Morgann Loaec and Laila Siddique MS2 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 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 History Disability 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 dressing Mobility 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 settings Acute 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