Stroke (Cerebrovascular

accident)
4.5
Ng Tsz Wing Rys
Wong Pak Sing Benson

Introduction
O2 deprivation after reduced blood supply to brain
Necrosis of brain tissue Fatal
Can cause long-term disability (motor / speech/
cognition)

Pathophysiology
Due to interrupted blood supply to brain
Ischemic
Thrombosis
Emobli

hemorrhage

Risk factors
Atherosclerosis (prone to clot formation and / or rupture)
Hypertension (damage arterial wall, promote atherosclerosis),
Cardiac pathosis (MI, AF)
Smoking
Diabetes (AGE deposition makes vessel fragile & narrow), obesity,
stress
Old age
TIA / previous stroke
High dietary fat/ obesity/ Hypercholesterol level
Physical inactivity

Type of stroke

Residual deficit

Unilateral paralysis
Numbness
Sensory impairment
Dysphasia
Blindness
Diplopia
Dysarthria
Return of function is unpredictable

sign

Transient ischemic attack (TIA)

Temporary disturbance in blood supply to a localized
area of brain
Numbness of face/leg/arm on one side of body
Weakness, tingling, weakness and speech disturbances
last less than 10 mins warning sign

Reversible ischemic neurologic deficit (RIND)

Similar to TIA but does not clear within 24 hrs

Stroke-in-evolution
Deficit has been present for several hours and continue
to worsen
Hemiplegia, temporary loss of speech, dimness of
vision, unexplained dizziness

The completed stroke

Medical T(x)
Stop dental T(x) immediate medical referral
hospitalization to lyse any clot [esp. if
ischemic]
Drug early thrombolytic drug (tPA, tissue
plasminogen activator) then antiplatelet /
anticoagulant
Surgery (thrombo-endarterectomy)
remove hematoma / obstruction in vessels [if
hemorrhage]

Dental T(x)
Check medical history and identify the severity
For TIA or stroke (within 6 months) defer dental T(x),
consult physicians
Anxiety and stress control
Short morning appointment and adequate pain control Oral
sedative like benzodiazepine (1 hour pre-op) if necessary
OR inhalational sedation like nitrous oxide (~ 30%) and
oxygen
Limit the use of LA (with Adr)
Usually 2 cartridges is safe to use (no significant change
in BP)
Avoid use of retraction cord which soaked in adrenaline
solution (Adr can diffuse via gingival sulcus)

Drug concern
(bleeding control)
Drug concern (bleeding control)
For antiplatelets (aspirin) discontinuation of
drug is unnecessary
For anticoagulants (warfarin) consult
physician first and monitor INR < 3
Warfarin is good to prevent thrombus / emboli,
thus to avoid stroke
But warfarin causes higher bleeding tendency
must consult physician and alter drug therapy
Adjunct with local homeostatic measures
sponge with topical thrombin in socket, suture

Supportive dental care

Aim at preventive and simplified treatment,
with anxiety and stress control
Aid in OHI electric toothbrush, learn to clean
with one hand (e.g. patients with one side
paralysis)
Preventive treatment (topical fluoride and
CHX), and use fixed instead of removable
prosthesis