S/S OF STROKE

Neurological Conditions Related to Stroke

Dysarthria

  • Definition: A condition where the patient is unable to speak clearly due to weak muscles.

  • Characteristics:

    • Results in slurred speech, as referenced in the mnemonic FAST (Face, Arms, Speech, Time).

    • Speech can be hard to understand, impacting communication effectively.

Apraxia

  • Definition: The inability to perform voluntary movements despite normal muscle function.

  • Examples of Difficulty:

    • Patients may struggle to perform purposeful movements like winking or reaching to scratch their arm.

    • They understand what they want to do but cannot execute the movements.

Agraphia

  • Definition: Loss of the ability to write.

  • Implications: The patient is unable to express thoughts through written language, impacting communication and cognitive assessment.

Alexia

  • Definition: Loss of the ability to read.

  • Characteristics:

    • Patients might struggle to comprehend text, or they may have difficulty seeing the words altogether.

    • The term is connected to 'dyslexia,' albeit 'alexia' pertains strictly to reading.

Agnosia

  • Definition: The inability to recognize or understand sensations, known objects, or people.

  • Example Scenario:

    • A patient shown a pencil might fail to identify it or call it by another name altogether, indicating a disconnect between perception and understanding.

Dysphagia

  • Definition: Difficulty swallowing.

  • Nursing Implication:

    • There is a heightened risk for aspiration, which can lead to pneumonia, making it critical to monitor this symptom in patients.

Hemianopia

  • Definition: Limited vision in half of the visual field.

  • Characteristics:

    • Patients may see only part of an object in view; for instance, they might see one half of a pencil but not the other half.

  • Etymology Breakdown:

    • "Hemia" signifies half, while "opnia" pertains to the eyes.

    • It is crucial for nursing care, as patients are at risk for injury due to visual limitations.

Stroke Diagnosis

Initial Diagnostic Strategies

  • Commonly Ordered Tests:

    • CT Scan of the Head:

    • Conducted immediately to rule out hemorrhagic stroke (bleeding in the brain).

    • Essential as patients with bleeding cannot receive certain treatments such as tPA.

    • MRI:

    • Used to assess the specific brain lobes and areas affected by the stroke to aid in diagnosis.

Treatment: Tissue Plasminogen Activator (tPA)

Overview of tPA

  • Definition: tPA is a clot-dissolving medication used specifically for ischemic strokes (caused by a clot).

  • Mechanism of Action: tPA activates the protein that promotes fibrinolysis, leading to the breakdown of clots and restoration of blood flow to brain tissue in need.

  • Administration Timeframe: Must be administered within three hours from the onset of symptoms to maximize effectiveness.

  • Exceptions: For some patients, if they meet strict criteria, administration can potentially occur within three to four and a half hours.

Critical Criteria for tPA Administration

  1. CT Scan:

    • Must be negative for signs of bleeding (indicates no hemorrhagic stroke).

    • Suspected Subarachnoid haemorrhage

    • Evidence of intracranial haemorrhage

  2. Laboratory Values:

    • All labs should be within normal limits, including:

      • Blood glucose levels (neither hypoglycemic nor hyperglycemic).

      • Clotting levels, particularly INR and platelets.

  3. Blood Pressure Control:

    • Systolic blood pressure must be less than 185 mmHg.

    • Diastolic blood pressure must be less than 110 mmHg before administration.

    • Often requires antihypertensive medications to manage high blood pressure in stroke patients.

  4. Recent Medication Usage:

    • Patients should not have received anticoagulants (e.g., heparin or warfarin), as a concurrent risk of bleeding may increase, but if stopped after a week can have TPA. Duration of action is 2-5days



Patient with ischemic stroke have permissible hypertension which is normal

If you drop BP too quickly, you can:

  • Reduce cerebral perfusion pressure (CPP)

  • Worsen ischemia

  • Expand the infarct area

So, the high BP is compensatory — the body’s way of maintaining blood flow around the blockage.


That’s why clinicians permit higher BP for the first 24–48 hours, unless there are specific reasons to lower it.