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Individual Case Study on Cerebrovascular Accident

Individual Case Study on Cerebrovascular Accident

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Published by: emman_m on Aug 23, 2009
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01/04/2014

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I. PERSONAL DATA
Name: Mrs. Celie Ara ApostleSex: FemaleAddress: Tallungan, Reina, MercedezBirth date: July 26, 1960Birth place: Luna, IsabellaAge: 49y/oOccupation: House KeeperReligion: Roman CatholicCivil Status: WidowNationality: Filipino
II. HISTORY OF PAST ILLNESS
 The daughter of the patient reported that the patient already hasdiabetes and hypertension during her 30’s and has no other sickness otherthan those. Visual problems were also verbalized by the patient. Also, thedaughter verbalized of no surgery was done to the patient.
III. HISTORY OF PRESENT ILLNESS
Prior to admission, patient is having a slurred speech and an elevatedblood pressure. According to her daughter, the patient suddenly fell from herseat and speech became incomprehensive, hand and feet movementsbecame imprecise.Patient was then admitted in General Faustino M. Dy, Sr, MemorialHospital by her attending physician, Dr. Paguirigan, at exactly 08:50 in theafternoon of July 7, 2009. She was admitted with the admitting diagnosis of CVA probable infarct vs. hemorrhage.Page
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IV. BRIEF DESCRIPTION OF THE DISEASECerebrovascular AccidentDefinition:
It is characterized by a relatively abrupt onset of persistingneurological symptoms due to the destruction of brain tissue (infarction)cause by ischemia (thrombus or embolism) or hemorrhage resulting fromdisorders in blood vessels that supply the brain. Also called strokeStroke – any sudden – onset focal neurological deficit
Causes:
Intracerebral hemmorhage (rupture of a blood vessel in the piamater or brain
Emboli (blood clots)
Atherosclerosis (formation of plaque) of the cerebral arteries.
Risk Factor:
1.Hypertension – leading risk factor for coronary heart disease and stroke– treatable and can be controlled.2.Modifiable by change in lifestylea.smokingb.elevated serum cholesterolc.obesityd.heart disease3.Modifiable by Medical meana.Transient Ischemic Attackb.Asymptomatic carotid bruitc.Diabetes Mellitusd.Increased blood viscositye.HPN4.Non – modifiable risk factorsa.ageb.sexc.raced.previous stroke
Types of Stroke by Etilogy:
1.
Hemorrhage stroke
(intracranial hemorrhage)
5% of all strokes
two division
a.
Intracerebral (10%) – due to rupture of weakened vesselswithin brain parenchyma as result of Hypertension,arteriovenous malformation or tumorPage
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b.Subarachnoid (5%) – result from aneurismal rupture of acerebral artery with blood loss into space surrounding thebrain; evolve over 1 –2 hours.
2.
Ischemic Strokes
(remaining 85%)
Large (40%) or small (20%) vessel thrombosis-most commonly occur in presence of atheroscleroticcerebrovascular disease-vascular changes or lipohyalinosis found in small deep penetratingarteries as associated with chronic hypertension can lead to smallvessel thrombosis.-rapid or prolonged interval of onset and may lead last many hours
Cerebral embolism (20%)-usually a cardiac origin-frequently result of chronic ischemic cardiovascular disease withsecondary ventricular wall hypokinessis or artial arrhythmia – bothconditions increase risk of intracardiac thrombus formation-quick onset and fully develop in a matter of minutes
Temporal Classification of Stroke1.Transient ischemic attack (TIA)
 – 
neurologic symptoms develop and disappear over severalminutes and completely resolve in 24 hours
 – 
most frequently associated with atherosclerotic carotid arterydisease
2.Reversible Ischemic Neurologic Deficit
 – 
etiology unknown
 – 
likely the result from small infarctions (Lacunes) of the deepsubcortical gray and white matter resulting in only temporaryimpairment
3.Stroke in Evolution
 – 
describe an unstable ischemic event characterized by theprogressive development of more severe neurologic impairment
 – 
often associated with active occlusive thrombosis of a majorcerebral artery.
 – 
Once stable called Complete Stroke
 – 
Most important sign – Intellectual RegressionPage
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