Discuss the pathophysiology and management of ischemic stroke., What are the key interventions used in the acute phase to improve outcomes including thrombolysis and mechanical thrombectomy?, How does stroke rehabilitation focus on neuroplasticity and what factors influence recovery after an ischemic event?, What are the secondary prevention strategies aimed at reducing recurrent strokes including antiplatelet therapy blood pressure control, and lifestyle modifications?
Ischemic Stroke: Pathophysiology and Management
1. Pathophysiology
- Ischemic stroke occurs due to an arterial blockage, leading to reduced cerebral blood flow and oxygen deprivation.
- Causes: Atherosclerosis, embolism (e.g., atrial fibrillation), small vessel disease (lacunar stroke).
- Neurons in the ischemic core die quickly, while the surrounding penumbra is salvageable with prompt intervention.
2. Acute Phase Interventions
- Thrombolysis (tPA, alteplase): Administered within 4.5 hours of symptom onset to dissolve clots.
- Mechanical Thrombectomy: Used for large artery occlusions up to 24 hours post-stroke.
- Supportive Care: Maintain oxygenation, blood glucose, and temperature to prevent further damage.
3. Stroke Rehabilitation & Neuroplasticity
- Neuroplasticity allows undamaged brain areas to adapt and take over lost functions.
- Physical, occupational, and speech therapy enhance motor and cognitive recovery.
- Early mobilization improves outcomes, but severity and comorbidities influence recovery rates.
4. Secondary Prevention Strategies
- Antiplatelet Therapy: Aspirin, clopidogrel, or dual therapy to prevent clot formation.
- Blood Pressure Control: ACE inhibitors, beta-blockers, and diuretics reduce stroke risk.
- Lipid Management: Statins lower LDL, stabilizing atherosclerotic plaques.
- Lifestyle Modifications: Smoking cessation, diet changes, and regular exercise reduce recurrence.
- Atrial Fibrillation Management: Anticoagulation (warfarin, DOACs) prevents embolic strokes. APA