STROKE ( CEREBROVASCULAR ACCIDENT-CVA)
Definition
Stroke is a sudden neurological deficit caused by interruption of blood supply to the brain or
bleeding into the brain, leading to brain tissue injury.
Causes
1. Ischemic Stroke (Most common)
Due to thrombotic or embolic occlusion of a cerebral artery
Results in reduced blood flow and brain infarction
2. Hemorrhagic Stroke
Due to rupture of a cerebral blood vessel
Leads to bleeding inside or around the brain
Risk Factors
Non-modifiable
Increasing age
Male sex
Race and ethnicity
Family history of stroke or TIA
Modifiable
Hypertension (most important risk factor)
Diabetes mellitus
Cardiac diseases (atrial fibrillation, valvular disease, heart failure)
Hypercholesterolemia
Transient ischemic attack (TIA)
Carotid artery stenosis
Smoking and alcohol abuse
Physical inactivity
Obesity
Oral contraceptive or hormone therapy
Clinical Picture
Sudden onset of:
Motor deficit: hemiparesis, monoparesis
Sensory loss: hemisensory deficit
Facial drooping
Speech problems: dysarthria, aphasia
Visual disturbances: visual field loss, diplopia, blindness
Ataxia and vertigo
Sudden loss of consciousness or coma
Seizures
Complications
Permanent neurological disability
Paralysis
Aspiration pneumonia
Seizures
Increased intracranial pressure
Depression and cognitive impairment
Death
Investigations
1. Brain Imaging
CT brain or MRI
o Confirm diagnosis
o Differentiate ischemic from hemorrhagic stroke
o Exclude brain tumors
2. Laboratory Tests
Blood glucose
Complete blood count (CBC)
Liver function tests (LFT)
Kidney function tests (KFT)
Treatment (Acute Management)
1. ABC (Priority)
Airway: clear airway, remove dentures, intubate if needed
Breathing: oxygen if SpO₂ < 95%, ventilate if hypoxic
Circulation: IV fluids for hypotension
2. Control of Associated Conditions
Blood pressure: treat only if >220/120 mmHg
o Lower BP gradually (15% in first 24 hours)
Temperature: treat fever with paracetamol
Blood glucose: correct hypo- or hyperglycemia
Seizure control if present
Nutrition: oral feeding if safe swallowing; NG tube if dysphagia
Good hydration
Early physiotherapy
3. Specific Therapy
Fibrinolytic therapy: alteplase (rt-PA) in selected ischemic stroke patients
Antiplatelet therapy: aspirin 325 mg within 24–48 hours (if no contraindication)
[Link] Responsibilities in Management
Monitor neurological status (level of consciousness, pupil response)
Maintain airway and oxygenation
Prevent complications (aspiration, pressure ulcers, DVT)
Assist with mobility and rehabilitation
Provide patient and family education