What is a stroke?

What is Stroke?

Stroke is a disease that affects the arteries leading to and within the brain. It is the No. 5 cause of death and a leading cause of disability in the United States.

A stroke occurs when a blood vessel that carries oxygen and nutrients to the brain is either blocked by a clot or bursts (or ruptures). When that happens , part of the brain cannot get the blood (and oxygen) it needs, so it and brain cells die.

The MAJOR treatable risk factors for Ischemic:

HTN,
Diabetes Mellitus,
– Smoking,
– Dyslipidemia

Hypertension is a risk for ‘atherosclerotic disease’ & is the most important modifiable risk for stroke. Current recommendation is a SBP goal of <150mmHg & DBP goal of <90mmHg in patients >60 year old.

Ischemic Stroke [Embolic stroke & Thrombotic stroke]

– Thrombolytics [e.g. activase] – is initial therapy, provided that treatment is initiated within 3-4.5 hours of clearly defined symptom onset.
– Aspirin [full dose 325mg] – Initial therapy for those who come in too late for thrombolytics. Also indicated AFTER the use of thrombolytics.
– Start clopidogrel [Plavix] – Switch to clopidogrel if patient developed stroke while on aspirin or patient does not tolerate aspirin [eg. Allergic or gastritis]
– Start dipyridamole [Persantine]– If patient is already on aspirin when a New stroke or TIA occurs. Add dipyridamole or switch to clopidogrel.
– Statin therapy – For patients with acute ischemic stroke. Start or continue statin treatment as soon as oral medications can be used safely regardless of their cholesterol status.
– Strict BP managed to keep it <185/105 mmHg but >140/90 mmHg to maintain cerebral perfusion & avoid hemorrhagic transformation. Treat HTN with ‘IV’ labetalol, nicardipine or nitroprusside.

In ischemic stroke (embolic stroke & thrombotic stroke), everyone must get:

– Non-contrast CT to rule out Hemorrhagic stroke
– Give a full dose Aspirin (325mg) right after the CT of head rules out hemorrhagic stroke. (Do not give any Aspirin or thrombolytics before obtaining head CT)
– EKG [look for a-fib],
– TTE or TEE to look for Thrombus, PFO, ASD, VSD. TEE is more sensitive but more invasive, so TTE is done more often than TEE.
– CT Angiogram or MR Angiogram may be obtained to evaluate intracranial vasculature or Duplex Ultrasound to evaluate carotids ‘Alone’.
– Non-contrast MRI can be done to Confirm ischemic stroke but not necessary.

 

 


Visit us (http://www.khanacademy.org/science/healthcare-and-medicine) for health and medicine content or (http://www.khanacademy.org/test-prep/mcat) for MCAT related content. These videos do not provide medical advice and are for informational purposes only. The videos are not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of a qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read or seen in any Khan Academy video. Created by Vishal Punwani.

Watch the next lesson: https://www.khanacademy.org/test-prep/nclex-rn/rn-cardiovascular-diseases/rn-stroke/v/risk-factors-for-stroke?utm_source=YT&utm_medium=Desc&utm_campaign=Nclex-rn

Missed the previous lesson? https://www.khanacademy.org/test-prep/nclex-rn/rn-cardiovascular-diseases/rn-stroke/v/cerebral-blood-supply-part-2?utm_source=YT&utm_medium=Desc&utm_campaign=Nclex-rn

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