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Cerebrovascular
accident, stroke, or brain attack
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- A Stroke occurs when an infarct (damage) to the brain occurs, either because there is not enough blood or oxygen (nonhemorrhagic Stroke) going to the brain, or due to bleeding into the brain (hemorrhagic Stroke). A Non-hemorrhagic Stroke is more common than a hemorrhagic Stroke. Strokes cause symptoms and
physical findings depending on the area injured in the
injured brain.
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- Arm or leg weakness and paralysis
- Speech difficulties
- Balance problems when walking
- Numbness or lack of sensation
- Hand clumsiness
- Sudden vision loss
- Confusion
- Nausea
- Room spinning
- Seizure
- Coma
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- Certain irregularities such as
atrial fibrillation to the brain, cause the blood clot to
move from the valve of the heart
- The blood clot moves from the
carotid arteries to the brain
- Blood vessels to the brain become
narrow due to cholesterol blockage
- Severely Low Blood Sugar
- Decreased oxygen in the blood due to
lung problems
- Myocardial Infarction
(heart attack), in which the heart does not pump enough
blood to the brain
- A heart arrythmia does not allow the
heart to pump enough blood to the brain
- Very High Blood Pressure
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- Neurological examination
- A CT scan can make an immediate diagnosis especially of hemorrhagic Strokes
- A MRI may be performed, but usually
is done for 2-3 days
- Laboratory:
- Complete blood count, Blood glucose, sedimentation rate, PT, PTT, Lipid (cholesterol)
profile.
- If a hypercoaguable (blood clots too easily) is suspected, then the lupus anticoagulant, and anticardiolipin antibodies are examined. Blood cultures are
checked if endocarditis (heart infection) is
suspected.
- An EKG can rule out a cardiac
problem
- Pulse oximetry to check blood
oxygenation
- Cardiac monitoring to rule out an
arrythmia
- Echocardiogram (or
Transesophageal echo) to check for blood clots on the heart
valve
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- If treatment can be started within
3 hours of the first symptom, then thrombolytic therapy
("clot breaking drug") with Altepase may be considered as
an option
- Low doses of intravenous heparin
is sometimes an option
- Supportive measures may be
considered as an option
- Blood pressure is cautiously controlled (Lowering blood pressure too much may cause another Stroke to
occur)
- Supportive measures only. All blood thinning medications will make a Stroke worse, and
therefore need to be avoided.
- Correct any bleeding problems. Again, blood pressure is controlled very cautiously (we do not want to lower blood pressure too much or a another Stroke may
occur)
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-
You need
immediate emergency medical treatment.
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- If the patient has atrial fibrillation (a heart irregularity), Coumadin (Warfarin) is
recommended. A secondary option here is aspirin.
- If there is Carotid Stenosis
(blockage or narrowing), then surgery is often recommended
to open blockages -- the decision on when and on whom to do
this on, is made by your doctor.
- Cholesterol lowering medications such as Pravachol have been shown to lower the risk of a Stroke.
- Cholesterol levels should be brought
to a normal level.
- Diabetes should be controlled
- You should stop smoking cigarettes. Discuss with your doctors methods to Quit Smoking (e.g.,
Zyban, Nicotine patches, hypnosis,
etc.)
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