A stroke, also known as a Cerebrovascular Accident (CVA), is a medical emergency that occurs when the blood supply to part of the brain is disrupted, leading to brain cell death. Strokes are among the leading causes of death and disability worldwide. Early recognition and treatment can mean the difference between recovery and permanent disability—or even life and death.
This guide provides a detailed explanation of types of strokes, causes, symptoms, treatments, risk factors, and nursing management, making it useful for students, caregivers, and healthcare professionals.
What Is a Stroke?
A stroke is defined as a sudden neurological deficit caused by interrupted blood flow to the brain. The brain requires a constant supply of oxygen and nutrients, and even a few minutes without adequate blood flow can result in irreversible brain damage.
There are two main types of strokes:
- Ischemic Stroke (Blockage of blood flow)
- Hemorrhagic Stroke (Bleeding into the brain)
Types of Stroke
1. Ischemic Stroke (Blockage)
An ischemic stroke occurs when a blood clot blocks or narrows an artery leading to the brain. It accounts for about 80–85% of all strokes.
- Thrombosis: A clot forms directly in the brain’s blood vessel due to atherosclerosis.
- Embolism: A clot forms elsewhere (e.g., heart) and travels to block a brain artery.
A related condition is Transient Ischemic Attack (TIA) or “mini-stroke.” In TIAs, symptoms are temporary, lasting minutes to hours, and there is no permanent brain damage. However, TIAs are warning signs of future strokes.
2. Hemorrhagic Stroke (Bleeding)
A hemorrhagic stroke occurs when a blood vessel in the brain ruptures, causing bleeding. The bleeding increases pressure inside the skull, reducing blood supply and damaging brain tissue.
- Causes: Aneurysm (weakened vessel wall), uncontrolled hypertension, or trauma.
- Complications: Intracranial pressure rises, leading to further ischemia and poor prognosis.
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Signs and Symptoms of Stroke
The acronym FAST helps remember common stroke warning signs:
- F – Face Drooping: Uneven smile, one side of the face may droop.
- A – Arm Weakness: Numbness or weakness in one arm; inability to lift both arms.
- S – Speech Difficulty: Slurred, slow, or incoherent speech.
- T – Time to Call Emergency Services (911): Immediate medical attention is critical.
Other symptoms may include:
- Severe headache
- Sudden vision changes
- Dizziness or loss of balance
- Confusion or altered mental status
Types of Aphasia in Stroke
Stroke often leads to aphasia, a language disorder. The type depends on the brain area affected:
- Receptive Aphasia (Wernicke’s area): Patient cannot comprehend speech but may speak fluently, though nonsensically.
- Expressive Aphasia (Broca’s area): Patient can understand speech but has difficulty expressing themselves.
Risk Factors for Stroke
Modifiable Risk Factors (can be managed):
- Hypertension (most significant risk factor)
- Atherosclerosis
- Diabetes mellitus
- Obesity
- Smoking and alcohol use
- Oral contraceptives
- Anticoagulation therapy
- Stress
Non-Modifiable Risk Factors (cannot be changed):
- Family history of stroke
- Older age
- Male gender
- Ethnicity (higher risk in Black and Hispanic populations)
Stroke Treatment
1. Ischemic Stroke Treatment
Fibrinolytic Therapy (tPA – Tissue Plasminogen Activator):
- Dissolves blood clots if given within 3–4.5 hours of symptom onset.
- Nursing precautions: avoid IM injections, unnecessary IV punctures, and monitor for bleeding.
- Patient placed on bed rest to prevent complications.
2. Hemorrhagic Stroke Treatment
- Focuses on stopping the bleeding and reducing intracranial pressure (ICP).
- Patients require intensive care monitoring.
- Surgery may be needed to remove blood clots or repair aneurysms.
- Prognosis is generally poorer compared to ischemic stroke.
Nursing Management of Stroke Patients
Nurses play a crucial role in acute care and rehabilitation of stroke patients.
Feeding and Nutrition:
- Assist with safe feeding, especially if swallowing reflex is impaired.
- Avoid oral intake if risk of aspiration is high.
- Provide modified diet (pureed, soft, thickened liquids).
Positioning and Mobility:
- Elevate head of bed to reduce ICP.
- Place a pillow under affected arm in neutral position.
- Encourage passive range of motion every 2 hours to prevent contractures.
Communication Support:
- Be patient and use simple, clear language.
- Support speech therapy exercises.
DVT Prevention:
- Compression stockings, frequent position changes, and early mobilization.
Activities of Daily Living (ADLs):
- Support independence where possible.
- Provide emotional reassurance and counseling.
Table: Ischemic vs Hemorrhagic Stroke
| Feature | Ischemic Stroke | Hemorrhagic Stroke |
|---|---|---|
| Cause | Blood clot (thrombus/embolus) | Ruptured artery, aneurysm, hypertension |
| Prevalence | ~85% of strokes | ~15% of strokes |
| Onset | Often sudden, sometimes with TIA warning | Sudden severe headache, nausea, vomiting |
| Treatment | Clot-busting drugs (tPA) | Stop bleeding, lower ICP, surgery if needed |
| Prognosis | Better if treated early | Poorer prognosis, higher mortality |
FAQs on Stroke (CVA)
Q1. What is the difference between a stroke and a TIA?
A stroke causes permanent brain damage, while a TIA (“mini-stroke”) is temporary and reversible but a warning sign for future stroke.
Q2. How quickly should stroke treatment begin?
For ischemic stroke, tPA must be given within 3–4.5 hours of onset for best results.
Q3. Can young people have strokes?
Yes. Though more common in older adults, strokes can occur at any age due to trauma, congenital vessel abnormalities, or lifestyle risk factors.
Q4. What is the recovery like after a stroke?
Recovery varies. Some regain independence with rehab, while others may face permanent disability. Early intervention improves outcomes.
Q5. How can stroke be prevented?
Prevention includes managing blood pressure, controlling diabetes, quitting smoking, exercising regularly, and maintaining a healthy diet.
