Cerebrovascular Accident and Degenerative Neuromuscular Disorders

stroke

• Ischemia to part of brain
• Hemorrhage into brain that
results in death of brain cells

thrombotic stroke

the process of a clot formation which results in narrowing of lumen, that blocks the passage of blood through the artery

embolic stroke

a blood clot or other debris circulating in the blood reaches and artery in the brain that is too narrow to pass through, it lodges there and blocks blood flow

hemorrhagic stroke

a burst blood vessel may allow blood to seep into and damage brain tissues until clotting shuts off and leaks

ischemic stroke

Result of inadequate blood
flow to brain from partial or
complete occlusion of an
artery

embolic and thrombotic stroke

patho of ischemic stroke

1. infiltration of LDL into healthy vessel

2. inflammatory process to clear LDL starts to monocyte infiltration

3. atherosclerotic plaque containing large macrophage foam cells starts to form

4. inflammatory process continues until the plaque ruptures and a thrombus is formed

manifestations of ischemic stroke

sudden onset of dizziness,
HA, one-sided facial droop, muscle weakness,
slurred speech, numbness, vision loss,
language disturbances, difficulty maintaining
balance

temporary ischemic stroke

Temporary episode of
neurologic dysfunction caused
by focal brain, spinal cord, or
retinal ischemia, but without
acute infarction of brain
• Ministrokes
• Associated with ↑ risk of stroke
• Symptoms last typically < 1 hour
• Outcome unpredictable
• 1/3 Rule

1/3 rul

if you have one TIA you will never have one again

the other 3rd will have a full blown stroke

drug to prevent TIA

simvastatin and lovastatin

non modifiable risk factors

• Age: Risk doubles each decade after 55
• Biologic sex: Biologic males > biologic
females
• Heredity/family history
• History of prior stroke

modifiable risk factors

• Hypertension #1
• Diabetes #2
• Heart disease and dysrhythmias
(atrial fibrillation)
• Hypercholesterolemia
• Hypercoagulopathy
• Physical inactivity
• Obesity
• Sleep apnea
• Poor diet
• Smoking
• Some oral contraceptives (especially
with smoking)
• Alcohol and drug abuse

manifestation of a right brain stroke

affects the left side of brain

manifestation of a left brain stroke

affects the right side of brain

right brain damage

paralyzed left side : hemiplegia

left side neglect

spatial-perpectual deficits

tends to deny or minimize problems

rapid performance and short attention span

impulse, safety problems

impaired judgement

impaired time concepts

left brain damage

paralyzed right side: hemiplegia

impaired speech/language aphasis

impaired right/left discrimination

slow performace, cautious

aware of deficits; depression or anxiety

impared comprehension related to language , math

Hemiplegia

Paralysis of the face, arm, and leg on the same side of the body

Hemiparesis

Weakness on one side of the body

Dysphagia

Difficulty in swallowing, ↑ risk of aspiration

Paraplegia

Paralysis of the legs and lower body typically caused by a spinal
cord injury/spinal cord stroke

Akinesia

Loss of control of
voluntary muscle movements
• Impairment of integration of
movements

receptive dysphagia

Loss of comprehension

expressive dysphagia

Loss of production of language

lobal dysphagia

Total inability to communicate. Unable to comprehend and unable to
produce language

Broca’s aphasia

• Damage to frontal lobe
• Speak in small phrases leaving off small words
• Typically understand others’ speech
• Aware of difficulties and become easily frustrated

wernicke aphasia

• Damage to left temporal lobe
• Speak in long sentences that have no meaning, add unnecessary words, made-up words
• Difficulty understanding others’ speech
• Unaware of difficulty speaking

Dysarthria

• Pronunciation
• Articulation
• Phonation

Agnosia

Inability to recognize object by sight, touch, or hearing

Apraxia

Inability to carry out learned sequential movements on
command

Homonymous hemianopsia

Blindness that occurs in the same half of
the visual fields of both eyes

FAST

facial drooping

arm weakness

speech difficulty

time to call medical help

stroke scale

0=no stroke
• 1-4=minor stroke
• 5-15=moderate stroke
• 16-20=moderate/severe stroke
• 21-42=severe stroke

Orders to anticipate after Code Fast
Team arrives

CT head – STAT
• CBC
• CMP
• PT/PTT/INR
• EKG