Stroke Case Study
A stroke, also known as a brain attack, occurs when the blood supply to a part of the brain is cut off or when a blood vessel in the brain bursts.
Parts of the brain are damaged or die in either case. A stroke can result in long-term brain damage, disability, or even death.
Learn about the medical conditions and lifestyle choices that can increase your stroke risk.
During a stroke, what happens in the brain?
Our movements are controlled by the brain, which also stores our memories and is the source of our thoughts, emotions, and language. Many bodily functions, such as breathing and digestion, are also controlled by the brain.
Your brain requires oxygen to function properly. All parts of your brain receive oxygen-rich blood via your arteries. Brain cells die within minutes if something blocks blood flow because they lack oxygen. This results in a stroke.
What are the different types of strokes?
Strokes are classified into two types:
Stroke caused by ischemia.
Stroke caused by hemorrhage
A transient ischemic attack (TIA) is called a “mini-stroke.” It differs from other types of stroke in that blood flow to the brain is interrupted for a short period—usually no more than 5 minutes. 1
Stroke caused by ischemia
The majority of strokes are ischemic.
2 When blood clots or other particles block the blood vessels to the brain, an ischemic stroke occurs.
Fatty deposits known as plaque can also cause blockages by accumulating in the blood vessels.
Stroke with hemorrhage
A hemorrhagic stroke occurs when a cerebral artery leaks or ruptures (breaks open). The leaking blood puts too much pressure on brain cells, causing them to break down.
Conditions that can cause a hemorrhagic stroke include high blood pressure and aneurysms, balloon-like bulges in an artery that can stretch and burst.
Stroke Case Study
Mr. S. is a 23-year-old man who sustained a traumatic brain injury as an unrestrained driver in a motor vehicle crash. On admission, his blood pressure (BP) was 158/72 mm Hg, heart rate (HR) 46 beats per minute, respiratory rate (RR) 28 breaths per minute, and temperature 96.2o F (35.6o C). His neurological examination reveals that his right pupil is at 6 mm and reacts sluggishly; his left pupil is 4 mm and reacts briskly. He is nonverbal, extends his arms bilaterally to pain, and opens his eyes minimally to pain. He is quickly intubated and placed on mechanical ventilation. A computed tomography (CT) scan is ordered, which reveals a large right subdural hematoma with cingulate herniation from right to left, as well as right-sided uncal herniation.
He is taken to surgery emergently for a craniotomy to remove the subdural hematoma. After surgery, he arrives in the critical care unit with a ventricular catheter to measure intracranial pressure (ICP). His initial ICP is 24 mm Hg, BP 130/67 mm Hg, mean arterial pressure (MAP) 88 mm Hg, HR 54 beats per minute, RR 12 breaths per minute (controlled ventilation), and temperature 96.1o F (35.5o C). His current Glasgow Coma Scale (GCS) score is 3, but the anesthesiologist did not reverse the anesthesia, choosing to allow it to wear off gradually. He has orders for 3% saline at 20 mL/hr intravenously.
- Based on the information provided, what is Mr. S.’s preoperative GCS? What is the significance of this number, and how would the nurse describe this to his family?
- Anatomically, what is the cause of his pupillary changes?
- Which of his postoperative findings are of concern?
- Why is the 3% saline ordered, and how will the nurse know if it is effective?