Cerebrovascular Accident (Stroke) Essay: Signs, Symptoms, Pathophysiology, And Pharmacological Therapy.

Types of Stroke

Question:

Explanation of pathophysiology and pharmacology ?

Cerebrovascular accident refers to the medical term that is used for stroke. Stroke occurs due to the poor blood flow in the brain, which causes the cell death (Berkhemer et al. 2015). Stroke is of two types that are ischemic and hemorrhagic. Ischemic stroke occurs due to the reduced blood flow. On the other hand, the hemorrhagic stroke occurs due to the bleeding.

However, cerebrovascular accident or stroke has various signs and symptoms. These signs and symptoms show the inability of the brain.

In the assignment, the pathophysiology and pharmacology are discussed. Cerebrovascular accidents have various signs and symptoms that are discussed. The next section discusses about the rationale of the cerebrovascular accident.

eorge and Steinberg (2015) mentioned that the main reason of ischemic stroke can be blood clot. This occurs when the artery affected or damaged that is called thrombosis. The arterial wall became blocked that leads to damage. Therefore, the blood vessel network became hampered. The single artery damage can cause the hampered blood circulation network. On the other hand, Bivard et al. (2014) stated that the arteries became harden that is known as the artherosclerosis. The damage of the arteries and the natural variation in collateral network helps to prevent collateral system from the compensating completely. This can result the loss of perfusion, blood supply to the brain. Arteriovenous malformation can cause of the abnormal tangles of the blood vessels. In such condition, the blood flow occurs from the veins to the arteries. Therefore, the flow of blood blocked and damage of the brain tissues occur.

In case of haemorrhagic stroke, the bleeding occurs due to the head trauma. The aneurysm ruptures that causes the bleeding. The bleeding occurs in between the innermost meninges, arachnoid mater and pia mater. Vasopasm that is the construction of arteries can help to reduce the bleeding, which is hampered. The brain tissues fail to respond as the blood pressures increases highly. Kim, Kawabori and Yenari (2014) mentioned that stroke mainly happens due to the hypertension. Brain tumors and blood clotting disorder can cause the stroke in the patient. Therefore, it is necessary to reduce the effects of the hypertension and other causes of stroke.

The pharmacologic therapy includes stroke specific treatment and the stroke prevention. However, Foushee et al. (2014) mentioned that the type of pharmacology depends on the type of stroke that is ischemic or haemorrhagic. In case of the ischemic stroke, the pharmacotherapeutic treatment includes the plasminogen activator and antiplatelet agents. On the other hand, the hemorrhagic stroke includes the control of blood pressure and the intracranial pressure. To treat the ischemic stroke, the IV tPA agents are used that the FDA approves. The tPA is very effective to control the ischemic stroke. Oppelt et al. (2014) mentioned that the patient who is affected by the ischemic stroke, needs to be treated within 3 hours of the attack. This will help to reduce the effect the stroke attack. In case of hemorrhagic stroke, surgery may be needed if the condition of the patient is serious. In case of non-surgical condition, the medication of IV vitamin K is necessary. The nurse should provide aspirin as earlier as possible to prevent the effects of stoke. In some cases, plasminogen activator is used as an injection, which is administered in the arm of the patient.

Pathophysiology of Stroke

Stroke has various signs and symptoms that include problem in movement. The patient may feel problem to move. Sometimes the patient may feel problem on one side of the body that is problem in movement. Hayek et al. (2014) stated that the patient feels problem in speaking. Sometimes the loss of vision occurs. The patient can feel like that the world is spinning. The signs and symptoms of the patient may occur soon after the stroke. Zeng et al. (2016) mentioned that when the symptoms of the stroke stay for more than 1 to 2 hours, it is called as the transient ischemic attack. On the other hand, Palmerini et al. (2015) opined that in case of hemorrhagic stroke, the patient may have severe headache. The symptoms of stroke can last for the long time. In case of long-term effect, the patient may suffer from pneumonia and loss of bladder control.

The risk factors of stroke are high blood pressure, high blood cholesterol, obesity, atrial fibrillation. Gruber, Lee and Moreno-Walton (2016) added that another risk factors of the stroke are the malpractice of tobacco smoking, previous TIA and diabetes mellitus. In case of ischemic stroke, the blood vessels ma ruptured, which can cause the bleeding. As a result, stroke occurs in the patient. When stroke occurs, the patient may faint and sweating may occur.

In the case study, the daughter of Greta’s friend is suffering from cerebrovascular accident. George and Steinberg (2015) stated that the bleeding causes the hemorrhagic stroke. It can happen due to the space in between the membrane space in the brain. The brain aneurysm can ruptured, which may result the stroke. The patient felt onset face weakness, abnormal speech and problem in arm drift. When these three symptoms are less, it means that the risk of stroke is decreasing. The patient faces the hemiplegia with the muscle weakness of face. In addition, the patient losses the vibration sensitivity and the symptoms of excessive reflexes occurs. in the case scenario, one side of the body of the patient is affected and the patient cannot move its head to one side as well as the body. The patient faced the apraxia, memory deficits, dysarthria, hemineglect and lack of eyesight. Hemineglect refers to the involvement of the parietal lobe. The patient lost consciousness and vomiting as the intracranial pressure increased. From the signs and symptoms, the condition of the patient is seen, which can be fatal for the patient. 

In case of stroke, the nurse can provide aspirin so that the ischemic stroke can be prevented. Aspirin can provide relief to the patient. In the emergency case, the injection may be administered to avoid the blockage. In some cases, surgery may be needed. In case of hemorrhagic stroke, the nurse needs to provide medication to reduce the high blood pressure. In such circumstances, the brain surgery can occur to reduce the pressure created in the brain. The surgery can repair the blood vessels of the brain, which is ruptured. The key responsibilities of nurse in case of stroke to administer the medication include the followings:

Table 1: Rationale of cerebrovascular accident

Conclusion

Based on the above discussion, it can be said that stroke is fatal and it can make the patient bed ridden for lifetime. The signs and symptoms of strokes need to be detected in the early stage of the stroke. If the stroke can be determined in the early stage then the chance of mortality and paralysis reduces. Moreover, the type of stroke is necessary to identify. The pharmacological treatment depends on the type of stroke. For this purpose, various tests need to be done. The long-term effect of stroke can affect the patient badly so it is necessary to reduce.

References

Berkhemer, O.A., Fransen, P.S., Beumer, D., Van Den Berg, L.A., Lingsma, H.F., Yoo, A.J., Schonewille, W.J., Vos, J.A., Nederkoorn, P.J., Wermer, M.J. and van Walderveen, M.A., 2015. A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med, 2015(372), pp.11-20.

Bivard, A., Levi, C., Krishnamurthy, V., Hislop-Jambrich, J., Salazar, P., Jackson, B., Davis, S. and Parsons, M., 2014. Defining acute ischemic stroke tissue pathophysiology with whole brain CT perfusion. Journal of Neuroradiology, 41(5), pp.307-315.

Foushee, J.A., Goodbar, N.H., Kelly, J.L. and Clarke, S.L., 2014. Cerebrovascular accident in a high-risk patient during the early initiation phase with canagliflozin. Annals of Pharmacotherapy, 48(8), pp.1066-1069.

George, P.M. and Steinberg, G.K., 2015. Novel stroke therapeutics: unraveling stroke pathophysiology and its impact on clinical treatments. Neuron, 87(2), pp.297-309.

Gruber, M., Lee, B.I. and Moreno-Walton, L., 2016. The Total Pentad: a Case Report of Thrombotic Thrombocytopenic Purpura Presenting as an Acute Cerebrovascular Accident. Nova Journal of Medical and Biological Sciences, 3(3).

Hayek, S., Zeineh, N., Lasorda, D. and Hajjali, R., 2014. Obesity and Prognosis in Patients with Acute Cerebrovascular Accident. Circulation, 130(Suppl 2), pp.A17049-A17049.

Kim, J.Y., Kawabori, M. and Yenari, M.A., 2014. Innate inflammatory responses in stroke: mechanisms and potential therapeutic targets. Current medicinal chemistry, 21(18), pp.2076-2097.

Oppelt, M., Juehring, D., Sorgenfrey, G., Harvey, P.J. and Larkin-Thier, S.M., 2014. A case study utilizing spinal manipulation and dynamic neuromuscular stabilization care to enhance function of a post cerebrovascular accident patient. Journal of bodywork and movement therapies, 18(1), pp.17-22.

Palmerini, T., Benedetto, U., Bacchi-Reggiani, L., Della Riva, D., Biondi-Zoccai, G., Feres, F., Abizaid, A., Hong, M.K., Kim, B.K., Jang, Y. and Kim, H.S., 2015. Mortality in patients treated with extended duration dual antiplatelet therapy after drug-eluting stent implantation: a pairwise and Bayesian network meta-analysis of randomised trials. The Lancet, 385(9985), pp.2371-2382.

Zeng, L.F., Liang, W.X., Liu, J.C., Chen, X.Y., Du, W.Y., Li, Z.P., Wang, Q., Cao, Y., Wang, L., Meng, C.R. and Wang, K.Z., 2016. Is adjunctive treatment with medication of liver-soothing-oriented method beneficial for depression after cerebrovascular accident?: A PRISMA-compliant meta-analysis. Medicine, 95(44), p.e5208.