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Contralateral Injuries in Stroke

  • Clients experiencing strokes may incur injuries on the side opposite to where the stroke occurs.
    • When a stroke occurs on the right side of the brain:
    • Results in weakness or paralysis on the left side of the body.
    • Conversely, a stroke on the left side will result in right-sided weakness or paralysis.
  • Brain edema and increased intracranial pressure can lead to secondary injuries following a stroke.

Hemorrhagic Stroke

  • Definition: A hemorrhagic stroke involves oxygen depletion resulting from blood filling an area of the brain, rather than oxygen depletion due to blockage.
  • Causes:
    • Often arises from an interruption of vessel integrity, leading to ruptures or false pockets in blood vessels.
    • Common cause: bleeding into the brain tissue or subarachnoid space.
  • Classification:
    • Intracerebral Hemorrhage (ICH): Bleeding within the brain tissue itself.
    • Subarachnoid Hemorrhage (SAH): Bleeding that occurs in the space between the brain and the tissue covering it.
    • Arteriovenous Malformation (AVM): A collection of thin-walled blood vessels without a capillary bed that can rupture easily, potentially leading to vasospasm.
  • Additional References: Consult your textbook for detailed features of different types of strokes.

Risk Factors for Cerebrovascular Accident (CVA)

Modifiable Risk Factors

  • Factors that can be altered or managed to reduce the risk of stroke:
    • Smoking: Significantly increases the risk of CVA.
    • Substance use: Particularly cocaine use, is a notable risk factor.
    • Obesity: Excess body weight can increase the likelihood of stroke events.
    • Sedentary lifestyle: Lack of physical activity contributes to increased CVA risk.
    • Oral contraceptives: May elevate the risk due to potential complications associated with blood clotting.
    • Heavy alcohol use: Chronic excessive intake can lead to health issues inclusive of stroke.
    • Phenylpropanolamine (PPA): Found in some antihistamines, noted for increasing CVA risk.

Nonmodifiable Risk Factors

  • Factors that cannot be changed:
    • Ethnic Background: Native American, Alaska Native, and African American populations have higher stroke risk.

Medically-Managed Risk Factors

  • Conditions that may require medical management to mitigate risk:
    • Hypertension: High blood pressure is a significant risk factor for stroke.
    • Diabetes: Diabetes management is crucial in reducing stroke risk.
    • Atherosclerosis: The buildup of fats and cholesterol in arteries can elevate stroke risk.
    • Aneurysm: Presence of aneurysms may increase the probability of hemorrhagic strokes occurring.

Assessment Tools

Glasgow Coma Scale

  • A tool used for assessing the consciousness level of patients.
  • Important note: A score of 3 on this scale indicates the lowest level of consciousness and can sometimes correspond with being deceased.

Stroke Mimics

  • Conditions that present similar symptoms to a stroke but are not actual strokes:

    • Low blood glucose: Hypoglycemia can produce stroke-like symptoms.
    • Low blood pressure: May result in symptoms that mimic a stroke.
    • Arteriospasm: Vasoconstriction can present similarly but can lead to an actual stroke if prolonged.

  • Important Consideration: If an arteriospasm persists, it has the potential to result in an actual stroke.