STROKE

Dr Arulita Ika Fibriana M.Kes

DEFINITION

Stroke is a rapidly developing loss ofbrain

function(s) disturbance in theblood supplyto
the brain.
This can be due toischemia(lack of blood flow)
caused by blockage (thrombosis,arterial embolism
), or a hemorrhage(leakage of blood).
As a result, the affected area of the brain is unable
to function
inability to move one or more limbs on one side of
the body
, inability to understandorformulatespeech, or an
inability to see one side of the visual field .

DEFINITION

World Health Organisation (WHO) definition of

stroke :
Stroke is defined as rapidly developing clinical
signs of focal or global disturbance of cerebral
function, with symptoms lasting 24 hour or
longer, or leading to death, with no apparent
cause other than of vascular origin
Time window of 24 hour distinguishes stroke
from Transient Ischaemic Attack (TIA), which
has the same definition but is defined as a
neurological deficit lasting less than 24 hour.

CLASSIFICATION
Stroke is classified into two major types:
Brain ischemia thrombosis, embolism, or
systemic hypoperfusion (cardiac pump failure
fromcardiac arrestor arrhythmias, or from
reducedcardiac outputas a result of myocardial
infarction)

Brain hemorrhage due to intracerebral

hemorrhage or subarachnoid hemorrhage
About 87% of strokes are caused by
ischemia, and the remainder by hemorrhage.

ISCHEMIC STROKE

EPIDEMIOLOGY

The second leading cause of death in the

Western world (after heart disease and before
cancer),and causes 10% of deaths worldwide.
Theincidenceof strokeincreases from 30 years of
age.
Advanced age is one of the most significant stroke risk
factors also increases a person's risk of dying.
95% of strokes occur in people age 45 and older, and
two-thirds of strokes occur in those over the age of
65.
However, stroke can occur at any age, including in
childhood.

EPIDEMIOLOGY

Family members may have a genetic

tendency for stroke or share a lifestyle
contributes to stroke.
Having had a stroke in the past greatly
increases one's risk of future strokes.
Men are 25% more likely to suffer strokes
than women,
60% of deaths from stroke occur in women
(women live longer, they are older when they
have their strokes and thus more often killed)

SIGN & SYMPTOMS

The symptoms depend on
the area of the brain that has
been affected and the amount of
brain tissue damage.
Small strokes may not cause any
symptoms, but can still damage
brain tissue. Strokes that do not
cause symptoms silent
strokes.

SIGN & SYMPTOMS

According to The U.S. National Institute of
Neurological Disorders and Stroke (NINDS), these
are the five major signs of stroke:
Sudden numbness orweaknessof the face, arm or
leg, especially on one side of the body. The loss of
voluntary movement and/or sensation may be
complete or partial. Try to raise both arms over
your head at the same time. If one arm begins to
fall, you may be having a stroke. Similarly, one side
of your mouth may droop when you try to smile.
Sudden troublewalking,dizziness, loss of balance or
coordination.

SIGN & SYMPTOMS

Suddenconfusionor trouble speaking or understanding.
Sometimes weakness in the muscles of the face can
causedrooling You may slur your words or be unable
to find the right words to explain what is happening to
you (aphasia). Try to repeat a simple sentence. If you
can't, you may be having a stroke.
Sudden trouble seeing in one or both eyes You may
suddenly have blurred or blackened vision, or you may
see double.
Sudden, severeheadachewith no known cause which
may be accompanied by vomiting, dizziness or altered
consciousness, may indicate you're having a stroke.

NEUROLOGICAL IMPACT
Potentially affected neurological domains are :
Motor:Motorimpairments (the most prevalent of all
deficits) face, arm, andleg,alone or in various
combinations. Motor functions include cranial nerve
function (including speechand swallowing),muscle
power and tone, reflexes, balance, gait,
coordination.
Sensory:Sensory deficits (numbness,tingling, or
altered sensitivity). Themore complex sensory
lossesinclude astereognosis, agraphia,and
extinction to double simultaneousstimuli.
Vision:Strokecan cause monocular visual loss.

NEUROLOGICAL IMPACT

Language:Dysphasia may be exhibited by

disturbances incomprehension,naming, repetition,
fluency, reading, or writing.
Cognition:impairments in memory,
attention,orientation, calculation abilities, and
construction assess ability to learn and retain
new information in the cognitiveevaluation.
Affect:Depression is the most common affective
disturbance. It tends to be observed more often in
the months after stroke than during the acute
event. Symptoms includeloss of energy, lack of
interests, loss of appetite, and insomnia.

RISK FACTORS
Controllable Risk Factors:
High Blood Pressure
Atrial Fibrillation
High Cholesterol
Diabetes
Atherosclerosis
Circulation Problems
Tobacco Use and Smoking
Alcohol Use
Physical Inactivity
Obesity

RISK FACTORS
Uncontrollable Risk Factors:
Age
Gender
Race
Family History
Previous StrokeorTIA
Fibromuscular Dysplasia
Patent Foramen Ovale(PFO or Hole in the Heart)

DIAGNOSIS

Aphysical examination, including taking amedical history

of the symptoms and a neurological status.
CT scans or MRI scans,Doppler ultrasound, and
arteriography.
Determine the underlying etiology (anultrasound of the
carotid arteries(to detectcarotid stenosis) or an
electrocardiogram(ECG) andechocardiogram (to identify
arrhythmiasand resultant clots in the heart which may
spread to the brain vessels through the bloodstream),
blood tests to determine hypercholesterolemia, anemia,
kidney andliver function, electrolyte abnormalities and
blood clotting function.

IMPACT OF STROKE

The third largest cause of death (behind

heart diseaseand all forms ofcancer).
Lost in work, hospitalization, and the care of
survivors in nursing homes disability affects 75%
of stroke survivors enough to decrease their
employability.
Lose most of the quality of life after a stroke The
major cost or impact of a stroke is the loss of
independence that occurs in 30% of the survivors.
Family members and friends may have their lives
altered as they find themselves in the new role as
caregivers.

TREATMENT OF A STROKE

Tissue plasminogen activator (TPA) Alteplase

(TPA) as a clot-buster drug to dissolve the blood clot
that is causing the stroke.
Anticoagulation for example,heparin are also
sometimes used in treating stroke patients in the hopes
of improving the patient's recovery.
Managing other Medical Problems :
Blood pressure controlled often using intravenous
medication to prevent stroke symptoms from
progressing.
In patients withdiabetes controlling the glucose level
in these patients may minimize the size of a stroke.

TREATMENT OF STROKE

Rehabilitation :
speech therapy to relearn talking and
swallowing;
occupational therapy to regain as much function
dexterity in the arms and hands as possible;
physical therapy to improve strength and
walking;
family education to orient them in
caring for their lovedone at home and the
challenges they will face.

PROGNOSIS

is related to the severity of the stroke and how

much of the brain has been damaged.
Some patients return to a near-normal
condition with minimal defects.
Many stroke patients are left with permanent
problems such as hemiplegia (weakness on
one side of the body),aphasia(difficulty or the
inability to speak), or
incontinence of the boweland/orbladder. A
significant number of persons become
unconscious and die following a major stroke.

PREVENTION

Risk factor reduction :

High blood pressure:Managing high blood
pressure so that it is well controlled and in the normal
range decreases the chances of a stroke.
Smoking:Chemicals in cigarettes are associated
with developing atherosclerosis or narrowing of the
arteries in the body.
Diabetes:Diabetes causes the small vessels to close
prematurely. When these blood vessels close in the
brain, small (lacunar) strokes may occur. Good
control of blood sugar is important in decreasing the
risk of stroke in people with diabetes.

PREVENTION

High cholesterol:Elevated cholesterol and/or

triglyceridesin the bloodstream are risk factors for a
stroke due to the eventual blockage of blood vessels
(atherosclerosis) and plaque formation. Ahealthy diet
andmedicationscan help normalize an elevated blood
cholesterol level.
Blood thinner/warfarin: blood clots can break off
and travel or embolize to blood vessels in the brain
blocking blood flow and causing a stroke. Warfarin
(Coumadin) is a blood "thinner" that prevents the blood
from clotting.
Antiplatelet therapy:act on platelets to decrease
their stickiness and reduce the tendency to clot blood.