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Ischemic Stroke: Diagnosis And Treatment

Ischemic stroke is one of the leading causes of death among populations across the world. The disease is deadly, thus requires timely management when symptoms appear. According to Mayo Clinic (2019), at least 795000 people in America suffer a new or recurring ischemic stroke, with relevant stakeholders now in the forefront to sensitize various communities on the best management approaches to managing the condition, caused by blood blockage to the brain. Other risk factors that may lead to the condition include polycythemia and unregulated use of oral contraceptives.

Many patients continue to suffer stroke attacks in Australia. At least 45000 patients per year suffer from the condition which attacks a new patient in every eleven minutes (World Health Organization, 2019, p1). Often, the vulnerability of a person to ischemic stroke is dependent on many factors. For instance, age determines susceptibility to the stroke as older people have an increased risk of developing stroke as compared to the younger generations. Besides, people from families who have had a history with the condition may be more vulnerable to the condition than those who have never been exposed to stroke. Ischemic stroke is also caused by the presence of other conditions in the body, or if a person had a history with certain diseases, then the chances that they may develop stroke are higher (Lindsay et al., 2014, p9). For instance, people with high cholesterol, high blood pressure, cardiovascular diseases, diabetes mellitus, thrombophilia, or previous stroke attacks are likely to develop ischemic stroke. Some lifestyle choices such as smoking have also been found to increase the vulnerability of people to ischemic stroke attacks. As a precaution, therefore, due diligence should be observed in dietary, nutritional choices and medications to reduce the risk of attack, and where possible, patients should seek urgent remedy when they acknowledge possible signs and symptoms of ischemic stroke.

Diagnosis of Ischemic stroke includes computed tomography (C.T.), Electrocardiogram, Chest X-ray, blood tests where health professionals test blood clotting ability, levels of fat and cholesterol, glucose levels, liver function, alcohol levels, pregnancy and kidney functionalities that may be associated with ischemic stroke. Other methodologies used in diagnosis include ultrasound for heart conditions or blood veins and carotid arteries around the neck that may experience blockage and a possible shortage of blood supply to the brain. Ischemic stroke is deadly, causes disabilities and general suffering that can be avoided with the most appropriate responses.

Considering the Patient Situation

Jane is a 65-year-old retired teacher. She stays with her 70-year-old husband, a retired truck driver. Both are not very active with physical activities except for a few house chores. Mostly, the husband spends his time watching telenovela, which he passionately enjoys while Jane enjoys cooking and tending to their flowerbed. In all their marriage life, the couple has enjoyed eating junk foods due to their fixed work schedules, and this has become a habit, hard to drop even after years into retirement. The husband also smokes, at least a packet of cigarettes a day while he watches television, something that has adeptly annoyed his wife, who has always reminded him of the possible future health hazards his smoking habits would land him into. He has previously passed out, but no severe medication was administered since a two-hour bed rest helped manage the situation.

One evening while running some errands, Jane’s husband fell unconscious at home. Their son, who had come to visit them found him helpless, numb, confused, and short of breath. He showed droopiness on one side of his face and experienced difficulty in speaking and understanding sentences. His speech was slurred. He also complained of severe headache. Their son did not hesitate to call the EMS, after assessing the situation which he suspected to be a stroke. Upon arrival at the scene fifteen minutes later, the Local EMS team arrived, conducted a glucose test, and identified potential stroke symptoms and recommended that a swift flight to a comprehensive stroke center.

Before the diagnosis, the team tried to evaluate the type of stroke the patient had suffered from, and the parts of the brain that had been affected, to determine the best treatment approach to the ischemic stroke attack. Also, examinations conducted revealed the condition was not as a result of a brain tumor, which is also another major cause of ischemic stroke attacks according to the National Stroke Foundation (Wright et al., 2012, p 562). Initial diagnosis of the stroke using the National Institute of Health Stroke Scale scored an ability of 3 but later increased to 20, in spite of the patient’s swift arrival within the healthcare facility when the signs for stroke first manifested. When the patient was closely monitored and examined by a team of healthcare professionals, he was diagnosed with global aphasia, right homonymous hemianopsia, left gaze preference, and right-sided hemiplegia. With the condition, there was a need for urgent C.T. scan, and the patient was quickly subjected to noncontract C.T., which identified that the head was normal. An intravenous alteplase IV r-tPA was administered to the patient within a time frame of sixteen minutes.

The results of the C.T. perfusion showed a significant mismatch between a considerable part of the hypoperfusion region of the left MCA territory and the hypodensity on Computed Tomography images. Further, when the catheter angiography was conducted on the patient, through local aspiration and stent retriever thrombectomy mechanisms, the results showed complete occlusion of the left internal carotid artery. After the treatment, the patient reported a series of improvements with the level of aphasia and facial droopiness and subsequent NIHSS reading of 2 after twenty-four hours. Also, the medical team providing care and management of the patients condition further performed a series of therapies to improve outcomes. The central goal of therapies in the patients acute ischemic stroke case was to preserve tissue in the ischemic penumbra, where perfusion is decreased but sufficient to stave off infarction. Tissue in this area of oligemia was preserved by restoring blood flow to the compromised area and optimizing collateral flow.

Other approaches to the patient’s safety included recanalization strategies, including the administration of intravenous (IV) recombinant tissue-type plasminogen activator (rt-PA) and intra-arterial approaches were also utilized to establish revascularization so that cells in the penumbra can be rescued before an irreversible injury occurs. All these practices were conducted in time to restore blood flow before further complications associated with the ischemic stroke could arise.

Over the years, the approaches given to the management of the acute ischemic stroke keep changing with the advent of new technology and changing livelihoods. Stakeholders have featured various methods of reperfusion therapy, surgical intervention, and new neuroprotective strategies that have improved the care accorded to ischemic stroke patients in critical conditions. Empirically, ischemic stroke is a neurological condition requiring urgent medical attention in the emergency department of a healthcare facility. Ischemic stroke patients fall under the category of critically ill patients, as such; their management involves continuous neurological, hemodynamic and respiratory monitoring in a well-equipped healthcare facility that meets the standards set by the Australian Healthcare System. Ischemic stroke is fatal, and healthcare providers need to find plausible mechanisms to manage the condition while improving the quality of life for various patients in need.

References

Mayoclinic.org. (2019). Stroke – Diagnosis and treatment – Mayo Clinic. [online] Available at: https://www.mayoclinic.org/diseases-conditions/stroke/diagnosis-treatment/drc-20350119 [Accessed 29 Sep. 2019].
Lindsay, P., Furie, K.L., Davis, S.M., Donnan, G.A. and Norrving, B., 2014. World Stroke Organization global stroke services guidelines and action plan. International Journal of Stroke, 9, pp.4-13.
World health Organization International.(2019). WHO | Stroke, Cerebrovascular accident. [online] Available at: https://www.who.int/topics/cerebrovascular_accident/en/ [Accessed 29 Sep. 2019].
Wright, L., Hill, K.M., Bernhardt, J., Lindley, R., Ada, L., Bajorek, B.V., Barber, P.A., Beer, C., Golledge, J., Gustafsson, L. and Hersh, D., 2012. Stroke management: updated recommendations for treatment along the care continuum. Internal medicine journal, 42(5), pp.562-569.

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