Ischemic

Stroke
HONEY CHILLE N. TOLENTINO RN MAN
DEAN, SCHOOL OF NURSING
Ischemic Stroke
➢ a subset that affects 87% of stroke population
➢results from atherosclerosis that affects predominantly the cerebral
vasculature
➢ Atherosclerosis of the blood vessels can lead to a cessation or
depletion of blood flow to the brain, triggering cerebral ischemia when
brain tissues are no longer viable.
➢Blood clots can also be formed in blood vessels and in the heart,
subsequently dislodging into the brain (‘embolic stroke’).
Risk Factors

Nonmodifable
•Advanced age (older than 55 years)
•Gender (Male)
•Race (African American)
 Risk Factors
Modifable

•Hypertension

•Hyperlipidemia

•Obesity

•Smoking

•Diabetes

•Asymptomatic carotid stenosis and valvular heart disease (eg, endocarditis, prosthetic heart valves)

•Periodontal disease
Pathophysiology
Go
Ischemic Stroke vs Hemorrhagic Stroke
Acute ischemic stroke subtypes
➢Large artery atherosclerosis

➢Cardio embolism

➢Small vessel occlusion

➢Stroke of other, unusual, determined etiology

➢Stroke of undetermined etiology

Endothelial Dysfunction
➢ a systemic pathological state of the endothelium.

➢ Along with acting as a semi-permeable membrane, the endothelium is responsible

for maintaining vascular tone and regulating oxidative stress by releasing mediators,
such as nitric oxide, prostacyclin and endothelin, and controlling local angiotensin-II
activity
 Cerebral Artery Occlusion
Thrombosis refers to obstruction of a blood vessel due to a localized
occlusive process within a blood vessel

The obstruction may occur acutely or gradually

Atherosclerosis may cause narrowing of the diseased vessel

May lead to:

Gradual restriction of blood flow

Platelets may adhere to the atherosclerotic plaque forming a clot leading to

acute occlusion of the vessel •

Atherosclerosis usually affects larger extracranial and intracranial vessels

Hemianesthesia
– a medical
condition that
causes loss of
sensation in one
side of the body
apraxia is an inability
to carry out simple
movements, even
though a person
with apraxia has full
use of their body and
understands
commands to
move.6
Apathy – complete
lack of emotions
about a human
being, thing or
activity
“Déviation conjuguée”, also known as
“conjugate eye deviation (CED)” or
“ipsilesional gaze shift,

A medical sign indicating brain damage, such

as a stroke in the middle cerebral artery.

Characterized by the pupils of the eye tending

to move toward the side of the body where
the lesion is located
Aphasia is a comprehension and
communication (reading, speaking, or
writing) disorder resulting from damage or
injury to the specific area in the brain.
Hypokinesia is a restriction of the
person's mobility
Hemianopsia, or hemianopia, is a loss of
vision or blindness (anopsia) in half the
visual field, usually on one side of the
vertical midline.
Affectation of CN II VII and XII
Parkinson’s results from the loss of cells in
various parts of the brain, including a region
called the substantia nigra. When dopamine
production is depleted, the motor system
nerves are unable to control movement and
coordination.
Hypacusis – hearing impairment
Ataxia is a term used to describe poor muscle control
or coordination. This can affect different types of
movements, including but not limited to walking,
eating, talking, and writing. It usually results from
damage to the part of the brain that controls muscle
coordination (cerebellum) or its connections
Nystagmus (dancing eye disease)
➢ a condition in which your eyes make rapid,
repetitive, uncontrolled movements. These
movements can be up and down (vertical
nystagmus), side to side (horizontal nystagmus), or
in a circle (rotary nystagmus).
Horner’s syndrome (also called
oculosympathetic paresis or Horner syndrome)
is a disorder that affects the eye and
surrounding tissues on one side of the face and
results from paralysis of certain nerves.
Horner’s syndrome results from a lesion to the
sympathetic pathways that supply the head
and neck, including the oculosympathetic
fibers
Tetraplegia, also known as quadriplegia, is
defined as the dysfunction or loss of motor
and/or sensory function in the cervical area of the
spinal cord
Pseudobulbar palsy is characterized by
dysarthria, dysphagia, facial and tongue
weakness, and emotional lability.
Nystagmus is a condition of involuntary eye
movement.
Ageusia is the loss of taste functions of the
tongue, particularly the inability to detect
sweetness, sourness, bitterness, saltiness, and
umami.
Hemihypesthesia is a reduction in sensitivity on
one side of the body. A person with this condition
may not be able to perceive being lightly touched
on one side, but has normal function on the other
side of the body
Tests

•Physical exam, including neuro assessment

•Blood tests. tests to check how fast the blood clots, whether the blood sugar is too high or
low, and infection.
•Computerized tomography (CT) scan. A CT scan uses a series of X-rays to create a detailed
image of your brain. A CT scan can show bleeding in the brain, an ischemic stroke, a tumor or
other conditions. Doctors may inject a dye into the bloodstream to view the blood vessels in
the neck and brain in greater detail (computerized tomography angiography).
•Magnetic resonance imaging (MRI). An MRI uses powerful radio waves and a magnetic field
to create a detailed view of the brain. An MRI can detect brain tissue damaged by an ischemic
stroke and brain hemorrhages. The doctor may inject a dye into a blood vessel to view the
arteries and veins and highlight blood flow (magnetic resonance angiography or magnetic
resonance venography).
Tests
•Carotid ultrasound. In this test, sound waves create detailed images of the inside of the
carotid arteries in the neck. This test shows buildup of fatty deposits (plaques) and blood flow
in the carotid arteries.
•Cerebral angiogram. In this uncommonly used test, the doctor inserts a thin, flexible tube
(catheter) through a small incision, usually in the groin, and guides it through the major
arteries and into the carotid or vertebral artery. Then the doctor injects a dye into the blood
vessels to make them visible under X-ray imaging. This procedure gives a detailed view of
arteries in the brain and neck.
•Echocardiogram. An echocardiogram uses sound waves to create detailed images of the
heart. An echocardiogram can find a source of clots in the heart that may have traveled from
the heart to the brain and caused a stroke.
FAST ASSESSMENT
To recognize the warning signs of a stroke, remember to think FAST:
•F is for face. Ask the person to smile. Look for a droop on one or both sides of their face, which is a
sign of muscle weakness or paralysis.
•A is for arm. A person having a stroke often has muscle weakness on one side. Ask them to raise their
arms. If they have one-sided weakness (and didn’t have it before), one arm will stay higher while the
other will sag and drop downward.
•S is for speech. Strokes often cause a person to lose their ability to speak. They might slur their
speech or have trouble choosing the right words.
•T is for time. Time is critical, so don’t wait to get help! If possible, look at your watch or a clock and
remember when symptoms start. Telling a healthcare provider when symptoms started can help the
provider know what treatment options are best for you.
 The symptoms of an ischemic stroke can
involve one or more of the following:
• One-sided weakness or paralysis. •Dizziness or vertigo.
•Nausea and vomiting.
• Aphasia (difficulty with or loss of speaking ability).
•Neck stiffness.
• Slurred or garbled speaking (dysarthria). •Emotional instability and personality changes.
•Confusion or agitation.
• Loss of muscle control on one side of your face or facial •Memory loss (amnesia).
droop. •Headaches (usually sudden and severe).
•Passing out or fainting.
• Sudden loss — either partial or total — of one or more
•Coma.
senses (vision, hearing, smell, taste and touch).

• Blurred or double vision (diplopia).

• Loss of coordination or clumsiness (ataxia).

Emergency Treatment

•Emergency IV medication.

An IV injection of recombinant tissue plasminogen activator (TPA) — also called alteplase

(Activase) or tenecteplase (TNKase) — is the gold standard treatment for ischemic stroke. An
injection of TPA is usually given through a vein in the arm within the first three hours.
Sometimes, TPA can be given up to 4.5 hours after stroke symptoms started.

This drug restores blood flow by dissolving the blood clot causing the stroke. By quickly
removing the cause of the stroke, it may help people recover more fully from a stroke. 9
Nursing Responsibilities:
•Checking for decrease in cerebral perfusion and increased ICP
•Comparing neurological status with baseline frequently
•Checking blood pressure, heart rate, respiration, and pupil reactivity
•Giving bed rest, elevating head, and supplementing oxygen as
required
•Administering medications as required
ICU Care
 Rehab Care
• Doctor trained in brain conditions (neurologist)

• Rehabilitation doctor (physiatrist)

• Rehabilitation nurse

• Dietitian

• Physical therapist

• Occupational therapist

• Recreational therapist

• Speech pathologist

• Social worker or case manager

• Psychologist or psychiatrist

• Chaplain