A stroke is a condition that causes death of brain tissue. Brain tissue death is usually caused by interruption of blood flow to that tissue. This can be caused by a blood clot in a vessel blocking the blood supply to an area of the brain, or by the rupture of a blood vessel causing bleeding in the brain.
Strokes result from vascular disease. Narrowed arteries with cholesterol plaque are easily blocked by a small blood clot. Narrowed cholesterol-filled arteries can actually cause clot formation if the cholesterol is brittle and develops small cracks in its surface. Platelets,the first line defense in the whole clotting mechanism, begin to plug the leak in a cut artery by recognizing the sharp edges of the cut. Sometimes the sharp edges of a crack in a piece of brittle cholesterol will fool them and they will begin to build a plug, initiating clot formation. There is no cut in the vessel wall in this case, but a clot forms around the cholesterol, building until it totally blocks the inside of the artery stopping blood flow.
This mechanism of clot formation inside an artery is the same process that causes a heart attack. In that case, of course, it’s an artery supplying the heart muscle as opposed to an artery in the brain as in a stroke. A weakening of an arterial wall can lead to the formation of a small aneurysm or bulging area that may burst causing bleeding and loss of blood flow to areas of the brain supplied by that artery.
High blood pressure plays a large role in both causes of stroke. High blood pressure, over time, damages arterial walls leading to areas that allow cholesterol plaque to adhere and build up. Fluctuations in blood pressure can then crack cholesterol plaques attracting clot formation. High blood pressure can also cause an aneurysm to form and, later, to burst.
Strokes are sometimes called Cerebrovascular Accidents, or CVAs. When a portion of the brain dies, that portion no longer functions and the person is left with a “neurological deficit”. This can be a loss of sensation on one side of the body or face, a weakness or total loss of muscle use on one side of the body or face, an inability to speak, or a combination of all of these. Severe strokes can cause coma and death.
In many cases, the earlier a developing stroke is diagnosed and treated, the less damage is done to the brain tissue and the less the resultant permanent deficit. There are cases of strokes being reversed in the emergency department by use of clot-dissolving medications. As with many medical emergencies, when it comes to a stroke, the sooner treatment begins, the better the outcome. At the first signs of a stroke, go directly to the ER or call 911. You should not delay.
Emergency Neurological Life Support (ENLS)
What to do in the first critical hour of a neurological emergency.
ENLS is a new course that is designed to help healthcare professionals improve patient care and outcomes during the most crucial time – the critical first hours of the patient’s neurological emergency. ENLS demonstrates a collaborative, multi-disciplinary approach and provides a consistent set of protocols, practical checklists, decision points, and suggested communication to use during patient management. This activity is designated for a maximum of 15 AMA PRA CME credits upon completion of the course.
Improved patient care and outcomes
Ability to be up to date/current on advancements in treatment
A select set of topics that are directly relevant to neurocritical care
MDs, critical care nurses, and other professionals who treat neurological emergencies benefit from ENLS’ in-depth presentations of 13 critical topics including Ischemic Stroke, Subarachnoid Hemorrhage, Traumatic Brain Injury, and Intracranial Hypertension and Herniation.
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