Introduction
As the population of United States continue to increase, so does the rise of acute ischemic stroke. Acute ischemic stroke is a condition which can cause sudden loss of blood circulation to critical parts of the brain, thus causing loss of neurologic function (Jauch, 2018). When there is a blood clot in the brain vessels, oxygen supply to the brain cells decreases, which causes the brain cells to die (Van der Worp, & Van Gijn, 2007). Acute ischemic stroke is highly prevalent and affects people of all age groups, however, there is more risk with increased age. It is the second leading cause of death globally (Musuka, 2015). People with this kind of stroke experience alteration in level of consciousness associated with acute neurologic deficits, such as, the inability to speak, decreased sensation, loss of balance, mental function problems, vision changes, walking problems and weakness in the arms or legs. The signs and symptoms of ischemic stroke ranges depending on the affected area of the brain (Caplan & Van Gijn, 2012). Common signs and symptoms include but not limited to sudden onset of monoparesis- paralysis of a single limb, hemiparesis- weakness of one side of the body and quadriparesis- weakness of all four limbs. When there is defects in the hemisensory capacity, there is loss of vision, facial droop, and other signs that indicate a loss of the abilities of a person to control their movements. The symptoms associated with acute ischemic stroke tend to occur in combination rather than presenting as individual symptoms. (Mittal, Rymer, & Lai, 2012). Although a person may either experience one of these symptoms, common observation is that most people experience more than one of these symptoms (Jauch, 2018).
This paper provides analytical review of acute ischemic stroke. It investigates mechanisms of acute ischemic stroke to the brain and key body functions. The evaluation processes as well as the treatment and management strategies would be assessed. Finally, guidelines as to how this condition could be prevented would be discussed.
Mechanisms of Acute Ischemic Stoke
The initiation of ischemia causes an infarction that is typically surrounded by viable but impaired tissues. However, efficient and expeditious reperfusion can effectively save the impaired tissue and restore its normal functionality. If this is not done immediately, there would be permanent structural changes and eventual necrosis of the neuronal cells. However, if there is expedited medical interventions, cases of acute ischemic stroke could be prevented because it helps to prevent the onset of cognitive dysfunction as well as a poor brain “reserve”. (Brown & Palesch, 2012
According to Chang & Jensen (2015), ischemic stroke causes focal hypoperfusion in the central nervous system with infarcts ranging in different sizes. When stroke happens in the brain stem, severe injury can affect both sides of the patient’s body and cause them to lose movement and functionality in areas below the neck (Chang ; Jensen, 2015). Acute ischemic stroke also affects the cerebellum; the area of the brain which controls balance, coordination and posture. If this stroke occurs in the limbic system, physiological processes are impaired and the people may experience difficulties in terms of sleep cycles, reproductive cycles, growth, and emotions. Further, as noted by Cruz-Flores (2017) up to two thirds of stroke occurs in the cerebrum which affects the cerebral cortex. This affects the patient’s capacities in spatial relationships, visual interpretation, perceptions, and how they carry out analytical tasks (Campbell, 2015).
Evaluation of Acute Ischemic Stroke
As noted by Jauch (2018), it is important for physicians to evaluate the symptoms and medical history of a patient in order to distinguish it from other conditions. Indeed, the author makes an observation that acute ischemic stroke presents some symptoms that are significantly related or observed in patients with hemorrhagic stroke. Evidence-based research indicates that nausea, headache, vomiting, and the sudden loss of consciousness commonly present in hemorrhagic stroke as compared to ischemic stroke (Jauch, 2018).Notably, since there is no historical feature which distinguishes ischemic stroke from hemorrhagic stroke, the physician or clinical nurse should carry out reperfusion options through fendovascular as well as fibrinolytic therapies (Yuh, 2017). The physician should carry out a brief neurologic examination to develop an accurate determination of the type of stroke that the patient is suffering from. This neurologic examination is beneficial because it has multifaceted benefits that include: distinguishing stroke from common conditions that mimic stroke, determining whether what the neurologic baseline for the patient is confirming that the patient has neurologic deficits, and establishing the severity of the stroke. This required the physician to use a structured neurologic exam that will help in prognosis as well as selection of therapies that will be used for managing the specific patient.
The neurologic examination for ischemic stroke involves a diverse assessment of different functionalities that include: sensory function, gait, cerebellar function, cranial nerves, expressive and receptive capabilities, deep tendon reflexes, and the mental status of the patient as well as their consciousness. Evidently, it seems that the evaluation for ischemic stroke is multifaceted because of the seriousness of this condition and the health implications associated with the condition. After evaluating the patient, it is recommended for the physician to carry out certain diagnostic practices (Musuka et al., 2015). One of the most essential diagnostic tests carried out for acute ischemic stroke is emergent brain imaging which is done through the use of noncontrast computed tonography (CT) scanning. If the CT scan is negative but there is still high suspicion of an ischemic stroke, then the physician should carry out a lumbar puncture to rule out the possibility of subarachnoid hemorrhage or meningitis (Jauch, 2018). The final step of the comprehensive evaluation for ischemic stroke is the use of laboratory tests which provide a scientific basis in the diagnosis process. As such, Jauch (2018) recommends laboratory tests such as: a complete blood count, coagulation studies, a basic chemistry panel, a toxicology screening, and cardiac biomarkers. As such, it appears that the process of determining whether a patient has ischemic stroke is quite detailed and it begins with an observation of the presenting symptoms following by scientific-based tests which provide an accurate result in diagnosis.
Treatment and Management strategies
Advani, Naess, & Kurz, (2017) explains that the treatment of patients with acute ischemic stroke should occur within the first 60 minutes after the onset of the patient’s symptoms. The authors refer to this as the “Golden Hour” means that all possible delays in treatment of the patient should be eliminated through adopting improved treatment routine.
As noted by Jauch (2018), physicians should ensure that the emergency management of stroke is done effectively and especially within the first 60 minutes. This is a three step process which begins with an assessment of the airway, circulation, and breathing so as to stabilize the patient. The next step is to complete the initial evaluation which includes laboratory studies and imagine. The final step is the initiation of the reperfusion therapy if deemed necessary depending on the specific patient. Musuka et al., (2015) explains that the intravenous administration of alteplase (recombinant tissue plasminogen activator) is useful in reducing the functional disability of the patient. Thus, this is the leading treatment that is recommended for the acute management of ischemic stroke (Musuka et al., 2015).
Another therapy that is used in the treatment of major acute ischemic stroke is endovascular treatment (Campbell et al., 2015). As Musuka et al., (2015) noted, research has shown that endovascular thrombectomy that uses contemporary devices can substantially reduce morbidity and mortality rates associated with acute ischemic stroke. Since the risk of harm in stroke patients increases rapidly with the time elapsed after the symptoms present, it means that timely diagnosis and treatment is important towards enhancing the chances of survival and also in preventing the patient from losing important body functions. Indeed, for the treatment process for acute ischemic stroke to be effective, the time from imaging to reperfusion of the blocked artery should be done in less than 90 minutes and contemporary devices should be available readily to open the blocked artery. This means that the patient should receive medical attention in a committed stroke unit that is available immediately for patient care. For patients that have that have disabling acute ischemic stroke, then a thrombolysis is the recommended treatment method (Misuka et al., 2015). However, for patients that have major underlying illnesses that are life-limiting, then acute treatment such as thrombolysis is not indicated because death is considered an inevitable outcome in such cases. Therefore, in such cases, the patent should be provided with palliative care that will improve their quality of life. It is important for healthcare practitioners to evaluate the overall clinical context and assess the patient to establish the best form of therapy and treatment option for each patient, depending on their unique health needs.
Prevention
The primary prevention of stroke involves the treatment of patients that do not have a previous history of stroke. The physician should assess the patient’s medical history and any positive risk factors so as to ensure that the primary prevention measures are suited to the needs of the patient. The clinical prevention of the stroke includes prescribing platelet antiagrregants and statins for the patient.
The patient should also be advised on the importance of undertaking light but regular physical exercises to keep their heart in a healthy state. The other primary prevention mechanism is through lifestyle interventions where the patient is advised to avoid smoking and to reduce the amount of alcohol intake (Jauch, 2018). For individuals that have had a previous experience of stroke, introducing secondary measures of preventing stroke can help to enhance their health outcomes (Jauch, 2018). This includes prescribing medications such as antihypertensives, statins, and platelet antiaggregants.
For both primary and secondary prevention of stroke, the patient should be provided with clinical education focused on prehospital and post hospital care. This means that patients at risk should be educated on the information on stroke that will help in early detection of symptoms. The process of rehabilitating stroke patients is done with the aim of restoring the patient’s functions and to reduce the effect caused by the stroke on the patients and on their caregivers. The rehabilitation process should begin early after discovery through assessment and mobilization when the patient is placed in the acute stroke unit. Disability and death can be reduced significantly through effective rehabilitative processes when the patient is in the stroke unit.
Conclusion
Acute ischemic stroke is a heath condition that is typically characterized by the sudden onset of neurologic deficit in a part of the brain. Acute ischemic stroke is a prevalent condition that is actually a leading cause of death globally. It also contributes to a large extent of disability due to the loss of key body functions. As stroke commonly affects brain cells, this may lead to long-lasting adverse effects in the impairment of senses, behavior, motor skills, memory, language ability, and thought processes. However, with proper evaluation and management strategies, it is possible to enhance the overall health outcomes, restore body functions and prevent future incidence of the condition. The evaluation of patients for acute ischemic stroke involves a multifaceted process that relies on laboratory technologies, physical, and medical examination. It is highly recommended for healthcare practitioners to assess the specific needs of each stroke patient immediately after the patient is brought to the emergency room. This is necessary to ensure that he best treatment and management strategy is adopted to enhance the wellbeing of each specific patient. The future of treatment of acute ischemic stroke is in utilizing reperfusion therapy and endovascular treatment. However, for patients that have serious underlying health issues, then thrombolysis should be recommended. Further, it is important for healthcare professionals to be provided with updated information on how to comply with the 60-minute rule which recommends that acute ischemic patients should be treated within an hour after the onset of the symptoms.
