• Modifiable: poor diet, high stress, hypertension, diabetes, smoking, etc.
• Non-modifiable: age, sex, genetic background

• Precursor/warning sign to strokes
• Short-lived
• Usually occur before thrombolytic (ischemic) strokes
• Temporary artery blockage or blood flow reduction in the brain

• A blood clot has occurred in the brain (thrombotic/embolic) 
• Can be either slow-growing or rapid in nature
• Causes more speech and movement deficits

• Caused by a bleed in the brain
• Bleed causes: trauma, aneurysm, AVM rupture
• Much more fatal than ischemic strokes

• Thrombotic: slow-growing, no sudden level-of-consciousness change detectable
• Embolic: sudden, usually a clot thrown to the brain from somewhere else in the body (most commonly from heart while in AFib), very significant symptoms, can resolve itself causing a misdiagnosis of TIA

• Intracerebral: most common in women, hypertension is huge risk factor, worsens over time, deficits are aggressive and quickly detectable, vessel ruptures on the brain
• Lacunar: usually the rupture of very small vessels in the deep middle brain
• Subarachnoid: may contain blood in the patient's cerebrospinal fluid

• Used for all stroke patients
• Contrast can increase bleeding, thus worsening hemorrhagic strokes. This is why no contrast dye is used.
• Embolic strokes may take 24 to 48 hours to appear
• Hemorrhagic strokes are very obvious on CT

• Right-sided weakness
• Both expressive and receptive language affected
• Patient is aware of their own deficits

• Left-sided weakness
• Spatial perceptual deficits (homonymous hemianopsia)
• Patients are not aware of their deficits; can lead to patient being impulsive due to lack of awareness of their own limitations

[image]

Half of a patient's vision is gone on the same side of both eyes. Occurs in right-sided strokes. 

• Should be administered within 4 hours
• Treatment overall should be started within 60 minutes of stroke detection

• Identify and treat risk factors
• Carotid endartectomy can be performed with 70% or more carotid blockage; enters carotid arteries and removes plaque in order to prevent ischemic stroke
• Carotid stenting (transluminal angioplasty)
• ECIC bypass (external carotid, internal carotid bypass)
• Coiling: reinforcing an aneurysm with a small coil that forms a wall that blocks blood flow into the aneurysm
• Clipping: cutting off an aneurysm to prevent blood flow into it
• Embolization: creating clots to block AVM branchese
• Anti-coagulation therapy

• The main priority is assessing the patient's level of consciousness due to the high risk of stroke post-procedure.
• Due to the proximity of the procedure to the airway, the next priority is to maintain a patent airway.

• Blood pressure will remain high for some time
• Fluids and electrolytes must be kept in check
• Monitor blood sugar: dextrose increases cerebral edema
• Fibrinolytic therapy
• Stent placement (surgical)

• Hypertension treatment: lobetalol titration
• Seizure precautions
• Evacuate aneurysm: AVM treatment, clipping, coiling
• Notify doctor of any anticoagulant use by patient

• Patients usually have some form of aphasia, but they can still understand what you are saying
• Bowel/bladder training
• Contracture prevention
• Swallow studies
• Feed in High Fowler's
• 15 to 30 degree head elevation at all times