CONCLUSION
Strokes, often called cerebrovascular accidents (CVAs), result from limitations or interruptions in cerebral perfusion. Stroke ranks fifth among all causes of death in the United States when considered apart from other cardiovascular diseases.
Most strokes result from blockages of an artery by a local blood clot or by an embolus from the heart or carotid artery. These strokes are called ischemic, and they are typically the product of years of atherosclerosis and hypertension. Strokes caused by intracranial bleeds are called hemorrhagic strokes, and they result from a ruptured cerebral artery or aneurysm. Hypertension is typically involved in generating a hemorrhagic stroke.
Symptomatically, all strokes appear as acute impairments in brain functioning. A person may suddenly have difficulty walking, seeing, speaking, or understanding. With severe hemorrhagic strokes, the person may lose consciousness. Most ischemic strokes are painless, although hemorrhagic strokes can produce severe headache.
An acute ischemic stroke is a medical emergency, requiring fast, organized care. There is a 4.5-hour interval after the onset of symptoms in which thrombolytic therapy (i.e., intravenous administration of rtPA) has a chance to reopen clogged cerebral arteries and save some of the underperfused brain tissue. Given this time constraint, EMS teams have the goal of getting potential stroke victims stabilized, evaluated, and to a stroke center in less than an hour.
The critical step in evaluating an acute stroke is making the distinction between ischemic and hemorrhagic strokes, and at this point, treatment paths for ischemic and hemorrhagic stroke patients diverge. For ischemic strokes, IV recombinant tissue plasminogen activator (rtPA) is administered. For hemorrhagic strokes due to a ruptured subarachnoid aneurysm, treatment by surgically clipping the aneurysm remnant or by endovascularly inserting a coil may be done.
Following initial evaluation and treatment, stroke patients are monitored in the ICU, and as soon as the patient is stabilized medically, usually within 24–48 hours, the rehabilitation team is consulted to assess rehabilitation needs, begin early rehabilitation efforts, and recommend the most appropriate poststroke setting. The goals of rehabilitation in the acute setting are to prevent, recognize, and manage comorbid medical conditions; to minimize impairments; and to maximize functional independence.
RESOURCES
National Institute of Neurologic Disorders and Stroke
Neurological flowsheet (Sutter Medical Center)
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