Cerebrovascular Accident

Prepared by: Cellanie P. Janson

Introduction
• Cerebrovascular accident: The sudden death of some brain cells due to lack of oxygen when the blood flow to the brain is impaired by blockage or rupture of an artery to the brain. A CVA is also referred to as a stroke or brain attack.

Incidence
• 3rd Cause of death in US and Canada Statistics • 2/3 in people >65 • = in men and women • Higher incidence and death rates among African-Americans, Hispanics, NativeAmerican, Asian Americans

ANATOMY AND PHYSIOLOGY .

It consist of • Dendrites • Cell body • Axons .Neurons • Receives stimuli and transmit action potential to the other neurons or the effector organs.

Horns • It is central gray part of the spinal cord Nerve tracts • White part forming nerve tracts .Spinal cord • Provides neuron and synapse networks to produce involuntary responses to sensory stimulation.

Meninges The meninges is a fibrous connective tissues that cover the brain and spinal cord. The layers of the meninges are the following: • Dura mater • Arachnoid membrane • Pia mater .

Ventricles • Fluid filled cavities • Consist of four.Cerebrospinal Fluid &Ventricles Cerebrospinal Fluid • Acts as protective cushion. which are located in the ventricles. and fourth ventricles . aids in the exchange of nutrients and wastes • It is produced by the choroid plexuses. right and left lateral ventricles. third ventricles.

. • For the entire brain. or 15 per cent of the resting cardiac output. this amounts to 750 to 900 ml/min. • The brain does not store nutrients and has a high metabolic demand that requires the high blood flow.Cerebral Circulation • Normal blood flow through the brain of the adult person averages 50 to 65 milliliters per 100 grams of brain tissue per minute.

.Blood supply by arteries Blood is supplied to the brain by two major pairs of arteries • Internal carotid arteries • Vertebral arteries • The internal carotids arise from the bifurcation of the common carotid and supply much of the anterior circulation of the brain.

Carotid arteries branch to supply most of the • Frontal. parietal. and temporal lobes • Basal ganglia • Part of the diencephalon – Thalamus – Hypothalamus .

and enter the cranium through the foramen magnum. flow back and upward on either side of the cervical vertebrae. .Blood supply by arteries • The vertebral arteries branch from the subclavian arteries.

Vertebral arteries join to form the basilar artery. which supply the • Middle and lower temporal lobes • Occipital lobes • Cerebellum • Brainstem • Part of the diencephalon .

and anterior and posterior communicating arteries •Functionally. •The arteries of the circle of Willis can provide collateral circulation if one or more of the four vessels supplying it become occluded or are ligated.•The circle of Willis and is formed from the branches of the internal carotid arteries. anterior and middle cerebral arteries. the posterior portion of the circulation and the anterior or carotid circulation usually remain separate. .

STROKE .

Two Categories of Stroke Intracerebral hemorrhage Subarachnoid hemorrhage Thrombotic stroke Embolic stroke .

Smoking. atrial fibrillation • Oral contraceptives • Sickle cell disease . Physical inactivity. Hyperlipidemia. Diabetes mellitus.Risk Factors Non Modifiable • Age • Gender • Race • Heredity Modifiable • Atherosclerosis which includes the following risk factors: HTN. • Polycythemia vera • Hypercoagulability • Asymptomatic carotid stenosis • Heart disease.

PATHOPHYSIOLOGY OF ISCHEMIC STROKE .

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PATHOPHYSIOLOGY OF HEMORRHAGIC STROKE .

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and the amount of collateral (secondary or accessory) blood flow. depending on the location of the lesion (which vessels are obstructed).Clinical Manifestation • Stroke can cause a wide variety of neurologic deficits. the size of the area of inadequate perfusion. .

needs a broad base to stand Difficulty in forming words Difficulty in swallowing Numbness and tingling of Extremity Difficulty with proprioception Unable to form words that are understandable. hostility. may be able to speak in single-word responses Unable to comprehend the spoken word. can speak but may not make sense Combination of both receptive and expressive aphasia Short. arm. and leg on the same side (due to a lesion in the opposite hemisphere) Staggering. unsteady gait Unable to keep feet together. and leg on the same side (due to a lesion in the opposite hemisphere) Paralysis of the face.and long-term memory loss Decreased attention span Impaired ability to concentrate Poor abstract reasoning Altered judgment Hemiplegia Ataxia Dysarthria Dysphagia Sensory Deficits Paresthesia (occurs on the side opposite the lesion) Verbal Deficits Expressive aphasia Receptive aphasia Global (mixed) aphasia Cognitive Deficits Emotional Deficits Loss of self-control Emotional lability Decreased tolerance to stressful situations Depression Withdrawal Fear.NEUROLOGIC DEFICIT Visual Field Deficits Homonymous hemianopsia (loss of half of the visual field) Loss of peripheral vision MANIFESTATION Unaware of persons or objects on side of visual loss Neglect of one side of the body Difficulty judging distances Difficulty seeing at night Unaware of objects or the borders of objects Double vision Diplopia Motor Deficits Hemiparesis Weakness of the face. and anger Feelings of isolation . arm.

• or global) • Altered intellectual ability • Slow. receptive. cautious behavior Comparison of Left and Right Hemispheric Strokes RIGHT HEMISPHERIC STROKE • Paralysis or weakness on left • side of body • Left visual field deficit • Spatial-perceptual deficits • Increased distractibility • Impulsive behavior and poor • judgment • Lack of awareness of deficits .LEFT HEMISPHERIC STROKE • Paralysis or weakness on right • side of body • Right visual field deficit • Aphasia (expressive.

MANAGEMENT .

Management Goals of stroke prevention include • Health management for the well individual • Education and management of modifiable risk factors to prevent a stroke .

Medical Management • Platelet-inhibiting medications(e. ACE inhibitors. dipyridamol) • Thrombolytic agents • Cholesterol-lowering statins • Antihypertensive medications (diuretics. angiotensin blockers. clopidogrel. calcium channel blockers.. aspirin.g. beta blockers.) • Calcium channel blockers . etc.

Surgical Management • • • • Carotid endarterectomy Transluminal angioplasty Stenting Cerebral bypass surgery .

Nursing Management Respiratory System • Maintain patent airway and administer O2 as prescribed Neurologic System • Monitor closely the patient for level of consciousness .

Maintain a BP of less than 150/100 • Monitor intake and output .Cardiovascular System • Monitoring vital signs frequently.

Musculoskeletal System • Trochanter roll at hip • Hand cones • Arm supports with slings and lap boards • PROM exercises .

Integumentary System • Maintain skin integrity • Provide skin care Gastrointestinal System • Assess gag reflex and ability to swallow • Feedings must be followed by scrupulous oral hygiene .

communication boards or computer technology.Communication • Speak slowly and calmly. . using simple words or sentences • Use picture boards.

• Approach the client from the unaffected side • Place the clients personal objects within the visual fields • Provide eye care for visual deficits • Place eye patch over the affected eye if the client has diplopia .