Cerebrovascular Accident

CEREBROVASCULAR ACCIDENT
CEREBROVASCULAR ACCIDENT/STROKE
• Also called “brain attack”, cerebral infarction, cerebral
hemorrhage, ischemic stroke or stroke
• A stroke is caused by the interruption of the blood
supply to the brain, usually because a blood vessel
bursts or is blocked by a clot. This cuts off the supply
of oxygen and nutrients, causing damage to the brain
tissue.
DIRECT CAUSES:
• CEREBRAL THROMBOSIS – a blood clot or plaque
blocks an artery that supplies a vital brain center.
• CEREBRAL HEMORRHAGE/ANEURYSM – an artery in
the brain bursts, weakens the aneurysm wall; severe
rise in BP causing hemorrhage and ischemia
• CEREBRAL EMBOLISM – a blood clot breaks off from a
thrombus elsewhere in the body, lodges in a blood
vessel in the brain and shuts off blood supply to that
part of the brain
TYPES:
ISCHEMIC STROKE – Occurs when a clot or a mass clogs a
blood vessel, cutting off the blood flow to brain cells.
• The underlying condition for this type of obstruction is
the development of fatty deposits lining the vessel
walls.
• This condition is called atherosclerosis. – Almost 85%
of strokes are ischemic
ATHEROSCLEROSIS - “hardening of the arteries” -
“athero” – gruel or paste - “sclerosis” – hardness –
• It’s the process in which deposits of fatty substances,
cholesterol, cellular waste products, calcium and
other substances build up in the inner lining of an
artery.
• This buildup is called plaque.
• HEMORRHAGIC STROKE – Results from a weakened
vessel that ruptures and bleeds into the surrounding
brain.
• The blood accumulates and compresses the
surrounding brain tissue. – About 15% of all strokes
but responsible for 30% of stroke deaths
2 Types---
• SUBARACHNOID HEMORRHAGE (SAH) Occurs when a
blood vessel on the surface of the brain ruptures and
bleeds into the space between the brain and the skull.
• INTRACEREBRAL HEMORRHAGE (ICH) Occurs when a
blood vessel bleeds into the tissue deep within the
brain.
STAGES OF CVA
Transient Ischemic Attack
• sudden and short-lived attack
• Is a "mini stroke" that occurs when a blood clot blocks
an artery for a short time.
Reversible ischemic neurologic deficit (RIND) similar to
TIA, but symptoms can last up to a week
Stroke in evolution (SIE) - Gradual worsening of
symptoms of brain ischemia
Completed stroke (CS) – symptoms of stroke stable over
a period and rehab can begin
Signs and Symptoms
In embolism - Usually occurs without warning
• Client often with history of cardiovascular disease
In thrombosis - Dizzy spells or sudden memory loss
• No pain, and client may ignore symptoms
In cerebral hemorrhage - May have warning like
dizziness and ringing in the ears (tinnitus) •
• Violent headache, with nausea and vomiting
Sudden Onset CVA - Usually most severe
• Loss of consciousness
• Face becomes red
• Breathing is noisy and strained
• Pulse is slow but full and bounding
• Elevated BP
• May be in a deep coma
TIME IS CRTITICAL!
• – The longer the time period that the person
remains unresponsive, the less likely it is that the
person will recover. –
• The first few days after onset is critical. –
• The responsive person may: Show signs of memory
loss or inconsistent behavior •
• May be easily fatigued, lose bowel and bladder
control, or have poor balance
RISK FACTORS:
• Being over age 55
• Being an African-American
• Having diabetes
• Having a family history of stroke
MEDICAL STROKE RISK
• Previous stroke
• Previous episode of transient ischemic attack (TIA) or
ministroke
• High cholesterol
• High blood pressure
• Heart disease
LIFESTYLE STROKE RISK
• Smoking
• Being overweight
• Drinking too much alcohol
Common STROKE symptoms
• Weakness or paralysis
• Numbness, tingling, decreased sensation
• Vision changes
• Speech problems
• Swallowing difficulties or drooling
• Loss of memory
• Vertigo, Loss of balance and coordination
• Personality changes, Mood changes (depression,
apathy)
• Drowsiness, lethargy, or loss of consciousness
• Uncontrollable eye movements or eyelid drooping
MAJOR EFFECT of STROKE
HEMIPLEGIA – most common result of CVA
• Paralysis of one side of the body
• May affect other functions, such as hearing, general
sensation and circulation
• The degree of impairment depends on the part of the
brain affected
Stages:
–Flaccid – numbness and weakness of affected side
–Spastic– muscles contracted and tense, movement
hard
–Recovery– therapy and rehab methods successful
• Aphasia and Dysphasia
• Brain Damage – extent of brain damage determines
chances of recovery
• Hemianopsia – blindness in half of the visual field of
one or both eyes
• Pain – usually very little.
• Autonomic Disturbances –Such as perspiration or
“goose flesh” above the level of paralysis.
• May have dilated pupils, high or low BP or headache
DIAGNOSIS
• Physical Examination (neurological examination &
medical history)
• Imaging (CT scan and MRI)
• ASSESSMENT – Monitor for signs and symptoms –
Symptoms will vary based on the area of the brain
involved-
• The left cerebral hemisphere is responsible for
language, mathematic skills and analytic thinking.
• The right cerebral hemisphere is responsible for visual
and spatial awareness and proprioception.
• Assess/Monitor Airway patency
• Glasgow Coma Scale score
STROKE PREVENTION
• Get screened for high BP.
• Regular cholesterol level checked.
• low-fat diet.
• Quit smoking.
• Exercise.
• Limit alcohol intake.

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