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Overview of a Stroke

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People often know of strokes or someone affected by a stroke, but not always what constitutes a stroke. A stroke occurs when blood flow to the brain is interrupted or reduced due to a blockage or rupture of a blood vessel or artery that supplies blood to the brain. The interruption of blood flow deprives the brain of necessary nutrients and oxygen supplies, killing surrounding cells in the brain.
There are three main types of strokes: ischemic stroke, hemorrhagic stroke, and transient ischemic stroke. Ischemic strokes occur due to an obstruction or clotting of a blood vessel or artery. There are two types of ischemic strokes: embolic and thrombotic strokes. An embolic stroke is when a blood clot or other substance forms in the body, travels through the blood stream, and eventually becomes lodged in a small blood vessel or artery supplying blood to the brain. A thrombotic stroke is when a blockage forms in one or more arteries to the brain. The second type of stroke, hemorrhagic stroke, is due to a rupture of a weakened blood vessel. There are two major ways in which blood vessels can weaken: aneurysm, a ballooning of a weak area in a blood vessel, and arteriovenous malformations (AVM), an abnormal connection of arteries to veins. A hemorrhagic stroke can either be an intraccerebral stroke, a bleed caused by a blood vessel within the brain, or a subarachnoid stroke, an aneurysm rupture in a large artery near the membrane surrounding the brain. Lastly, transient ischemic attacks are temporary traveling clots that cause “miniature” or “warning” strokes.
There are many causes of strokes and risk factors that can increase likelihood of stroke. Causes include conditions such as atherosclerosis, also known as plaque build...

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...and Prevention. (2013, December 10). Stroke Facts. USA.gov.
Retrieved January 17, 2014, from http://www.cdc.gov/stroke/facts.htm
American Stroke Association. (2012, October 23). About Stroke. American Stroke Association.
Retrieved January 18, 2014, from http://www.strokeassociation.org/STROKEORG/AboutStroke/About-Stroke_UCM_308529_SubHomePage.jsp
National Stoke Association. (2014). What is stroke? National Stroke Association. Retrieved
January 18, 2014, from http://www.stroke.org/site/PageServer?pagename=stroke
Mayo Clinic. (1998). Disease and Conditions Stroke. Mayo Clinic. Retrieved January 19, 2014 from http://www.mayoclinic.org/diseases-conditions/stroke/basics/treatment/con-20042884
University Hospital Newark, New Jersey. (n.d.). Stroke Statistics. University Hospital Newark,
New Jersey. Retrieved January 19, 2014, from http://www.uhnj.org/stroke/stats.htm

In this essay, the author

  • Explains that strokes occur when blood flow to the brain is interrupted or reduced due to blockage or rupture of a blood vessel or artery.
  • Explains that there are three main types of strokes: ischemic, hemorrhagic, and transient.
  • Explains that there are many causes of strokes and risk factors that can increase likelihood of a stroke, such as atherosclerosis, plaque buildup, and carotid artery disease.
  • Explains the various medical instruments used to diagnose strokes, such as brain ct, magnetic resonance imaging, carotid angiography, doppler ultrasound, electrocardiogram, and echo.
  • Describes the treatment options for hemorrhagic strokes based on the time and type of stroke diagnosed.
  • Explains that strokes can affect any individual, but prevalence and incidence vary based on age, sex and race.
  • Cites the national institute of neurological disorders and stroke.
  • Cites the american stroke association's website: http://www.stroke.org/site/pageserver?pagename=stroke and the national stoke association.
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    • Stroke Case Study Studies Case Studies
      comparative essay
      The formation of a clot in the arteries leading to or within the brain causing an interruption to the flow of blood to a specific area of the brain. (National Stroke Association, 2014)

      In this essay, the author

      • Explains the formation of a clot in the arteries leading to or within the brain causing an interruption to the flow of blood.
      • Explains that men are typically more at risk of having a stroke than women.
      • Explains that beta blockers cause dizziness, low exercise tolerance, postural hypotension and weakness.
      • Describes the causes of pressure sores, contractures, respiratory problems, postural hypotension, muscle disuse atrophy and weakness, odema, osteoporosis, degenerative joint disease, and thromboembolism.
      • Explains that due to weakness of the l side the pt may develop a subluxed shoulder.
      • Advises that shoulder strapping should be checked for capillary refill, allergic reactions to tape, no creases, not too tight, and be aware of blisters.
      • Describes exercises that strengthen the muscles around the shoulder so that they can hold the joint in place.
      • Explains how rx can increase proprioception if they can't use approximation to increase it.
      • Explains the benefits of brushing and stroking to encourage the muscle fibres to contract while performing a functional activity.
      • Explains how to improve pt's muscle strength by 1 grade from 4- -> 4+/5- (15 min out of the 1hr session/day for 2 weeks).
      • Recommends maintaining mobility of affected limbs to prevent contractures. if flaccidity/spasticity is still present, teach the pt how to mobilise themselves.
      • Advises that focus should now be on retraining lie -> sit – make sure that activities are functional.
      • Explains how to improve pt's sense of self in space (15min out of the 1hr session/day for 2 weeks).
      • Explains how to improve pt's muscle strength by 1 grade —> gr 3 – 4-/4 (20 min out of the 1hr session/day for 3 weeks).
      • Explains how to inhibit tone if present, encourage increased muscle activity, and maintain mobility of affected limb to prevent contractures.
      • Explains how to improve control of the affected side, teach the pt to plan their movements (15 min out of 1hr session/day for 2 weeks).
      • Advises to stand close to the pr to avoid falling over and possibly injuring herself.
      • Advises not to prescribe crutches or one handed walking aids as the pt may push towards the affected side and fall, rather prescribe a walking frame if needed.
      • Explains how to complete the pt's assessment to determine any abnormalities and pin point the components contributing to her main problem.
      • Analyzes how the pt performs a movement on their own in order to pin point the components that they are struggling with.
      • Explains the importance of completing a poms for the pt in order to develop an adequate treatment program as well as determining the timeline.
      • Explains that a pt will take at least 6 weeks to recover depending on the severity of the stroke.
      • Suggests using toe poms to break down each component contributing to the problem into steps and set realistic goals that will form the rehabilitation process for each goal.
      • Explains that once a treatment plan has been decided, introduce the ideas to the pt, ensure that the activities that have been determined on are functional to get the most out of the session and encourage motivation.
      • Opines that the pt may need to be taught how to do things from scratch. encouragement and support is key.
      • Recommends making each activity as functional as possible so that the pt can apply the principles in wards or at home. functional activities may trigger a memory of how they performed the activities.
      • Advises that the pt should progress the exercises once it is able to perform the activities they have decided on.
      • Describes the short- and long-term goals for the main problem, and explains that some goals may take some time to reach. if the pt is discharged, ask her to come back as an out patient.
      • Explains that chronic hypertension leads to atherosclerosis (plaque build-up) which causes the walls of the arteries to harden and in turn can lead to blockage/clots.
      • Explains pushers syndrome: stroke pt pushes towards the affected side which results in a loss of balance. their perception of where they are in space and how they react to gravity is affected.
      • Explains that isometric contractions, palpate, and feel for flickers of muscle movement can be graded as gr 1 and gr 2 if the pt is able to move it fully. bilateral movements and exercises can encourage movement and strengthening of the affected side.
      • Advises that the pt should be aware of her posture and correct herself if she tilts to the left. they suggest using a mirror and masking tape to remind them to do so during activity.
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    • Stroke Case Study In Case Studies
      explanatory essay
      The differ between those two mainly due to the underlying pathology involving the blood vessel of the brain. Ischemic stroke accounts for about 80 percent of stroke, the pathology involved in this type of stroke maybe intrinsic to the vessel as in thromboembolism, large artery stenosis, small vessel disease and hypoperfusion. Hemorrhagic stroke accounts for about 17 percent of stroke. The pathology involve in this type of stroke is due to the rupture of the vessel that supplying the brain. This condition is more severe than ischemic stroke.

      In this essay, the author

      • Explains that stroke is the third most common cause of death in the uk, and one quarter of all stroke occur before age 65.
      • Explains that brain ischemia can be transient or persist for longer periods, but the neurologic symptoms don't indicate the cause of the infarction.
      • Explains that ischemic and hemorrhagic strokes differ due to the underlying pathology involving the blood vessel of the brain. ischemic stroke accounts for about 80 percent of stroke.
      • Explains that the evaluation of neurologic symptoms is important in determining acute and long-term management for the patient.
      • Describes the case of a 67-year-old malay man who developed left-sided body weakness two days prior to admission to hukm.
      • Describes the patient's history of multiple admissions to the ward due to multiple diseases. he was on aspirin, madopar, and clopidogrel, but was not compliant with the follow-up schedule.
      • Explains that the patient has a strong family history of hypertension in his family. he has no allergy to food and drugs and no significant past surgical history.
      • Explains that the patient was alert and conscious, afebriled with the glasgow coma scale (gcs) 15/15, his blood pressure was 160/100, respiratory rate was 18 breaths per minute, and his oxygen level under room air was 97%.
      • Explains that neurological examination showed left upper and lower limb weakness, power of 3/5 with hypertonia, hyperflexia and upgoing babinski sign.
      • Explains that ct scan revealed hypodensities at the right corona radiata and right sided pons, and bilateral centrum semiovale in keeping with age-related cerebral atrophy.
      • Explains the laboratory work-up revealed haemoglobin level of 13.7g/dl, a total white cell count of 5.9x 109/l and platelet.
      • Explains that the patient was admitted to the medical ward 6d because of recurrent cva, worsening unstable angina, and parkinson disease. he was put on closed observation, coma nursing, maintenance of electrolyte and glucose within normal range,dvt prophylaxis and treatment of associated illnesses.
      • Explains that the patient was discharged with discharge medication including aspirin, madopar, clopidogrel, and amilodipine. he was given a referral letter to continue his appointment for parkinson disease with the neuro team hkl on march 2016.
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