Depletion of blood flow in a cerebral

influences
Aetiology
Depletion of blood flow in a cerebral artery resulting from a thrombus or embolus. (1)
Pathogenesis
Occlusion of cerebral artery production of ATP failure of energy pumps influx of sodium and calcium ions and efflux of potassium passive inflow of water cytotoxic oedema destruction of cells in infarct core.
Membrane depolarisation release of glutamate excessive calcium influx into neurons destruction of cells by lipolysis, proteolysis and free radicals.
infarct core and ischaemic penumbra
necrotic tissue not able to conduct impulses interrupting normal function such as motor and sensory transmission and speech.
 
 
 
Risk factors
Obesity
Smoking
Sedentary lifestyle
Age 1.
ageg
Clinical features
Right-sided hemiplegia and weakness
Sensory loss on right side
Inability to see the right visual field of each eye
Aphasia
Apraxia
Dysarthria
Impaired reasoning
Behavioural changes
Problems with memory
 
Diagnosis
Complete history
Physical and neurological examination
Brain MRI or CT scan differentiate cerebral haemorrhage from ischaemic stroke
Other tests for vascular imaging CT angiography, magnetic resonance angiography
Primary prevention
Dont smoke
Diet high in fruit and vegetables
Diet low in fats and salt
30 minutes of exercise daily
Limit alcohol
1,7
Treatment
Medical
Reperfusion Thrombolytic (tPA )
Nursing acute phase
Frequent evaluation of neurological status and vital signs
Oxygen saturations administer oxygen if required
Screen for swallowing manage hydration and nutrition
Manage activities of daily living
Address appropriate communication strategies
Prevent complications
Rehabilitation
Passive and active movement
Encourage activities provided by physiotherapists, speech and occupational therapists e.g. mobility, speech, ADL
Education-
Secondary prevention
Neuroprotection e.g, aspirin
Course of disease
With reperfusion blood restored to area, many symptoms gradually resolve
Without treatment ischaemia extends to penumbra symptoms worsen. Recovery may continue 6 months to a year but left with disability. Requires rehabilitation to optimise function 8
Complications
Contractures
Incontinence
Falls
Mood disturbances
Dysarthria and aphasia
Death of brain tissue resulting from an occluded cerebral artery in the left side of the brain.. 6.
Prognosis
One in five likely to die within one month.
Of those who recover about 90% will experience some impairment. 9
causes
Atherosclerosis
Prevents formation of
 
 
4,7
6,7
 
5
1,2,4
1,2,3
Leads to need for immediate
diagnoses
Diagnosed by
Results in