Medications used in Mavis’s treatment – Thrombosis Treatment Conclusion- Page 11. Word count: 3,350 Introduction A Cerebrovascular accident (stroke) is a sudden, non-convulsive focal neurological deficit. Stroke is the second-highest cause of death behind coronary artery disease and is the primary cause of disability in Australia and New Zealand (Craft, Gordon, & Tiziani, 2011). Mavis, a 70 year old woman was admitted to hospital after losing control of her left arm and left leg, which lead to her falling out of bed.
After investigations, Mavis was diagnosed with having suffered an acute ischaemic stroke. This essay will discuss the pathophysiology of ischaemic and haemorrhagic strokes and the underlying factors that contributes to Mavis having an acute ischaemic stroke. In regards to the subjective and objective data collected, there are many variables to consider when determining the possible causes of Mavis’s brain attack. The various amount of diagnostic tools used to diagnose an acute ischemic stroke will be discussed, following a management plan to allow Mavis to return home. Education on specific medications used whilst in hospital and when Mavis returns home, needs to be explained to her, to allow her to understand the importance of medication adherence. If Mavis understands her condition, and the signs and symptoms of a stroke, it may prevent a reoccurrence. Pathophysiology Pathophysiology of Ischemic Stroke and Haemorrhagic Stroke.
Atherosclerosis begins by injuring the endothelial cells that line the artery walls (Craft, Gordon, & Tiziani, 2011). Injured endothelial cells become inflamed and therefore lose the ability of vasodilation, which increases the likelihood of thrombosis. Once a thrombosis (clot) has formed, it can occupy majority of the vessel preventing blood from flowing through the cell . The restricted blood flow to the neurons downstream of the thrombosis are deprived of oxygen and without oxygen, death of neurons occur within a few minutes.
Embolic strokes involve fragments that break from a thrombus formed outside the brain, commonly when a fragment in the heart breaks away during abnormal heart function, which travels to the brain (Craft, Gordon, & Tiziani, 2011). The fragments that have travelled to the brain become jammed in small brain vessels which cause obstruction and ischemia to the brain tissue. The longer the occlusion of the vessels continues to deprive neurons of oxygen, the more neurological damage is done.
In contrast to ischaemic stroke where the neuronal damage is due to inadequate blood flow, haemorrhagic stroke occurs in response to bleeding in the brain (Craft, Gordon, & Tiziani, 2011, p. 191). There are also two main types of haemorrhagic stroke; Firstly, Intracerebral haemorrhage which is related to hypertension and ruptured aneurysms. Other causes include bleeding into a tumour, bleeding disorders, anticoagulation medications and head trauma. A subarachnoid haemorrhage, the second type of haemorrhagic stroke, occurs when blood escapes from an injured or deformed vessel into the subarachnoid space.
This bleeding increases intracranial volume and impairs the circulation of cerebral spinal fluid, which together increase the intracranial pressure (ICP) (Craft, Gordon, & Tiziani, 2011). The expanding mass of clotted blood compresses and displaces the brain tissue, causing irreversible damage. In the brains attempt to decrease the ICP, blood flow is decreased to the brain which contributes to ischemia which can cause further damage. (Craft, Gordon, & Tiziani, 2011, p. 192)
Risk factors Associated With Ischemic Stroke. There are a variety of variables that may have caused Mavis to have an ischaemic stroke. The subjective data collected revealed that Mavis had a brief episode of left-sided weakness and tingling of the face, arm and hand approximately 3 months ago which was resolved 24 hours later. These symptoms are compatible with the symptoms of a Transient ischaemic attack (TIA). This is a temporary decrease in brain blood flow resulting in brief changes in brain function.
TIA may be due to blood clots or a vessel undertaking a spasm and narrowing (seen in atherosclerosis) causing a temporary blockage of circulation. TIA’s are a warning sign that cerebrovascular disease is developing and that another TIA or more severe stroke is likely to occur soon afterward (Craft, Gordon, & Tiziani, 2011). As Mavis did not seek medication treatment or education after this episode, the likelihood that a stroke would occur was increased. Mavis stated that she was not taking her medication for high cholesterol and blood pressure levels.
As high cholesterol levels contribute to atherosclerosis, medication to control her cholesterol should not have been ceased. Mavis, having a BMI of 34, is classified as overweight, which is another risk factor of stoke, especially combined with high cholesterol and blood pressure levels. The average age of people suffering from strokes is 74 years of age, Mavis, being 70 years of age, is in the prime age-range to suffer this event (Craft, Gordon, & Tiziani, 2011). Clinical Manifestation of an Ischemic Stroke Stroke is a major cause of morbidity and mortality rates across the world.
Acute ischaemic Stroke can have unique manifestations in individuals depending on which area of the brain is affected. If the area of damage is restricted to one side of the brain, then the symptoms will be seen only on the opposite side of the body. Classic clinical manifestations of a stroke include; weakness, numbness or paralysis, arm or leg, difficulty speaking or understanding, dizziness or loss of balance, loss of vision, sudden or blurred vision, headache, usually severe and of abrupt onset and difficulty swallowing (Craft, Gordon, & Tiziani, 2011, p.192). Mavis experienced numbness of her left arm and left leg which is a classic symptom when the right side of the motor cortex is affected as this controls movement of the left side of the body. Mavis also experienced left sided numbness, indicating that her sensory cortex may have been affected on the right side of her brain. By Mavis experiencing left homonymous hemianopia; loss of half the visual field in both eyes; it shows that the stroke has affected her visual cortex on the right side of the brain (Chen & Hayes, 2009).
Although Mavis is orientated and can answer questions appropriately, she is demonstrating a slower response. This is shown in her GCS being 11, which is lower than normal. Following an ischaemic stroke, fluid accumulates between neurons, which results in cellular oedema, this can account for the amount of deficits seen in Mavis’s body, however, cellular oedema can take up to 2 weeks to resolve, which may resolve some of her initial symptoms. Diagnostic Tests and Investigations It is essential to determine whether an ischaemic or a haemorrhagic stroke occurred to be able to appropriately guide medical treatment.