BRAIN ATTACK: STROKE

WHAT IS STROKE?
Brain tissue is damaged from a sudden loss of blood flow, resulting in a loss of neurological function Causes:
Blockage (blood clot) occurring inside a blood vessel; obstruction in blood flow Blood vessel leaks blood due to rupture of artery which feeds the brain

TYPES OF STROKES
Ischemic Stroke (85%)

Hemorrhagic Stroke (15%)

Ischemic Stroke
Deficiency of blood to the brain caused by an occlusion of an artery from a thrombus or embolism Ischemia deficiency of blood in a part, usually due functional constriction or actual obstruction of blood vessel

ISCHEMIC STROKE
Types of Ischemic Stroke
Embolic Stroke
Blood clot travels to the brain

Thrombotic Stroke
Blood flow is blocked to the brain

HEMORRHAGIC STROKE
Bleeding occurs from vessels within the brain. High blood pressure or a rupture of a blood vessel or an aneurysm may be the cause.

TRANSIENT ISCHEMIC ATTACKS (TIA)

A stroke-like event lasting minutes, or hours, that occurs when the brain is deprived of oxygen-rich blood temporarily, but in which the effects wear off completely after the blood-flow returns temporary interruption in blood flow to part of the brain TIAs do not result in permanent brain damage TIA is serious and too often ignored

WHO GETS STROKE?

WHO GETS STROKE?

Anyone can suffer from stroke Over age 55 Male A family history of stroke High blood pressure High cholesterol Smoking cigarettes Diabetes Obesity and overweight Cardiovascular disease A previous stroke or transient ischemic attack (TIA) High levels of homocysteine (an amino acid in blood) Birth control use or other hormone therapy Cocaine use Heavy use of alcohol-- heavy regular drinkers have a considerably higher risk of stroke early in life compared to others. Men from divorced families have a higher chance of suffering a stroke than those from families which are still intact (because of stress)

 Stroke affects people of All Ages All Ethnic Groups

All Backgrounds
Most strokes are preventable, take steps NOW to reduce having a stroke!

SIGNS AND SYMPTOMS OF STROKE

SIGNS AND SYMPTOMS OF STROKE

Sudden numbness or weakness of the face, arm, or leg, especially on one side of the body Sudden confusion, trouble speaking or understanding Sudden trouble seeing in one or both eyes Sudden trouble walking, dizziness, loss of balance or coordination Sudden, severe headache with no known cause Blurred, blackened, or double vision

 Strokes occur in the brain and affect the opposite side of the body

RISK FACTORS
Risk factors you can control:
DIET - How we eat, do we follow our diet? EXERCISE - Do we exercise or get some physical activity? MEDICATIONS - Taking medications correctly SMOKING - Stop smoking

LIST OF RISK FACTORS

 Strokes can affect different parts of the brain, this results in patients experiencing different symptoms

How is a stroke diagnosed?

Imaging tests: these obtain a clear image of the brain. These may include a CT (computerised tomography) scan and an MRI (magnetic resonance imaging) scan. These scans can help doctors to determine whether the stroke was a result of a haemorrhage or blockage. Electrical tests: tests such as an evoked response test and an EEG (electroencephalogram) may be carried out to check the electrical impulses in the brain. These tests can also check the sensory processes. Blood tests: tests such as the Doppler ultrasound test can highlight any changes or abnormalities relating to the flow of blood to the brain.

 EKG may show atrial fibrillation

 Carotid Ultrasound will show if there is stenosis (narrowing of the blood vessel)

 Echocardiog ram detects if any thrombus (blood clot) within the heart chambers

CHEST XRAY

LABORATORY WORK - BLOOD SAMPLE

Any labs may be ordered, Lipid Profile (checking your cholesterol level) is done on all patients.

ACT IN TIME
Stroke is a medical emergency. Every minute counts when someone is having a stroke. The longer blood flow is cut off to the brain, the greater the damage. Immediate treatment can save people's lives and enhance their chances for successful recovery

PRIMARY GOAL
primary goal in treating ischemic stroke is to restore blood flow to the brain. attempted using blood clot-busting drugs such as aspirin, heparin, or tissue plasminogen activators that must be administered within three hours of the stroke.

TREATMENT AND MEDICATIONS

TPA (Tissue Plasminogen Activator)

is a clot-busting drug
Ischemic strokes, the most common type of strokes, can be treated with a drug called t-PA, that dissolves blood clots obstructing blood flow to the brain.

 Window of opportunity to start treating stroke patients is three hours, but to be evaluated and receive treatment, patients need to get to the hospital within 60 minutes.

LIST OF MEDICATIONS
Aspirin Aggrenox Plavix Blood pressure medication if appropriate Cholesterol lowering medicines if needed

HOSPITAL TREATMENT FOR STROKE

Medical Management
Dietary Physical & Occupational Therapy Speech Therapy if indicated Nursing

HOSPITAL TREATMENT FOR STROKE

Rehabilitation
Physical Medicine Consult Determine what type of therapy best for patient
Rehab Unit Subacute Rehab Extended Care Facility Home Care with PT/OT

DISCHARGE PLANNING
Starts upon admission to the hospital
Consult social worker or care coordinator to help identify discharge needs Provide patient/family with Stroke education
Stroke Support Group meetings

ACT FAST
FACE FACIAL DROOP UNEVEN SMILE ARM NUMBNESS ARM WEAKNESS SLURRED SPEECH DIFFICULTY SPEAKING/ UNDERSTANDING

ARM

SPEECH

TIME

CALL THE NEAREST HOSPITAL AND GO THERE IMMEDIATELY STROKE IS AN EMERGENCY. EVERY MINUTE COUNTS.

Dental management of patients with stroke

A patient with stroke in his record shall get special care during dental treatment: appointments shall be for choice in the morning, shall be short and without stress. Clinical approach shall take into consideration several aspects

 - Disabled patients shall be helped by the nurse to sit on dental chair, their airways shall be free and they shall be accompanied by the persons taking care of them, especially if speech difficulties are present;

dentist shall stand in front of the patient, without mask, shall look him in the eyes, shall move slowly and questions shall be simple and clear, for plain answers (yes/no);

 - Anamnesis should reveal patients risk factors: if the medical record shows high blood pressure, cardiac diseases, transient vascular accidents, diabetes, dyslipidemia, coronary atheromatosis, (heavy) smoking, old age, then such a patient is prone to stroke and/or myocardial infarction;

 - History of past strokes needs to be elicited: date, seriousness, treatment, disabilities. There are situations when patients speech is not affected, but he cannot realize the extent of the palsy (he is not aware of it) or situations when a patient with brain injury on his right side is neglecting his left side of the body; - Blood pressure and pain should be monitored and under control during the entire intervention.

 Emergency dental treatment is allowed six months after stroke, it should be performed carefully, by neurologists advice and some precautions are needed, according to the specific characters of the stroke

 - If needed, dental treatment produces bleeding (teeth extraction, pulpectomy, subgingival scaling, periodontal surgery), anticoagulant systemic medication may cause serious haemorrhage, therefore anticoagulant drugs like heparin should be stopped at least 6-12 hours before treatment.

 Six hours after bleeding, when blood clots are built up, heparin systemic treatment can be resumed. If there is some other anticoagulant medication involved, it should be stopped several hours or days before bleeding dental treatment, after determining the International Clotting Rate (ICR) and decision depends on neurologists advice.

- The dentist should be ready for emergency intervention in case of local hemorrhage, with haemostatic medication and cautery, blood pressure should be monitored and oxygen therapy device is needed in dental office.

 The minimal amount of anaesthetic solutions should be injected, concentration of added epinephrine should be very low (1:100.000 or 1:200.000). Use of gingival retraction cord soaked with epinephrine should be avoided.

 Metronidazolum and tetracycline should be avoided, since they may affect blood clotting.

- If the patient shows symptoms of stroke, he should get oxygen therapy immediately and should be referred to a hospital as soon as possible. Patients with transient ischemic attack (TIA) or with stroke in their medical record have a very complex dental and periodontal pathology.

If patients show minor physical disabilities after stroke, they can present poor oral hygiene. For such patients, dentists will advise the use of electric toothbrushes, easier to handle, use of dental floss, oral irrigation and prophylaxis using chlorhexydine and fluoride.

GROUP 3 -STROKEAGBAYANI, Cassiopeia CO, Florence JUAN, Faye Ann TESORO, Joseph Paulo VELASCO, Philipp Rey