Saturday, October 23, 2010

Stroke Management

In caring for stroke patients, there are a few things to note in relation to the circumstances experienced by patients. All this is done for convenience and create conditions so that patients recover faster. Things that need to do:
- Position the body in a state lying on his side (lateral decubitus)
- Avoid giving food or drink orally
- Avoid permanent catheter placement.

Thursday, October 21, 2010

Treatment of Acute Stroke Patients

Acute-phase treatment program conducted with the initial step of acute stroke treatment. First focus on general medical resuscitation ABC.

A. Water Way
The first action in dealing with acute stroke patients is to assess the respiratory system. Examination of the water-way includes the area of the mouth, such as food scraps, dentures or foreign objects blocking the water way sufferers.

Way the water issue generally occurs in patients with bleeding strokes. For patients with ischemic stroke, water-way is usually stabilkecuali on brain stem infarction or recurrent seizures. To avoid blockage of water on the way stroke patients are not aware, the patient should be in the lateral decubitus position, mild hyperextension neck, and shoulders lifted, aspirated secretions, endotracheal testing. If intubation required more than 3 days, the tracheostomy may be considered.

B. Breathing
All stroke patients are given supplemental oxygen 1-2 liters per minute through the nose until there is blood gas analysis. Then adjusted with a target partial Pa O2> 80-100 mmHg. Oxygen delivery in patients with stroke is generally beneficial, because the brain requires a lot to carry oxygen metabolism. Levels of carbon dioxide Pa CO2 = 30-35 mmHg.

C. Circulation
After the action of water-way and oxygenation, then the next important also is to improve circulation and brain perfusion adequately in a way keep cardiac output and blood pressure. Then checked state of circulation such as blood pressure and pulse.

Tuesday, October 19, 2010

Examination Stroke

In treating stroke patients, need to be considered so that the treatment process or tahapam right on target:
- The acute phase: usually lasts between 4-7 days. Target patient survived
- Phase of recovery: after the acute phase had passed, the next is pemulihanyang phase lasts about 2-4 weeks. Target patient bekajar disturbed motor skills and learn new adjustments to compensate for limitations.
- Rehabilitation: target to continue the recovery process to achieve improved physical ability, mental, social and speaking skills.
- Phase Everyday life: after the acute phase is exceeded, then the preventive therapy to avoid recurrence of acute stroke.

Hospital Handling
Handling of hyperacute phase of stroke patients should be performed in a hospital. Actions taken at the hospital depends on the type and weight experienced a stroke. Patients may be encouraged to stay to find out the cause of the stroke. Although patients must stay in the hospital, does not mean a stroke will bring harm or disability. Stroke is not always predictable, and may take several days to find out clearly against the possibility further. Hospital doctors will take some action to ensure that the diagnosis was a stroke, not other diseases whose symptoms are similar to stroke such as brain tumors, epilepsy, migraine. The doctor will perform several checks:
- CT-scan (computerised tomography scanning)
- MRI (magnetic resonance imaging)
- ECG / EKG (electrocardiograph)
- EEG (electroencephalogram)
- Blood tests
- Angiogram or arteriogram
- Roentgen rays

State of the patient as a whole should also be considered include hemoglobin, electrolytes, albumin, cleanliness of the respiratory tract and urinary tract.

Sunday, October 17, 2010

Stroke Diagnosis

The diagnosis is usually based on the course of the disease and results of physical examination. Physical examination can help determine the location of brain damage. Inspection procedures to be performed should not much time for too long, for the sake of minimizing the loss of time between the onset of disease and the start of therapy.

Examination Support
CT-scan should be performed on sema patients with suspected acute stroke. CT-scan without contrast to distinguish ischemic stroke, hemorrhage and stroke. At the stroke of bleeding, lesions form hiperdens. While in ischemic stroke, lesions form hipodens or normal. It should be noted that about 5% of stroke subarachnoid hemorrhage CT-scan can be normal, so we need punksi lumbar examination. Cerebrospinal fluid in subarachnoid hemorrhage of blood red.

Differential Diagnosis
Some diseases that need to be considered because it has symptoms similar to acute stroke:
- Trauma to the head or neck
- Meningnitis / encephalitis (brain infection)
- Hypertensive encephalopathy / brain disorders due to hypertension
- Intracranial mass: tumor, hematoma
- The attack seizures with a temporary nerve disorder
- Migraine with temporary neurological disorders
- Metabolic Disorders: hyperglycemia, hypoglycemia, heart post-ischemia, toxic poisoning, endocrine disorders / myxedema, uremia
- Psychiatric Disorders
- Shock accompanied by hypoperfusion of the central nervous

Friday, October 15, 2010

Advanced Stroke Symptoms

Here are the symptoms of a stroke that is more detailed:
- The offensive focal neurological deficits, weakness or paralysis of the arm, or one side of the body.
- Loss of taste or abnormal sensations in the arm or one side of the body. Side numbness, cramp, was on fire.
- Mouth, tongue can not be straight.
- Impaired swallowing, difficulty swallowing, hard to drink.
- Talk is not clear, difficult to speak, the spoken word is not as you wish, nasal, aphasia. Talk is not smooth, just a few words were spoken.
- It's hard to think or say the right words.
- Not understanding the speech of others.
- Not able to read, write and do not understand the writing.
- Unable to count, decreased intelligence.
- Not able to recognize parts of the body.
- Loss of bladder control.
- It's hard to walk.
- Forgetful (dementia)
- Vertigo
- Start of rapid disease, sudden
- Loss of vision, vision be disturbed, dark vision
Eyelids open hard-
- Hearing loss or hearing loss
- Become more sensitive
- Always wanted to sleep
- Loss of balance, body movements are not well coordinated
- Disturbance of consciousness, fainting

Wednesday, October 13, 2010

Stroke Symptoms

The following disorder may be a symptom of someone affected by stroke:
- Facial Drop
Normal: both sides of the face moved symmetrically
Abnormal: one side of the front left
- Speech and language disorders
Normal: to pronounce sentence correctly and clearly
Abnormal: difficulty speaking, using the wrong word
- Arm Drift
Normal: both arms to move simultaneously and parallel
Abnormal: One arm moves down / not aligned
- Eye movement disorders and impaired coordination

Symptoms of mild stroke
When a stroke occurs, should be immediately taken to the hospital. When the doctor checked and found no symptoms of stroke, the patient is exposed to the possibility of temporary ischemic stroke or transient ischemic attack or minor stroke. Patients will recover after 24 hours after the stroke occurred. To prevent repeat strokes, then the patient should lead a healthy lifestyle and consume a drug that can destroy the blockage or plaque in arteries.

Early Stroke Symptoms
Initial attack of stroke is usually a disturbance of consciousness. Disturbance of consciousness can be a feeling of wanting to sleep, confusion, difficulty remembering, blurred vision and so forth. In the next few hours of consciousness disturbance will continue, reduce muscle strength and coordination, in the form of difficulty concentrating on reading or hearing. Alternatively, the patient not easy to talk and do activities such as standing, walking and holding something. Another disturbance in the form of difficulty breathing. Other early symptoms include loss of muscle force as limp fingers, legs become stiff and lose coordination of movement. If the symptoms are more severe then the patient should be taken to the hospital.

Most cases of stroke occur suddenly, very quickly and cause brain damage within minutes. Stroke can get worse within a few hours or several days due to increased area of dead brain tissue. The development of the disease are usually interspersed with stable periods, where the expansion of brain tissue dies and stops while going improvement. Symptoms of acute stroke patients depending on the affected brain regions.

Broadly speaking, the brain consists of 3 parts:
1. Cerebrum: functions associated with higher intellectual function, speech function, the integration of sensory information and control of fine movements
2. Small brain: functions to manage the coordination of movement and balance the body.
3. Brain stem: controls the basic functions of the organs, such as eye movements, balance, awareness, breathing and heart function.

Right-brain part associated with the introduction of space, body, ability to draw, art and buildings. While the left brain function on speech, numeracy and writing.

Monday, October 11, 2010

Hemorrhagic Stroke

Obstruction of blood supply to the brain can be caused by arteries that supply blood to the brain is broken by certain causes. For example, blood pressure suddenly high. Increased blood pressure suddenly height can be caused by hypertension, psychological stress, head trauma or increased pressure such as coughing loudly and others. The blood vessels that rupture is usually due to artery-shaped thin-walled balloon, called aneurysms or atherosclerotic arterial wounds. Brain bleeding may occur in the brain called brain hemorrhage, so the brain contaminated by blood collection (hematoma), or blood into the subarachnoid space called the subarachnoid hemorrhage.

Subarachnoid hemorrhage there are 2 types, namely primary and secondary. Primary when a ruptured blood vessel from an artery in the subarachnoid. Secondary when the source of blood from other places outside the subarachnoid space into the room subarachnoid. In the blood vessels that rupture can occur contraction / vasocontraction, namely diminution arterial lumen or channel which can inhibit brain blood flow, and symptoms that arise depend on which brain areas are affected.

Hemorrhagic strokes are divided into:
- Subarachnoid hemorrhage (PSA)
- Intracerebral hemorrhage (PIS), or intraventrikel intraparenkim

Saturday, October 9, 2010

Ischemic Stroke

The brain can function well if blood flow to the brain does not experience obstacles. However, if supply of oxygen and nutrients carried by blood cells and plasma blocked by blood clots or thrombosis occurs in blood vessels supplying the brain, an ischemic stroke will occur. This can result in cell death / brain tissue supplied. Obstruction of blood flow to the brain can be caused by a thrombosis or embolism and hardening of the arteries called atherosclerotic plaques through the process of atherosclerosis.

Based on the clinical course, a stroke ischemic grouped into:
- Transient Ischemic Attack (TIA): temporary stroke that lasts less than
24 hours
- Reversible ischemic neurologic deficit (RIND): neurological symptoms will disappear between
> 24 hours to 21 days
- Progressing stroke or stroke in evolution: abnormalities or neurologic deficit lasted
gradually from light to become severe.
- Completed complete stroke or stroke: neurological abnormalities has been settled and no
expand again.

According to the classification test of Neurological Disorders The National Stroke Part III, based on the cause of ischemic stroke were divided into 4 groups:
- Therothrombotic: blockage of blood vessels by plaque
- Kardioemboli: blockage of blood vessels by plaque fragments (emboli) of cardiac
- Lakuner: blockage of plaque on blood vessel-shaped hole
- Other causes that lead to hypotension

There are several causes of ischemic stroke:
1. Atheroma
In ischemic stroke, blockage can occur in the path of the arteries to the brain, such as an atheroma can form in the carotid arteries causing reduced blood flow. The situation is very serious because the carotid artery in normal circumstances to give blood to most of the brain.

2. Embolism
Fat deposition can also be separated from the artery walls and flows in the blood, clogging arteries and smaller. Carotid artery and vertebral artery and its branches can be blocked due to blood clot originating from elsewhere, eg, from the heart. Formed when fat embolism from bone marrow that broke loose in the bloodstream and eventually clog the small arteries. Embolic stroke due to blockage is rare.

3. Infection
Strokes can occur when infection causes inflammation narrowing of blood vessels leading to the brain.

4. Drugs
The drugs also can lead to stroke, such as cocaine and amphetamines. By way of narrowing the lumen of blood vessels in the brain and cause strokes.

5. Hypotension
Decrease in blood pressure that suddenly can cause reduced blood flow to the brain, which usually causes a person to faint. Stroke can occur if very severe low blood pressure. This occurs when a person experiences a lot of blood loss due to injury or surgery, heart attack or abnormal heart.

Thursday, October 7, 2010

Causes of Stroke

A stroke is caused by 2 main things, namely blockage of an artery that carries blood to the brain (ischemic stroke) and since the bleeding in the brain (hemorrhagic stroke). There are several factors causing stroke (multirisk factors). Eating goat and smoking is often regarded as the only cause, but there are many other factors such as eating fatty food, patterns and lifestyle, hormonal factors, and psychiatric conditions, exposed to free radicals, and the adequacy of vitamins and minerals.

In contrast to those classified as risky, such a factor hiyperlipoproteinemia (and triglyseride cholesterol in the blood above normal), although reducing fatty foods, living regular and adequate exercise, but still vulnerable to stroke.

Tuesday, October 5, 2010

Definition of Stroke

Stroke is a form of brain functional disorders penyalit nerve palsy / neurologic deficit due to interruption of blood flow in one part of the brain. Stroke is defined as a disease of the brain due to interruption of blood supply to the brain due to blockage or bleeding, with symptoms of momentary paralysis, or severe symptoms until loss of consciousness or death. Stroke can be ischemic or bleeding (hemorrhagic).

In ischemic stroke, blood flow to the brain stops because of atherosclerotic or blood clot that has clogged the blood vessels, through the process of atherosclerosis.

At the stroke bleeding / hemorrhagic, rupture of blood vessels so that blood flow becomes abnormal and the blood that comes out into a region in the brain and cause damage.

Acute stroke, either ischemic or bleeding is a medical emergency requiring immediate treatment because it can cause permanent disability or death.

According to WHO, stroke is the clinical signs of disturbance of cerebral function both locally and globally, is growing rapidly, with symptoms that lasted for 24 hours or more, or leading to death without visible cause, in addition to signs pertaining to the flow blood in the brain. Stroke is a disease of acute brain functional disorders, both locally and globally, due to interruption of blood flow to the brain because of bleeding or blockage, which can recover completely, recover with a disability or result in death.

Sunday, October 3, 2010

Introduction About Stroke (2)

Stroke can be classified in chronic penyakir because of a long process, although it occurs in acute stroke. Process until the occurrence of stroke may have occurred several years before a stroke appear. Symptoms of stroke depend on where yamg affected brain vessels, the amount of blockage in the brain, the part where the blood vessels that rupture and whether parts of the brain are affected quite vital. Not all strokes cause symptoms.

Although there is no presenting symptoms in patients with stroke, does not mean definitely not a stroke. Maybe the process is already underway, because the symptoms of stroke occur if the blockage has reached 80%. These conditions are for those at risk of stroke preventive save meanings. If only the process of stroke can be prevented or stopped, then the likelihood of stroke does not occur. But people who experience a stroke process usually do not realize that his brain is being threatened stroke. Someone had to know if a stroke occurs when the examination process with tools.

The initial symptoms of stroke that may arise, could be in the form of momentary paralysis (Transient Ischaemic Attack) which is often called a mild stroke. That is an initial process towards a severe stroke emerging in part and usually recovers itself within 1-2 days. But when a minor stroke which left without treatment means, a time will appear more severe stroke, and most will be too late to be cured completely. A variety of stroke symptoms to watch out for, especially for those at risk of stroke, such as hypertension, diabetes mellitus, hiperlipdemia, hypercholesterolemia or who suffer from heart disease, fragile psychological stress or a combination of these factors.

Stroke in an early stage may appear as a stroke in evolution. Namely stroke symptoms had appeared, but the process has not finished a stroke, still continues so still will flourish again. Within hours, the condition of the patient worsens or the patient becomes unconscious conscious self.

There is also a direct cause of stroke that paralyzed half of the body is called completed strokes. Where the stroke has been completed and no longer growing.

The case of a stroke can occur as a recurrent stroke. If the first stroke treatment is not done to hinder the process of stroke, the stroke aftershocks will occur again. Attacks could occur at the same location of the brain, as well as in other areas of the brain with symptoms and manifestations are different.

All cases of stroke must be addressed urgently, in within 3 hours after the first stroke appears. The goal is to damage brain cells are still in the process does not get worse, so that could still be saved.

Friday, October 1, 2010

Introduction About Stroke (1)

Stroke is still the leading cause of death in the world. These diseases also have an impact on the most disabled adults who are still productive. The high cases of stroke due to low public awareness in addressing the various risk factors that could cause a stroke.

Stroke (cerebroscascular accident) is not just attacking people aged over 50 years, but also the productive age are still working. Even in some cases, this disease is still aged under 30 years old.

Stroke is a brain attack that occurs suddenly, without any advance warning. The disease is partly due to blockage of plaque thrombotic and bleeding. That is an artery or rupture of blood vessels in the brain tiaba blue.

Stroke can actually be prevented, treated and rehabilitated. Stroke patients may seek to control the situation better than the previous time. We can realize that to overcome some or almost all matters relating to stroke, and return to a healthy lifestyle. Strategies to reduce the number of defects due to stroke and death is by primary prevention, secondary and effective treatment to optimize quality of life.