VI.

Patho-physiology

A. Theoretical Based
Cerebrovascular disease is a group of brain dysfunctions related to disease of the blood vessels
supplying the brain. Hypertension is the most important
cause; it damages the blood vessel lining, endothelium, exposing the
underlying collagen where platelets aggregate to initiate a repairing process
which is not always complete and perfect. Sustained hypertension
permanently changes the architecture of the blood vessels making them
narrow, stiff, deformed, uneven and more vulnerable to fluctuations in blood
pressure.

A stroke is caused by the interruption of the blood supply to the brain, usuallybecause a blood
vessel bursts or is blocked by a clot. This cuts off the supplyof oxygen and nutrients, causing damage to
the brain tissue.

The most common symptom of a stroke is sudden weakness or numbness of

the face, arm or leg, most often on one side of the body. Other symptoms
include: confusion, difficulty speaking or understanding speech; difficulty
seeing with one or both eyes; difficulty walking, dizziness, loss of balance or
coordination; severe headache with no known cause; fainting or
unconsciousness.

The effects of a stroke depend on which part of the brain is injured and how severely it is affected. A
very severe stroke can cause sudden death. The 1990 Global Burden of Disease (GBD) study provided
the first global
estimate on the burden of 135 diseases, and cerebrovascular diseases
ranked as the second leading cause of death after ischemic heart disease.

During the past decade the quantity of especially routine mortality data has
increased, and is now covering approximately one-third of the
world’s population. The increase in data availability provides the possibility
for updating the estimated global burden of stroke.

Additionally, cerebrovascular disease is the leading cause of disability in

adults and each year millions of stroke survivors has to adapt to a life with
restrictions in activities of daily living as a consequence of cerebrovascular
disease. Many surviving stroke patients will often depend on other people’s
continuous support to survive
 B. Client Based

Modifiable: Non-modifiable:

 Sedentary lifestyle  Age: 63 years old

 Smoking: 30 sticks/day  Gender: Male
 Alcohol intake: occasional
 Food and diet

↑ Triglycerides: 242.48 mg/dL

↓HDL: 29.73 mg/dL

Carotid stenosis

Decreased Cardiac Output

Compensatory rennin-aldosterone, ADH

Adequate or increased blood volume Catecholamine compensatory release
Increased SVR

Systemic and pulmonary edema

Increased Preload, stroke volume, and Heart rate

Dyspnea Increased Myocardial oxygen requirements

Decreased Cardiac output, Decreased ejection fraction

Increased Blood pressure

Decreased tissue perfusion

Impaired cellular metabolism