Using Diffusion-Weighted Imaging to Detect the Early Stages of Acute Ischemic Stroke

Mrs. Alice Palmer is a 54-year old married woman who has been admitted and is being treated with an ischemic stroke which she had 18 hours ago. This paper explores the nursing care of Mrs. Alice Palmer based on the clinical reasoning cycle by considering her situation first, collecting cues and information about her, processing the information gathered, then identifying problems or issues she is experiencing, and finally carrying out a detailed assessment. Also, the paper focuses on setting goals and establishing a nursing care plan in the community, and target ethnically safe practice. Ischemic stroke occurs when the brain tissue does not receive sufficient oxygenated blood due to an obstruction of the carotid artery (Brunner, Suddarth, & Smeltzer, 2008). When the brain does not receive enough oxygenated blood, some or all of its tissues may get damaged

All MR images were evaluated in T2WI and DWI for site, size, and signal intensity of the

Using Functional MRI helps to visualize the brain functionality through local metabolism. In this technology it allows the researcher to measure and track the brain functions by discovering the correlated changes in blood flow. From this functional Mri when a brain function is acted out the flow of oxygenated rich blood is detected and highlighted on the specific location where the functionality came from on the brain.

MRI uses the body’s natural magnetic properties to formulate an image of the soft tissues. It does this by using the hydrogen atom nucleus which has a single proton and is a spinning charged particle. The human body is made up of 70% water, which is hydrogen and oxygen. Those hydrogen nuclei (protons) spin inside the body, creating their own magnetic field. They are orientated randomly and cancel each other out when no field is applied.

Ischaemic stroke is a serious neurological condition in which a blood clot stops blood flow to the brain and for which immediate action is required. It is the fourth cause of death in Western society, causing 87% of all strokes, and also results in long-term disability among survivors (Bunevicius et al., 2013). In the United States, about 800,000 strokes occur each year, and approximately six million Americans are living with neurological deficits caused by ischaemic strokes (Duong, 2012). Therefore, neuroradiological imaging has become a major section in radiology departments.

The following hypothesis was made in regard to effect of the concentration gradient on the rate of diffusion: The higher the concentration gradient, the faster the rate of diffusion.

As mentioned above, strokes are pathophysiological changes. Ischemia which accounts for 87% of all strokes is a decrease or absent circulating blood which deprives neurons of necessary substrates. As there is no storage of glucose in the brain it leaves no opportunity for the chief ingredient for energy substrate and is incapable of anaerobic metabolism (Shah, MD, n.d.). Ischemia is a medical condition diagnosed when tissues do not have a sufficient oxygen supply, therefor resulting in a decrease in ATP energy, leading to necrosis of tissue. Decreased oxygen supply to tissue (ischemia) is caused by a blockage in an artery mainly from an embolism. An embolism is the breakage of an atherosclerosis formed in any coronary arteries. This floats freely in the blood stream, which eventually may plug a major artery in the brain (stroke), heart (MI) or lungs (lung failure). A thrombus occurs when an already

used to diagnose stroke and to determine the location and size of a brain tumor,

Diffusion is the movement of molecules from a region of higher concentration to a region of lower concentration. The rate at which molecules diffuse can be determined by the relationship of molecular weight and that rate of diffusion through a membrane. Hypothesis of this experiment is that the fluid with higher molecular weight will diffuse at a slower rate and distance.

Apparent diffusion coefficient is the most widely used diffusion MRI parameter which can be easily and rapidly obtained and could be used to grade cerebral gliomas. ADC assesses water diffusivity and inversely correlated with tumor grade.

A stroke is a condition which is characterised as loss of brain functioning due to an interruption in the blood flow to the brain (Buzzard, 2013, pg. 5). There are two types of strokes, ischaemic and hemorrhagic strokes (Buzzard, 2013, pg. 6). Ischaemic strokes are the most common type of stroke (Gomes & Wachsman, 2013). This type of stroke occurs due to an insufficient flow of blood to the brain, which is usually caused by an artery blockage (Gomes & Wachsman, 2013). Hemorrhagic strokes are due to hypertension and may be caused by medical problems or blood vessel abnormalities (Gomes & Wachsman, 2013). The strokes severity and location of the brain that is affected determines the impact of the stroke in an individual (Gomes & Wachsman, 2013).(Gomes, 2013)

Magnetic resonance imaging (MRI) - This technique uses a magnetic field and radio waves to create detailed images in cross section of the brain. The MRI machine allows producing 3-D images that can be viewed from different angles.

Mr X, a 60 year- old Caucasian male, admitted to the stroke unit with a diagnosis Left MCA infract. He presented to the emergency department right sided hemiparesis, neglect of affected limbs, dysphasia and right side facial droop. He was on cardiac monitor for close observation for 48 hours. Stroke critical care pathway and commenced and care provided as per protocol.. Stroke is a serious and deadly condition including cerebral circulation within the brain and can extremely affect a person ability to maintain a safe environment, communication and mobility as well as other activities of living. The purpose of this essay is to give an overview of the Pathophysiology of ischaemic stroke, the required nursing care and the rationale behind it, followed by medical management and treatment provided to the patient.

I declare that all material in this assessment is my own work except where there is a clear acknowledgement and reference to the work of others. I have read the University’s Academic and Scientific Misconduct Policy and understand its implications.* http://www.cdu.edu.au/governance/documents/3.3academicandscientificmisconduct.pdf

A stroke caused by a blocked artery by a blood clot or bursting of a blood vessel because of uncontrolled high blood pressure. There are main three types of the stroke. An ischemic stroke occurs when a blood clot blocks one of the arteries which supply blood to brain. A clot may be caused by fatty deposits (plaque) that build up in arteries and cause reduced blood flow (atherosclerosis) or other artery conditions. (mayo clinic). About 89%, strokes are ischemic strokes. Ischemic stroke includes thrombotic stroke. A thrombotic stroke occurs when a thrombus stuck in one of the arteries that supply blood to the brain. A clot build-up of fatty deposits in arteries. Another type of stroke is called the hemorrhagic stroke. This stroke occurs when a blood vessel leaks or ruptures in the brain. A bold vessel leaks or ruptures from many conditions like uncontrolled high blood pressure or overtreatment with anticoagulants and the weak spot in blood vessel walls. (mayo). Some people experience a mini-stroke it is known as a transient ischemic attack (TIA). A temporary decrease or clot stuck in a vessel in our brain causes TIA. It happens less than five minutes. This stroke does not have any symptom, because the blockage is