Acute Stroke

     If doctors agree that a stroke has taken place, they may do other tests to determine where the stroke occurred, how large of an area is damaged, and how the blood flow with in the brain has been effected; they do this by taking a CAT scan. They may also take an ECG to determine if there is any heart disease that may have caused the stroke. In addition, they take tests to see if the patient has high blood pressure or they may test the arteries themselves because this is a major cause of stroke in most people. Catheterization, injecting dye into the arteries, and blood tests are the most common tests done. A high glucose level in the blood may reveal diabetes and high blood fats indicate thickened red blood and arteriosclerosis. There may also be a high level of red blood cells, changing the consistency of the blood. These conditions must be treated to prevent further strokes.

Strokes are caused by a block in the blood supply to the brain which causes a decrease in oxygen and delivery of other important supplies which facilitate proper functioning. Fifteen million cases are reported worldwide annually, although not all of these cases are mortalities, the large prevalence of strokes ranks it as the fourth leading cause of death in the United States. (Figueroa) Because of the time sensitivity associated with the lack of resources to the brain, strokes are considered a medical emergency and early recognition of symptoms can help decrease the amount of damage caused . Although strokes do not always cause death, strokes most often leave the individual with some physical and cognitive impairment.

Mariam background is 60 year old lady admitted with left sided weakness and facial droop. Once confirmed stroke using the Recognition of Stroke in the Emergency Room (ROSIER) scale. Catangui (2015) states ROSIER scale is used to distinguish whether the patient is having a stroke or stroke mimics e.g. seizures or brain tumours. Computed tomography CT brain showed ischemic stroke. Ischaemic stroke is lack of sufficient blood supply to perfuse the brain/ cerebral tissue due to narrowing or blocked arteries in the brain (Morrison, 2014). According to Stroke Association (2015) statics shows that 1520000 strokes occur in the United Kingdom.

Also, a cardiac ECHO with Definity study was scheduled for 5/22/17 to reevaluate the LV thrombus, pending which a decision for anticoagulation was to be made. Inpatient Neurology evaluated him on 5/20/17, and also mentioned in their consult note that the patient had an acute CVA in April 2017, and recommended continuation of ASA and Plavix, along with considering initiating statins, and that MRI brain can be done after 6 weeks of stent placement if there were no contraindications (Although per the Neurologist’s note – the patient informed that he had PTCA 1 month ago, while in reality, his stent was placed in 3/2017; and a MRI of the brain was never subsequently done during this admission).

Ischemic stroke is the blockage of blood vessels in the brain as a result of blood clots (thrombi), causing the portions of the brain nourished by the vessel and its tributaries to be starved of nutrients, poisoned, and to eventually die (“Symptoms

It is important that the type of stroke is diagnosed quickly to reduce the damage done to the brain and also to determine the right type of treatment because one treatment for one kind of stroke can be harmful to someone who has had a different kind. A number of different medications may be given at the hospital to help break up the clot and prevent the formation of new clots. For Ischemic stroke the treatment can begin with drugs to break down clots and prevent further ones from forming. Aspirin can be given, along with an injection of a tissue plasminogen activator (TPA). TPA works by dissolving clots but it needs to be injected within 4.5 hours of stroke symptoms once they have presented themselves. Hemorrhagic stroke treatment can begin with drugs being given to reduce the pressure in the brain, overall blood pressure, prevent seizures and prevent sudden constrictions of blood vessels.(http://www.mayoclinic.org/diseases-conditions/stroke/diagnosis-treatment/treatment/txc-20117296) Because strokes are life-changing events that can affect a person both physically and emotionally, temporarily or permanently. After a stroke,

Neuroradiological imaging plays an important role in the process of diagnosing ischaemic stroke. The different imaging modalities that can be used to diagnose ischaemic stroke include computed tomography (CT), magnetic imaging resonance (MRI), and radionuclide imaging. In this article, the different modalities that contribute to the diagnostic process are discussed, with a focus on CT scan protocols.

Strokes are caused by pathophysiological changes. The two major mechanisms of stroke consist of ischemia and haemorrhage. Ischemia is when there is no oxygen or not, merely enough oxygen to fuel the tissue level in the body. Haemorrhage in the brain, causing strokes can be due to non-traumatic intracerebral haemorrhage (Shah, MD, n.d.) (see appendix 1). This essay will further discuss the implications of strokes on a cellular, organ and system level. Explain the clinical presentation of the signs and symptoms of strokes and how the condition will be managed by a paramedic.

The stroke from a blocked artery is called ischemia, and the ruptured artery is hemorrhagic. As time is critical after the cerebrovascular accident, lack of treatment will lead to brain cell apoptosis and neural injuries are permanent. Evaluation using brief tests of cognitive impairment includes analysis of executive functioning, memory, language, and visuospatial performance, neuropsychiatric as well as depressive symptoms (Grant and Adams, 2009).

The diagnostic process for a formally diagnosing Cerebral Vascular Accident (CVA/stroke), would consist with a number of test including a physical exam and questions regarding your family history of strokes, any signs or symptoms that may have been present before the patient had the stroke. The physician would also order a few tests like a MRI, CT scan, Cerebral Carotid ultrasound, Cerebral Angiogram and an Echo Cardiogram. The physical exam is important to listen to the hearts sounds, take your blood pressure and also use a ophthalmoscope ( a scope to look in your eyes, ears and nose) to see if there are any cholesterol crystals behind the eyes("Diagnosis - Stroke - Mayo Clinic," 2015). A MRI, uses radio and magnetic waves to show a detailed

A CVA occurs when a part of the brain is damaged or destroyed due to an interruption of blood flow to the area resulting in brain cell death (Martini, Nath & Bartholomew 2015 pp. 496-470).There are two main types of a CVA, Ischaemic stroke and Haemorrhagic stroke (AIHW 2013). The most common cause of stroke is ischaemic, which can be caused by embolism/thrombosis (AIHW 2013). An embolism/thrombosis occurs when there is a clot in an artery or vein, which stops blood flow to the brain (AIHW 2013). A haemorrhagic stroke is when an artery ruptures and bleeds into the surrounding brain tissue (AIHW 2013). This form of stroke occurs when blood pools and forms a clot therefore putting pressure on the area of the brain depriving it of oxygen and nutrients it needs to remain healthy (AIHW 2013).

Intracerebral drain stroke is a seeping inside the mind tissue because of the burst of veins, record 10% of all stroke cases. Generally coming about because of hypertension is the primary driver, coagulation figure issue, anticoagulant and thrombolytic treatment, cerebrum tumor, injury, and a burst of an aneurysm. ICH generally happens amid a time of movement, and has a sudden onset that advance with minutes to additional keeping in mind the end goal to create draining inclination figure (7), (Lewis, et al. 2014 and Ignatavicius & Workman, 2015b).

Cerebral Vascular Accident also known as a stroke, happens when the artery that supplies the blood flow to your brain becomes substantially blocked or completely blocked ("Overview - Stroke - Mayo Clinic," 2015). Without adequate blood supply the brain cells begin to die or become damaged. It is very important to get medical assistance as soon as you think you may be having a stroke, this will help lessen the damage done to the brain ("Overview - Stroke - Mayo Clinic," 2015).

Stroke previously known as Cerebrovascular accident is well-defined as ‘an abrupt cessation of cerebral circulation in one or more of the blood vessels distributing the brain. Due to the interruption or diminish of oxygen supply causes serious damage or necrosis in the brain tissues (Jauch, Kissella & Stettler, 2005). There is a presence of one or more symptoms such as weakness or numbness or paralysis of the face, arm or leg, difficulty speaking or swallowing, dizziness, loss of balance, loss of vision, sudden blurring or decreased vision in one or both eyes and headache. Stoke is categorised into two types, Ischaemic and haemorrhagic

Depending on the most likely cause of your stroke, your doctor may advise specific medication or consider surgery to remove fatty deposits in your carotid artery.