Welcome to Scribd. Sign in or start your free trial to enjoy unlimited e-books, audiobooks & documents.Find out more
Standard view
Full view
of .
Look up keyword
Like this
0 of .
Results for:
No results containing your search query
P. 1
Clients With Cerebrovascular Disease Cerebrovascular Accident (CVA)  Commonly Known

Clients With Cerebrovascular Disease Cerebrovascular Accident (CVA)  Commonly Known

Ratings: (0)|Views: 961|Likes:
Published by neil0522

More info:

Published by: neil0522 on Dec 30, 2009
Copyright:Attribution Non-commercial


Read on Scribd mobile: iPhone, iPad and Android.
download as DOC, PDF, TXT or read online from Scribd
See more
See less





Clients with Cerebrovascular DiseaseCerebrovascular Accident (CVA)
Commonly known as stroke or brain attack
A condition in which
neurologic deficits result from decreased blood flow to localized area of the brain
Neurologic deficits determined by the area of brain involved, size of affected area, length of time blood flow is decreased or stopped
Major loss of blood supply to brain can cause severe disability or death; if short or small area involved client may not be aware
Characterized by gradual, rapid onset of neurologic deficits due tocompromised cerebral blood flow
Blood flow and oxygenation of cerebral neurons decreased or interrupted; changes occur in 4 – 5 minutes
Cells swell and cerebral blood vessels swell decreasing blood flow;vasospasm and increased blood viscosity further impede blood flow
Penumbra is a central core of dead or dying cells surrounded byband of minimally perfused cells
Cells of the penumbra receives marginal blood flow and their metabolic activities are impaired
These cells may survive if adequate circulation is re-established
Neurologic deficits occur on opposite side where stroke occurred inbrain:
contralateral deficit 
Occurs when the blood supply to a part of the brain isinterrupted or totally occluded
Commonly due to thrombosis or embolism
Thrombotic (large vessel) stroke
The most common cause of ischemic stroke
Atherosclerosis is the primary cause
Fatty materials deposit on large vessel walls(especially at arterial bifurcations) andeventually these plaques causes stenosis of theartery
Blood swirls around the irregular surface of theplaques causing platelets to adhere and thevessel becomes obstructed
These causes infarcts usually affecting thecortex
Most common type of stroke in people withdiabetes
Lacunar (small vessel) stroke
Endothelium of smaller vessel is primarilyaffected due to hypertension
Leading to arteriosclerosis and stenosis
Infarcts are usually located in the deeper,noncortical parts of the brain or in the brainstem
Embolic stroke
Occlusion of a cerebral artery by an embolus or blood clot
Embolus forms outside the brain, detaches andtravels through the cerebral circulation where itlodges and causes an obstruction
Chronic atrial fibrillation is associated with ahigh incidence
Other sources of emboli include tumor, fat,bacteria and air 
Usually has a sudden onset with immediatemaximum deficit
Results from rupture of a cerebral vessel causing bleedinginto the brain tissues
Bleeding results with edema, compression of the braincontents or spasm of the adjacent blood vessels
Often secondary to hypertension and most common after age50
Other factors includes ruptured intracranial aneurysms,trauma, erosion of blood vessels by tumors, arteriovenousmalformations, anticoagulant therapy, blood disorders
Usually produce extensive residual functional loss andslowest recovery
Risk factors
Diabetes mellitus
Substance abuse including alcohol, nicotine, heroin, amphetamines,cocaine
Obesity, sedentary life-style, hyperlipidemia, atrial fibrillation, cardiacdisease, cigarette smoking, previous transient ischemic attacks
Women: oral contraceptive use, pregnancy, menopause
Clinical manifestations
Stroke manifestations can be correlated with the cause and with thearea of the brain in which perfusion is affected
Manifestations of thrombotic stroke develop over minutes tohours to days (slow onset is related to increasing size of thethrombus)
Embolic strokes occur suddenly and without warning
Hemorrhagic stroke occurs rapidly with manifestationsdeveloping over minutes to hours
General findings unrelated to specific vessel sites includesheadache, vomiting, seizures and changes in mental status
Early warnings of impending ischemic stroke includes
Transient hemiparesis
Loss of speech
Hemisensory loss
Specific deficits after stroke
Motor deficits
Affects connections involving motor areas of cerebral cortex,basal ganglia, cerebellum, peripheral nerves
Produce effects in contralateral side ranging from mildweakness to severe limitation
(paralysis of half of body)
(weakness of half of body)
(inability to perform a previously learned skilled taskin the absence of paralysis)
Able to conceptualize the content of the message tosend to muscles but motor patterns necessary toconvey the impulse cannot be reconstructed
Instructions do not reach the limb from the brain anddesired action cannot happen
E.g. dressing and bathing
Flaccidity (absence of muscle tone or hypotonia)
Spasticity (increased muscle tone usually with some degreeof weakness)
Affected arm and leg are initially flaccid and become spasticin 6 – 8 weeks, causes characteristic body positioning
When voluntary muscle control is lost, strong flexor muscles overbalance the extensors
Imbalance can cause serious contractures
Adduction of shoulder 
Pronation of forearm
Flexion of fingers
Extension of hip and knee
Foot drop, outward rotation of leg, withdependent edema
Muscles of the thorax and abdomen are usually not affectedbecause they are innervated from both cerebral hemispheres
Communication disorders

Activity (6)

You've already reviewed this. Edit your review.
1 hundred reads
1 thousand reads
Paolo Quinto liked this
Susi Sudarsanah liked this
boinkxxiv liked this

You're Reading a Free Preview

/*********** DO NOT ALTER ANYTHING BELOW THIS LINE ! ************/ var s_code=s.t();if(s_code)document.write(s_code)//-->