🧠 Stroke – Ischemic

📌 Definition

An ischemic stroke is a sudden loss of blood flow to part of the brain, caused by a blockage (thrombus or embolus) in a cerebral artery, resulting in brain tissue ischemia and infarction.

🧠 Anatomy & Physiology: Brain

  • The brain requires continuous blood flow for oxygen and glucose
  • Supplied by:
    • Carotid arteries (anterior circulation)
    • Vertebral-basilar system (posterior circulation)
    • Circle of Willis provides collateral circulation
  • Ischemia >5 min → irreversible neuronal damage
  • Cerebral cortex: motor/sensory control
  • Brainstem: vital centers for respiration and cardiac function

⚠️ Etiology: Causes & Risk Factors

  • Modifiable:
    • Hypertension
    • Atherosclerosis
    • Diabetes mellitus
    • Smoking
    • Hyperlipidemia
    • Atrial fibrillation (embolic stroke)
    • Sedentary lifestyle
  • Non-modifiable:
    • Age >55
    • Male sex
    • Family history
    • Prior stroke or TIA

🩺 Symptomatology

  • Sudden onset of:
    • Weakness or numbness (usually unilateral)
    • Facial droop, arm drift, slurred speech (FAST)
    • Visual disturbances (blurred/loss of vision)
    • Confusion or difficulty speaking (aphasia)
    • Loss of coordination, balance, or dizziness
    • Severe headache (less common in ischemic than hemorrhagic)

🔁 Pathophysiology (Simplified)

  1. Blood vessel blocked by thrombus or embolus
  2. ↓ Cerebral blood flow → ↓ oxygen and glucose to neurons
  3. Ischemic core forms (irreversible damage)
  4. Penumbra surrounds the core (potentially salvageable with quick treatment)
  5. Without reperfusion, infarction extends → permanent neurologic deficit

🧪 Medical Management

🔬 Labs & Diagnostics

  • Non-contrast CT scan: rules out hemorrhage, confirms ischemia
  • MRI/MRA of brain: defines ischemic area and vessels
  • CBC, PT/INR, blood glucose: assess for stroke mimics and coagulopathy

💊 Medications

  • Alteplase (tPA): thrombolytic if within 3–4.5 hours
  • Aspirin or Clopidogrel: antiplatelet therapy
  • Statins: reduce cholesterol and plaque

🛠️ Treatment Options

  • IV thrombolysis (tPA)
  • Mechanical thrombectomy (large vessel occlusion)
  • Stroke unit care (close neuro and BP monitoring)
  • Long-term rehab: PT, OT, speech therapy

🧑‍⚕️ Nursing Management: 5 Key Interventions

  1. Monitor neurologic status (GCS, NIHSS) frequently
  2. Maintain airway, oxygenation; suction if needed
  3. Ensure timely thrombolytic administration if eligible
  4. Prevent complications (aspiration, pressure ulcers, DVT)
  5. Support for communication and ADLs (esp. aphasia/hemiparesis)

🩹 Priority Nursing Diagnoses

  • Ineffective cerebral tissue perfusion r/t interrupted blood flow
  • Impaired physical mobility r/t hemiparesis
  • Risk for aspiration r/t dysphagia
  • Impaired verbal communication r/t expressive/receptive aphasia
  • Self-care deficit r/t neurologic impairment

📉 Prognosis

  • Early intervention significantly improves outcome
  • Best prognosis if treated in the golden window (≤4.5 hrs)
  • Recovery depends on location, infarct size, speed of treatment
  • Common complications:
    • Disability (motor/sensory deficits)
    • Seizures
    • Depression
    • Risk of recurrent stroke