Cerebrovascular Accident

Cerebrovascular accident or stroke (Table 13) is a syndrome associated with the interruption of blood supply to a portion of the brain causing neurologic deficit. Most commonly, a stroke is secondary to an evolving blood clot associated with atherosclerosis that progressively blocks a cerebral artery. Alternatively, it may be due to an embolus that lodged in a cerebral artery obstructing blood flow or result from subarachnoid or intracerebral hemorrhage into brain tissue. Stroke-like symptoms lasting less than 1 hour are termed transient ischemia attacks (TIA).

Table 13. Cerebrovascular Accident.

Prevention:

Identify at-risk patient
- Reduce anxiety
- Ensure profound local anesthesia
  - Use local anesthetic agents containing a vasoconstrictor congruent with the patient’s functional capacity

Signs and symptoms:

Headache, stiffness in the neck
Nausea and vomiting
Pupils unequal
Slurred speech
Motor dysfunction
- Facial drooping
- Hemiplegia
Focal or generalized seizure
Altered mentation

Emergency response:

Stroke assessment²²
- Place patient in an upright or semi-reclining position
  - Ask patient to smile
    - Normal: both sides of face move equally
    - Abnormal: one side of face does not move at all
  - Ask patient to raise both arms
    - Normal: both arms move equally or not at all
    - Abnormal: one arm drifts compared to the other
  - Ask the patient to repeat “you can’t teach an old dog new tricks”
    - Normal: patient uses correct words with no slurring
    - Abnormal: slurred or inappropriate words or mute
- If any one of the 3 signs of stroke assessment is abnormal
  - Notify EMS
    - Administer oxygen
      - 2 to 4 L/minute by nasal cannula
    - Monitor vital signs
      - If at any time the patient becomes unresponsive, no normal breathing, and no palpable pulse consider the diagnosis of respiratory and/or cardiac arrest
        
        Immediate CPR and defibrillation congruent with current recommendations

Nota bene:

Signs of recovery: patient regains consciousness, respiration returns to normal
Signs of deterioration: unconsciousness persists, respiratory depression progressing to respiratory arrest

Managing Adult Medical Emergencies in the Dental Office Cerebrovascular Accident

Cerebrovascular Accident

Managing Adult Medical Emergencies in the Dental Office
Cerebrovascular Accident