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.

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.

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.

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

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

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.

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