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Stroke
What is a stroke?
Stroke primarily refers to cerebrovascular disease. Acute onset of stroke usually presents with focal neurological deficits, mainly divided into ischemic and hemorrhagic strokes. Ischemic stroke, primarily referring to cerebral infarction, occurs due to an interruption in the blood supply to the brain, causing vessel occlusion and resulting in various clinical syndromes. Clinically, it presents rapidly with symptoms such as limb paralysis, slurred speech, and facial drooping. The pathogenesis of ischemic stroke is caused by central arteriosclerosis of large vessels. Additionally, stroke also includes cerebral embolism, mainly referring to atrial fibrillation-induced emboli from wall-attached thrombi, and other foreign bodies causing embolic blockage, leading to necrosis of brain tissue. Stroke also encompasses hemorrhagic stroke, with a typical condition being cerebral hemorrhage, which is due to long-term hypertension causing hyaline degeneration of the small arterial walls, eventually leading to necrosis and rupture with bleeding, resulting in neurological deficits.
Six Common Manifestations of Stroke
Firstly, patients may experience language impairment, primarily characterized by unclear speech or sensory aphasia, where they cannot understand others' conversations. Secondly, motor dysfunction is also a very common symptom, typically presenting as hemiplegia on one side of the body. Thirdly, sensory dysfunction can occur, manifested as numbness in one side of the body, an inability to feel pain, and an inability to sense temperature. Fourthly, there may be signs of ataxia, such as unstable walking or standing. Fifthly, there may be difficulties in swallowing, coughing while drinking water, and articulation disorders. Lastly, cognitive dysfunction can also occur, characterized by slow responsiveness and similar symptoms.
What medicine is used for stroke?
Stroke primarily refers to cerebrovascular disease, which is divided into two main categories. The first category is hemorrhagic stroke, including cerebral hemorrhage, subarachnoid hemorrhage, and other diseases. The second category is ischemic cerebrovascular diseases, including cerebral thrombosis, cerebral embolism, and other diseases. Thus, although both categories are classified as stroke, the medications used are different. For cerebral hemorrhage, the patient needs to rest in bed and must strictly control blood pressure, primarily using medications that strictly control blood pressure. There are no special oral medications, but intravenous medications can be given to protect brain nerves. If intracranial pressure is high, some dehydrating and intracranial pressure-reducing medications can be administered. For ischemic stroke, such as cerebral thrombosis, it is crucial to get to the hospital quickly. If it is within the thrombolytic time window, intravenous thrombolytic drugs can be administered for treatment, from which many patients may benefit. Additionally, it is necessary to take long-term medications that prevent platelet aggregation and regulate blood lipids, as well as stabilize arterial atherosclerotic plaques.
Nursing Care of Thrombolytic Therapy for Stroke
Thrombolytic therapy for stroke is an important tool in the treatment of cerebral thrombosis. If administered within the thrombolytic time window, which is currently within four and a half hours from onset, intravenous thrombolytic treatment can significantly save lives and improve the quality of life for patients. Post-thrombolysis care is also crucial, as there are some complications associated with thrombolytic therapy. It is essential to strictly monitor blood pressure after thrombolysis; typically, blood pressure should be checked every 15 minutes, as high blood pressure can significantly increase the tendency for bleeding. During the care process, it is also important to monitor for signs of bleeding such as nosebleeds, bleeding gums, the appearance of petechiae or ecchymosis on the skin and mucous membranes, and any bleeding in the urinary system. Additionally, changes in the patient’s consciousness and limb mobility should be noted. If the patient experiences worsening paralysis or significant headaches, a cranial CT scan must be promptly revisited. In summary, the nursing care following stroke thrombolytic treatment primarily involves monitoring blood pressure, watching for signs of bleeding, and observing changes in limb mobility and consciousness.
Can stroke paralysis be cured?
For a disease like stroke, if paralysis occurs, a small portion of patients can be completely cured without any sequelae. These patients generally are younger in age, receive timely treatment, and do not have a particularly large area of cerebral infarction. However, for the majority of patients, some degree of sequelae is likely to remain. After a stroke, it is crucial to go to the hospital as quickly as possible. If thrombolytic treatment can be administered during the intravenous thrombolysis time window, it can be very effective, and a few patients may even be completely cured. For most patients, further treatment with antiplatelet therapy and rehabilitation training is needed. Although symptoms can significantly improve, complete recovery is relatively difficult.
Post-stroke depression
Recent studies have confirmed that in addition to language dysfunction, cognitive impairment, and motor dysfunction, stroke patients also exhibit many signs of depression. According to guidelines published in China in 2016, about 33% of stroke patients experience post-stroke depression, which is a very high proportion. The main symptoms of post-stroke depression include a lack of interest in anything, unwillingness to communicate with others, being quiet and reticent, non-compliance with medication, and non-cooperation with rehabilitation training. Post-stroke depression significantly affects the recovery of patients and their future quality of life. Some patients may even turn to suicide due to depression. Therefore, it is crucial to pay attention to depression after a stroke, as the incidence rate of post-stroke depression is very high, reaching up to 33%. Clinicians must carefully identify it, and family members of patients must be attentive in their care.
Main manifestations of pre-stroke warning signs
The precursor of cerebral thrombosis in neurology is called transient ischemic attack (TIA). As the name suggests, this is a transient disease, mainly characterized by symptomatic speech impairment, facial droop, drooling, episodic dizziness, blurred vision, and episodic numbness and weakness of limbs. These symptoms are generally transient, usually lasting from several minutes to a few hours and can be completely relieved. The precursor of cerebral thrombosis is regarded as an emergency in neurology and must be treated promptly. Delayed treatment can possibly progress to cerebral infarction, severely affecting the patient's quality of life and physical health. In considering this disease, one must immediately rush to the hospital for appropriate treatment with antiplatelet drugs, lipid-regulating drugs to stabilize plaques, and treatments such as volume expansion and fluid supplementation.
Causes of Dysphagia after Stroke
The causes of dysphagia resulting from a stroke are largely related to the location of the stroke. Dysphagia mainly involves the glossopharyngeal and vagus nerves, which are distributed in the medulla oblongata of the brainstem. Therefore, if you have a brainstem stroke, specifically at the medulla oblongata, there is a significant chance of experiencing coughing due to aspiration and dysphagia. If the stroke occurs in a different area, these symptoms are unlikely to appear. A stroke in the cerebral hemisphere, since it has bilateral nerve supply, does not lead to noticeable coughing if only one side is affected. However, if one side is affected this year and the other side next year, similar symptoms of aspiration cough and dysphagia will occur. Therefore, neurologically, the location and specific site of the stroke are crucial, as each location presents different symptoms.
Key Points in the Treatment of Different Recovery Stages of Stroke
Stroke includes ischemic stroke and hemorrhagic stroke, namely cerebral infarction and cerebral hemorrhage. Their treatments are generally opposite. If it is a cerebral infarction, thrombolytic therapy is needed within 4.5 hours of the acute phase. It is necessary to consider whether there are indications and contraindications, and whether the patient and family members agree to undergo thrombolytic therapy. Regardless of whether thrombolytic therapy is administered, it is essential to subsequently check the condition of the cranial vessels to determine if surgical treatment is needed. If surgery is not required, hospitalization for conservative treatment might be necessary. Typically, about 7 to 14 days after the acute phase, rehabilitation treatment may be needed once the patient's condition stabilizes. The duration of rehabilitation treatment usually depends on the patient's recovery progress. Afterwards, it is important to consider the patient's underlying diseases, such as hypertension, diabetes, and other risk factors, to perform secondary prevention, which involves medication and control of risk factors. In the case of cerebral hemorrhage, the treatment during the acute phase depends on the amount and location of the bleeding and whether there are indications for surgery to determine if surgical treatment is necessary. If conservative treatment is chosen, it also involves hospital treatment, followed by possible rehabilitation treatment once stabilized.
What is a stroke?
The English term for 脑卒中 is stroke, which generally refers to a group of cerebrovascular diseases. These diseases often onset acutely and mainly consist of two types. The first type is ischemic stroke, which includes diseases like cerebral thrombosis, watershed infarction, cerebral infarction, and cerebral embolism. The second type is hemorrhagic stroke, which primarily includes cerebral hemorrhage and subarachnoid hemorrhage among other bleeding-related disorders. Regardless of the type, the onset of stroke is very sudden, and patients rapidly develop severe neurological deficits. For example, a patient may experience sudden slurred speech, paralysis of one side of the body, or numbness and weakness on one side. There will inevitably be obvious symptoms like dizziness, headache, nausea, vomiting, and stiffness of the neck. If a stroke is suspected, it is crucial to rush to the hospital immediately. Doctors will make an accurate diagnosis and provide appropriate treatment based on the patient's medical history and cranial CT scans.