Ischemic Stroke

Overview

Ischemic stroke is characterized by the sudden loss of blood circulation or also known as cerebral infarction to an area of the brain, resulting in a corresponding loss of neurological function. Cerebral infarction is mostly due to thromboembolic disease secondary to atherosclerosis in the major extracranial arteries(carotid artery and aortic arch). In an embolic stroke, the blood clot or plaque forms somewhere in the body (usually heart) and travels to the brain. Meanwhile, a thrombotic stroke is caused by blood clots that forms inside one of the arteries that supplies the brain.

Signs and Symptoms

Weakness/paralysis-hemiplegia/quadriplegia, Slurred speech,Visual disturbances, Altered sensory, Locked in syndrome(aware but unable to respond), Instability in movements, Unable to walk, Altered consciousness, Atrial fibrillation, Carotid bruit

Common Causes

Thromboembolic disease secondary to atherosclerosis

Risk Factors

Age >60 years, Heredity, Previous vascular event such as myocardial infarction, stroke, peripheral embolism, High fibrinogen, Hypertension, Heart disease (atrial fibrillation, heart failure, endocarditis), Diabetes mellitus, Hyperlipidemia, Smoking and alcohol intake, Oral contraceptives

Investigation Techniques

Full blood count, Blood glucose, Lipid levels, CT brain, Magnetic Resonance Image, Elecrocardography, Echocardiography

Treatment and Prevention

Ensure the airways, breathing and circulation Maintain the hydration by giving IV fluids Provide nutrition adequately, insert nasogastric tube if necessary Give antiplatelet agents (aspirin) Onset of symptoms was <4.5 hours start thrombolysis by giving alteplase(gold standard), always do CT 24 hours post lysis to identify bleeds Thrombectomy: intra-arterial mechanical thrombectomy Monitor blood pressure and blood glucose Secondary prevention: start antiplatelet drugs, statins, anticoagulant, antihypertensives Rehabilitation Phsiotherapy Counselling

Psychological Issues

Stress