1. Ischaemic Stroke

2. Ischemic Stroke Synonyms : brain attack, cerebrovascular accident,
It is a sudden loss of function resulting from disruption of the blood supply to a part of the brain. The event is the result of long-standing cerebrovascular disease.

3. Ischaemic strokes divided into five different types according their cause :
large artery thrombosis : atherosclerotic plaques in the large blood vessels of the brain. Thrombus formation and occlusion at the site of the atherosclerosis – ischaemia and infarction
small penetrating artery thrombosis : one or more vessels are affectedmost common. Also called lacunar strokes because of the cavity that is created when the infarcted brain tissue disintegrates
cardiogenic embolic stroke : associated with cardiac arrhythmias : atrial fibrillation. Emboli may be prevented by the use of anticoagulation therapy
cryptogenic and others : no known cause

4. Major Types of Stroke and Their Causes
CLASSIFICATION CAUSES
Ischemic large artery thrombosis
small penetrating artery thrombosis
cardiogenic embolic
cryptogenic (no known cause)
others
Hemorrhagic intracerebral haemorrhage
Subarachnoid haemorrhage
cerebral aneurysm
arteriovenous malformation

5. Pathophysiology
In ischemic brain attack : disruption of blood flow due to obstruction of a blood vessel  ischaemic cascade
Early in the cascade, an area of low cerebral blood flow, referred to as the Penumbra region exists around the area of infarction
Timely intervention may prevent infarction from spreading into the penumbra region

6. Clinical Manifestations
Neurological deficits
Numbness or weakness of the face, arm, or leg, especially on one side of the body
Confusion or change in mental status
Trouble speaking or understanding speech
Visual disturbances
Difficulty walking, dizziness, or loss of balance or coordination
Sudden severe headache
Motor, sensory, cranial nerve, cognitive, and other functions may be disrupted

7. Motor loss : hemiplegia or hemiparesis
Communication loss : dysarthria, dysphasia or aphasia expressive or receptive or global (mixed) aphasia
Apraxia : inability to perform a previously learned action - combing using fork
Perceptual disturbances : homonymous hemianopsia – same side as paralysis
Sensory loss : touch sensation; proprioception, visual, tactile, and auditory stimuli
Cognitive impairment and psychological effects:
frontal lobe damage : learning capacit, memory, or other higher cortical intellectual functions may be impaired. Memory affected.
Inattention +, lack of motivation, depression, emotional lability, hostility, frustation, resentment, lack of cooperation

8. Assessment And Diagnostic Findings
History and neurological examination
Transient ischaemic attack
Reversible ischemic neurologic deficit
Stroke in evolution
Completed stroke
Initially non-contrast CT brain – ischaemic or haemorrhagic
ECG, carotid ultrasound cerebral angiography, transcranial doppler flow studies, transthoracicor transesophageal echocardiography, manetic resonance imaging of the brain or neck, xenon CT, single photon emission CT. , digital subtraction angiography for carotid artery

9. An ischemic stroke occurs when an artery in the brain becomes blocked.

13. A major ischemic stroke

19. Ischemic Stroke

20. Haemorrhagic stroke

21. CT angiogram of the neck with arrow pointing to blockage in the internal carotid artery)

22. Carotid endarterectomy

23. Carotid stenting

24. Ischemic stroke
Acute care: Thrombolysis ("clot busting") is sometimes used to dissolve the clot causing an acute stroked. This involves administering a medication into the blood stream (either intravenous or directly into the clot within an artery) within hours of the stroke. Studies indicate that after three hours of symptom onset the damage to the brain is irreversible, and that thrombolysis provides no benefit.
Long term care: This type of stroke is usually caused by hypoperfusion as a result of narrowing or occlusion of the arteries in the neck which supply blood to the brain. Often, this can be surgically corrected by a procedure called carotid endarterectomy, which cleans out the involved

25. Prevention Treat hypertension Treat hyperglycemia Stop smoking
Reduce high cholesterol
Reduce obsity
Low cholesterol low fat diet
exercise

26. Medical treatment
AF : warfarin or aspirin or clopidogrel (antiplatelet regimen)
Administration of t-PA – loading dose and then infusion
Low molecular weight heparin – dalteparin
If ICT is increased – mannitol, maintaining PaCO2 within the range of 30 – 35 mmHg. , positioning to avoid hypoxia
Elevation of head end
Intubation if needed
Bp within 180/100 mmHg

27. Nursing interventions
Improving and preventing joint deformities
Preventing shoulder adduction
Positioning the hand and fingers
Changing positions
Establishing an exercising program
Preparing for ambulation
Preventing shoulder pain
Enhancing self care
Managing dyphagia
Managing tube feeding

28. Nursing interventions
Attaining bladder and bowel control
Improving thought processes
Improving communication
Maintaining skin integrity
Improving family coping
Helping the patient cope with sexual dysfunction
Teaching self care and continuing care

31. Glossary
Agnosia : failure to recognize familiar objects perceived by the senses
Aneurysm : a weakening or bulge in an arterial wall
Aphasia : inability to express oneself or to understand language
Apraxia : inability to perform previously learned purposeful motor acts on a voluntary basis
Ataxia : impaired ability to coordinate movement, often seen as a staggering gait or postural imbalance
Dysarthria : difficulty in articulation due to neurologic causes
Expressive aphasia : inability to express oneself often associated with damage to th left frontal lobe area
Hemianopsia : blindness of half of the field of vision on one or both eyes