Diagnosis and Treatment of Stroke Patients

Question: Describe about the Diagnosis and Treatment of Stroke Patients? Answer: Introduction Stroke is the third largest death causing disease in the United States. It is seen that one death out of fifteen is due to stroke. According to the Frizzell, 2005, every year about 0.7 million peoples are diagnosed with stroke and 2 million go through second stroke. Stroke is the abrupt interruption of the blood supply in the brain. The NICE, 2008 states that the stroke is of two types, one is ischemic stroke in which an artery supplying blood to the brain suddenly blocked, thus decreased blood supply leads to brain infarction. According to the internet stroke centre, other one is haemorrhage stroke which occurred due to leakage of blood into the brain tissue when a blood vessel burst. About 80% of cases are diagnosed with ischemic stroke and the main causative agent is clot and sometimes stenosis (narrowing of the blood vessels due to deposition of the plaque. Whereas NICE, 2008 states that 20 % cases of stroke are diagnosed with haemorrhage stroke. According to the NICE, 2008 Frizzell, 2005, the main cause of aneurysm is, weak point in an artery wall, which enlarges with time under high arterial pressure. Thus the artery wall rupture and leak out the blood around brain tissues. Sign and symptoms The symptoms of stroke are sudden. One must be tentative and should take action rapidly by watching symptoms of stroke. One can recognise symptoms of stroke as person feel abrupt numbness and weakness in the face, arm or leg. He or she may feel confused, inability to talk or trouble in understanding. According to the National institute of neurological disorders stroke, patient seems trouble in seeing with eyes, unable to walk or stand straight, loss of coordination and can feel headache without any reason. Diagnosis for the stroke: The stroke can be diagnosed on the basis of sign symptoms, medical history, physical examination and test results. Medical history and physical examination: According to the National institues of heart and NHS choice, 2015, the doctor will look out for the family history of stroke and other unhealthy factors such as smoking, hypertension or heart diseases. During physical examination, doctor will look for signs like carotid artery disease and even check the persons coordination, stability and alertness. Diagnostic tests: Stroke can be diagnosed by performing following of the tests: Brain CT scan: It is also called as brain computed tomography, which is the painless test and use x-rays to look inside the brain. It is usually done after the stroke suspected. The pictures of the CT scan shows damaged brain cells or internal clotting in the brain. MRI: Magnetic resonance imaging uses magnet and radio waves to picture the organ and brain structures. This test helps in detecting the changes in the brain tissues and blood vessels in the brain. CT arteriogram (CTA) and magnetic resonance arteriogram (MRA): The Computed tomography arteriogram and magnetic resonance arteriogram shows clear pictures of damage inside the large blood vessels or clot in the brain. It also shows blood flow in the brain. Carotid ultrasound: It uses sound waves to look inside the carotid arteries. This test can also include Doppler ultrasound, which tells the speed and direction of blood moving in the brain blood vessels. Carotid angiography: This test uses a dye along with special x-rays to look inside the carotid vessels of the brain. The dye is injected through the catheter from the upper thigh. Blood tests: Blood glucose test is used to check the amount of blood glucose in body, if it is low then, it may be a reason of the stroke. The Blood platelet count is done to count the platelets in the body. If the platelet count is low then, the person has bleeding disorder and if the platelet count is high then, one has thrombotic disorder, the either of the cases can be a cause of stroke. Treatments for the stroke: According to the Nurses labs, n.d., the drug therapy is the first choice of treatment in the stroke. There are two class of drugs, antithrombotic which includes antiplatelet agents and anticoagulants and other one is thrombotic drugs. For ischemic stroke: Antithrombotic drugs: According to the National institute of neurological disorders stroke, these drugs used to prevent the clotting in the blood vessels, as these clots block the brain arteries and vessels thus causes ischemic stroke. Antiplatelet which belongs to this category also helps in preventing the blood clot. The drug belongs to this category are clopidogrel, ticlopidine. Anticoagulants helps in decreasing the risk of clotting property of the blood. The drugs are warfarin, heparin, and enoxaparin. Statins: According to the NHS choice, 2015, if cholesterol levels are high in the body, they are controlled by statins which blocks the cholesterol converting enzyme in the liver. Antihypertensive agents: According to the NHS choice, 2015, these are used to control the high blood pressure in the body. These are of type ACE inhibitors, ca++ channel blocker, and alpha and beta blocker. Thrombolytic drugs: This work by dissolving the blood clot that causes the blockage of an artery. These drugs are used to work on an ongoing stroke. Thus dissolves the clot and regulates the blood flow to the brain. According to the American stroke association and the internet stroke centre, a genetically engineered product called as recombinant tissue plasminogen activator which is a form of t-PA is an example of this type of agent. Carotid endarterectomy: According to the National institute of neurological disorders stroke, the removal of the plaque from the carotid artery which supplies blood to the brain. For haemorrhagic stroke: According to the National institute of neurological disorders stroke American stroke association, there are several surgical procedures which helps in regulating the blood flow in the brain e.g. Extra cranial/intracranial bypass. The block artery rerouted by the healthy artery in the affected area of the brain, this is done in the extra cranial/intracranial bypass procedure. This surgical procedure is done in haemorrhagic stroke. Summary: The stroke is a neurologic event which occurs due to an abrupt supply of blood in the brain. The risk associated with this disease is diabetes mellitus, high blood pressure, and the family history of stroke. Many treatment are available, which helps in controlling the stroke such as statin, thrombolytic, antithrombotic agents. Research is going on to evolve the novel effective treatment of stroke. The government initiated many intervention programs in the hospitals, to provide good care to the stroke patients. References American stroke association. (n.d.). Retrieved August 2015, from https://www.strokeassociation.org: https://www.strokeassociation.org/STROKEORG/AboutStroke/Treatment/Stroke-Treatments_UCM_310892_Article.jsp Frizzell, J. P. (2005). Acute Stroke Pathophysiology, Diagnosis, and Treatment. AACN Clinical Issues, 16(4), 421-440. Retrieved August 2015 National institues of heart. (n.d.). Retrieved August 2015, from https://www.nhlbi.nih.gov: https://www.nhlbi.nih.gov/health/health-topics/topics/stroke/diagnosis National institute of neurological disorders stroke. (n.d.). Retrieved August 2015, from https://www.ninds.nih.gov: https://www.ninds.nih.gov/disorders/stroke/detail_stroke.htm NHS choice. (2015, August). Retrieved from https://www.nhs.uk: https://www.nhs.uk/Conditions/Stroke/Pages/treatment.aspx NICE. (2008, july). Stroke Diagnosis and initial management of acute stroke and transient ischaemic attack (TIA). Retrieved August 16, 2015, from www.nice.org.uk/accreditation: guidance.nice.org.uk/cg68 Nurses labs. (n.d.). Retrieved August 16, 2015, from https://nurseslabs.com: https://nurseslabs.com/8-cerebrovascular-accident-stroke-nursing-care-plans/ The internet stroke centre. (n.d.). Retrieved August 16, 2015, from https://www.strokecenter.org: https://www.strokecenter.org/patients/about-stroke/what-is-a-stroke/