Comprehensive Notes on Stroke

Definition: Stroke is defined as ischemia to part of the brain or hemorrhage into the brain that leads to the death of brain cells. It is also referred to as a brain attack or cerebrovascular accident (CVA).

Ischemic Stroke: Occurs due to inadequate blood flow from partial or complete occlusion of an artery. It is classified into:
- Thrombotic Stroke: Injury to blood vessel wall leads to clot formation, often associated with hypertension or diabetes, and usually preceded by a transient ischemic attack (TIA).
- Embolic Stroke: An embolus lodges in cerebral artery, leading to infarction and edema in the supplied area.
Hemorrhagic Stroke: Involves bleeding into:
- Intracerebral tissue due to vessel rupture.
- Subarachnoid space, often from aneurysms or trauma.

Non-modifiable: Age (risk doubles each decade after 55), gender (more common in men; more women die), ethnicity (higher incidence in blacks), and hereditary factors.
Modifiable: Hypertension, heart disease, diabetes, high serum cholesterol, smoking, obesity, sleep apnea, metabolic syndrome, lack of exercise, poor diet, and substance use.

Physical Impact: Varies depending on the area of the brain affected. Commonly results in mobility impairments, respiratory function issues, difficulty swallowing (dysphagia), and compromised self-care abilities.
Cognitive and Emotional Impact: May cause confusion, personality changes, depression, and anxiety. The stroke can also affect memory and judgment.
Aphasia: Language impairment due to brain damage. Can be receptive (difficulty understanding), expressive (difficulty speaking), or global (total loss of communication ability).

Diagnostic tools include:
- Noncontrast CT scan or MRI for lesion identification and stroke type differentiation.
- Further studies like CTA, MRA, or cerebral angiography to assess blood flow and vascular structure.

Primary Prevention: Focus on risk factor modification, such as maintaining a healthy diet, regular exercise, and managing blood pressure. Educating patients about warning signs of stroke is crucial.
Acute Management: For ischemic strokes, tissue plasminogen activator (tPA) can be given within 3-4.5 hours post-symptom onset. For hemorrhagic strokes, management includes monitoring blood pressure and considering surgical interventions.
Rehabilitation: Focus on maximizing patient capabilities post-stroke. Rehab may start early and involves physical, occupational, and speech therapy to recover as much functionality as possible.
Emotional Support: Address emotional and psychological needs through counseling and involving family in the recovery process.

Preserve life, prevent further brain damage, and reduce disability.
Goals of Care: Stabilize the patient, maximize rehabilitation potential, assist with daily living activities, and provide emotional and social support.

Families often need guidance on coping with changes associated with stroke, including role changes and emotional impacts. Building a support system is essential for recovery and coping post-stroke.