due to rupture of blood vessel in brain or hemorrhage blood accumulates in the brain. Blood has its own mass effect and due to its pressure death of brain tissues occur. It is called as hemorrhagic stroke. High blood pressure may cause hemorrhagic stroke. Blood is seen under CT scan. If massive brain area is involved in hemorrhage then we need an immediate referral to neurosurgeon. He will make a small sized hole in patient’s skull to remove blood immediately called burr hole craniotomy. This is surgical intervention of brain hematoma. We need to control blood pressure to a moderate level. Nursing care is required. If patient is unable to eat NG tube is inserted. For defecation problems Foley’s catheter is inserted. Physiotherapy is required in rehabilitation phase.

Risk factors:

  • Diabetes
  • High blood pressure
  • Obese
  • Hypercholesterolemia
  • Smoking
  • Red meat users
  • Protein CS deficiency

Clinical presentation:

Patient was normal at night but in the morning he was unable to move his limbs. He got paralyzed. But, in case of cerebellar damage patient’s attendants might complain he is having problem in holding glass or spoon due to impaired balance.

Examination:

CT scan is used to differentiate between ischemic and hemorrhagic stroke. Check out the following in a sequential manner,

  • Muscle tone
  • Power
  • Strength
  • Reflexes
  • Sensation
  • CT scan

Treatment:

Treatment plan is suggested according to the symptoms.

  • Antiplatelet medications
  • Antilipidemic drugs
  • Rehabilitation
  • Nursing care
  • Physical therapy
  • Blood pressure management
  • Cholesterol management

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