Stroke and paralysis (cerebrovascular accident)

Stroke

A stroke occurs when the blood supply to some part of the brain is interrupted. This is generally caused by:

· a blood clot forming in the blood vessel (cerebral thrombosis)

· a rupture of the blood vessel wall (cerebral haemorrhage)

· obstruction of a cerebral blood vessel by a clot or other material from another part of the vascular system (cerebral embolism)

· pressure on a blood vessel, e.g., by a tumour.

A stroke can be a complication of high blood pressure.

A stroke generally occurs suddenly, usually in middle-aged or old people, without warning signs. In more severe cases, there is a rapidly developing loss of consciousness and a flabby, relaxed paralysis of the affected side of the body. Headache, nausea, vomiting, and convulsions may be present. The face is usually flushed, but may become pale or ashen. The pupils of the eyes are often unequal in size. The pulse is usually full and rapid, and breathing is laboured and irregular. The mouth may be drawn to one side and often there is difficulty in speaking and swallowing.

The specific symptoms will vary with the site of the lesion and the extent of brain damage. In mild cases, there may be no loss of consciousness and paralysis may be limited to weakness on one side of the body.

In a severe stroke there is loss of consciousness, the breathing is heavy and laboured, and the patient may lapse into a coma and die.

The outcome of a stroke will depend upon the degree of brain compression or damage. When it is fatal, death usually occurs in 2-14 days and seldom at the time of the attack. Most patients with first or second attacks recover, but recurrent attacks are likely. The extent of permanent paralysis will not be determined for at least 6 months.

Treatment

Good nursing care is essential after a stroke. The patient should be undressed as gently as possible and placed in bed with the trunk of the body, shoulders, and head elevated slightly on pillows. An attendant should be assigned to stay with the patient. Extra care should be taken to prevent the patient from choking on saliva or vomit. The patient's head should be turned to one side so that fluids can flow out of the mouth. Mucus and food debris should be removed from the mouth with a piece of cloth wrapped round a finger. If there is fever, cold compresses should be applied to the forehead. If the patient is conscious and able to swallow, liquid and soft foods may be given. To prevent bedsores the patient should be kept clean and turned to a different position in bed every 3-4 hours. Bowel regularity should be maintained.

RADIO MEDICAL ADVICE must be obtained, and early evacuation to hospital should be anticipated.

I. Read and translate the text

II. Speak on your actions if someone on board has a cerebrovascular accident.