Overview
A stroke usually occurs due to decreased or interrupted blood supply to the whole or part of the brain, which prevents the brain from getting enough nutrients and oxygen. When this is not corrected immediately, brain cells begin to die within few minutes. A stroke is considered a medical emergency that needs prompt management. Early treatment of stroke can prevent brain complications and reduce damages that are caused due to stroke (Catanese et al., 2017). This essay will discuss ischemic stroke origin, systems and organs involved, statistics, clinical manifestation, diagnostic measures, and treatment.
Ischemic stroke is the most prevalent type of stroke within the communities. Ischemic stroke develops when blood supply to the brain is obstructed reduced. This obstruction is caused by blocked or narrowed blood vessels, causing reduced oxygen supply to the brain. The cause of narrowed and blocked blood vessels includes fatty deposits that line in the blood vessels’ walls, known as atherosclerosis, which is the main cause of ischemic stroke (Catanese et al., 2017). Atherosclerosis can cause two types of blood vessel occlusion, which include cerebral thrombosis and cerebral embolism. In cerebral thrombosis, a thrombus is formed by the fatty plaque in the walls of the blood vessels. In cerebral embolism, an embolus is formed in other parts of the circulatory system, commonly the heart and the large arteries in the neck and the chest. This thrombus from other locations breaks loose and travels in the bloodstream to the brains where it findings blood vessels that are small to pass and lodges there (Powers, 2020). The main cause of emboli formation is irregular heartbeats such as atrial fibrillation.
Organs Involved
The organ in the body that is affected by ischemic stroke in the brain. The brain is responsible for sending signals around the body to perform certain functions. The brain is divided into two halves, the right and left hemispheres, which perform specific body functions. The right hemisphere of the brain performs functions on the left part of the body and vice versa. The different brain areas perform specific body functions, such as speaking and writing (Hinkle & Cheever, 2018). The effects of an ischemic stroke depend on the part of the brain affected and the severity of reduced blood supply to the brain.
The systems that are involved in ischemic stroke includes the neurological and the circulatory system. The neurological system is made up of the brain, whereby its blood vessels are occluded to deprive the brain of oxygen. This system contains nerves that send signals to the rest of the body. Brain damage due to ischemia leads to neurological dysfunction affecting the other body systems. In the circulatory system, blood clots form within the blood vessels. Thrombus forms in the blood vessels due to the fatty deposits within the blood vessels (Hinkle & Cheever, 2018). These clots also occur due to smoking, hypertension, high cholesterol levels, and diabetes.
Morbidity and Mortality Statistics of Ischemic Stroke
Stroke is the leading cause of cognitive impairment, disability, and deaths within the US. It accounts for about 1.7% of the national expenditure on health. In 2014-2016, the costs related to stroke within the US were approximately $46 billion (Rennert et al., 2019). This amount includes the amount of money used to treat stroke, missed days at work, and healthcare services. This is due to the increased elderly population who are more prone to stroke. This risk doubles every successive decade for the population at 55, and the costs are rise dramatically. It is estimated that about 795 000 individuals experience recurrent and new every year. Approximately 610,000 new people experience stroke, and 185,000 people experience recurrent stroke. Stroke incidence depends on gender, age, socio-economic status, and ethnicity. Studies have shown that about 87% of all strokes within the US are due to ischemic stroke, whereby there is blocked blood supply to the brain. It is reported that a 4.2-6.5 incidence of stroke per 1000 people is 55 years (Centers for Disease Control, 2021). It is estimated that 25% of ischemic stroke is deadly in one month, and it is reduced to one-third within six months and by 50% within a year.
In 2018, it was reported that one death was due to stroke in every six death associated with cardiovascular diseases. It is approximated that in every 40 seconds within the US, one person develops stroke, and within 4 minutes, one individual dies due to stroke. The risk of stroke depends on ethnicity and race, for example, the risk of developing a stroke is doubled for the African-Americans population (Centers for Disease Control, 2021). The rates of deaths among this population due to stroke prevales in this race as compared to other races.
Clinical Manifestations
Mostly ischemic strokes rapidly occur within minutes, hours, and days. Access to medical care is crucial to prevent brain damage which has devastating consequences. The signs of ischemic stroke include sudden confusion, weakness, or numbness of the face, leg, or harm, especially unilateral. The other clinical manifestations include sudden difficulty in walking, speaking, and vision. These symptoms include dysarthria, diplopia, nystagmus, and aphasia. A patient with this condition will experience sudden dizziness, a severe headache of no known cause, and loss of balance due to loss of brain coordination. Patients will present with abrupt onset of hemiparesis, quadriparesis, or monoparesis. Patients of the feminine gender experience more symptoms such as leg, face, and arm pain. The other symptoms include nausea, hiccups, palpitations, chest pains, and shortness of breath (Hinkle & Cheever, 2018). It is important to understand that not all the symptoms will occur in ischemic stroke.
Diagnostic Measures
Imaging studies are vital in the evaluation of ischemic stroke. In neuroimaging non-contrast, computed tomography is used to evaluate the presence of acute stroke. The other neuroimaging techniques that can be used also include computed tomography, angiography, and perfusion scanning. Magnetic resonance imaging, carotid duplex imaging, and digital subtraction angiography. Lumbar puncture is needed to rule out meningitis when computed tomography scan is negative (Cassella & Jagoda, 2017). Laboratory studies that can be performed to diagnosis this condition include complete blood count. A complete blood count is done to identify the causes of stroke, such as thrombocytopenia, polycythemia, and leukemia which provides evidence of other concurrent diseases. These studies rule out thrombocytopenia when prescribing fibrinolytic therapy. Coagulation studies may be performed to identify coagulopathies which is important when using fibrinolytic. Basic chemistry is performed to identify stroke mimicking conditions such as hyponatremia and hypoglycemia. Cardiac biomarkers are taken to identify coronary, heart diseases, and cerebrovascular disease (Hasan et al., 2018). Toxicology screening is done to identify sympathomimetics that can cause ischemic stroke.
Curative treatment of Ischemic Stroke
The goal of treating acute ischemic stroke is the preservation of brain tissues in areas with decreased oxygen perfusion. This can be corrected by increasing blood supply to the compromised areas of the brain. The drugs that can be used to treatment of ischemic stroke include fibrinolytic such as alteplase. 0.9mg/kg with a maximum dose of 90mg of alteplase is administered intravenously within 3 hours. 10% of this drug is given as a bolus over the first minute of this drug administration (Cassella & Jagoda, 2017). This drug dissolves blood clots, immediately restoring blood flow which helps in preventing damage to the brain tissues.
Antiplatelets such as aspirin can also be used to treat this condition. This drug is recommended to be used within 24-48 hours of the onset of symptoms. According to a Cochrane review, aspirin, which is administered within 48 hours of the onset of ischemic stroke symptoms, can prevent ischemic stroke recurrence and improve the outcomes. The other management of this illness is mechanical thrombectomy recommended by American Heart Association (Hasan et al., 2018). Reports from 2015 stroke trials showed that endovascular thrombectomy use within the first six hours is a better treatment for patients with large-vessel arterial occlusion proximal to anterior circulation.
Future Research on Ischemic Stroke
There is an increased identification and collaboration for closer interactions and experimental designs between preclinical and clinical researchers. There is hope in the stroke field due to improved and new treatments found to benefit patients. This can be illustrated by reinvigoration and excitement, which was brought by successes in endovascular thrombectomy. Guidelines that were published recently aims to improve models of preclinical stroke to provide more evidence of progress. With the increased number of patients recovering from stroke, there is a need to expand focus to the complications of post-stroke, affecting the quality of life of an individual (Kurisu & Yenari, 2018). These include complications, speech and motor impairments, and dementia, depression, anxiety, and epilepsy.
References
Cassella, C. R., & Jagoda, A. (2017). Ischemic stroke: Advances in diagnosis and management. Emergency Medicine Clinics, 35(4), 911-930. Web.
Catanese, L., Tarsia, J., & Fisher, M. (2017). Acute ischemic stroke therapy overview. Circulation Research, 120(3), 541-558.
Centers for Disease Control and Prevention. (2021). Stroke statistics.
Hasan, T. F., Rabinstein, A. A., Middlebrooks, E. H., Haranhalli, N., Silliman, S. L., Meschia, J. F., & Tawk, R. G. (2018). Diagnosis and management of acute ischemic stroke. Mayo Clinic Proceedings 93(4), 523-538.
Hinkle, J. L., Cheever, K. H., & Hinkle, J. L. (2018). Brunner & Suddarth’s textbook of medical-surgical nursing (14th ed). Philadelphia: Wolters Kluwer.
Kurisu, K., & Yenari, M. A. (2018). Therapeutic hypothermia for ischemic stroke; Pathophysiology and future promise. Neuropharmacology, 134, 302-309.
Powers, W. J. (2020). Acute ischemic stroke. New England Journal of Medicine, 383(3), 252-260. Web.
Rennert, R. C., Wali, A. R., Steinberg, J. A., Santiago-Dieppa, D. R., Olson, S. E., Pannell, J. S., & Khalessi, A. A. (2019). Epidemiology, natural history, and clinical presentation of large vessel ischemic stroke. Neurosurgery, 85(suppl_1), S4-S8.