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Predisposing Factors:

1) Age ۞
VI. PATHOPHYSIOLOGY
2) Heredity
3) Race
4) Sex
5) Prior Stroke, TIA or heart attack
6) Socioeconomic Factors ۞
ETIOLOGY: Precipitating Factors:
unknown 1) Hypertension ۞
2) Cigarette Smoking
3) Diabetes Meliitus
4) Carotid or other Artery Disease
5) Atrial Fibrillation
6) Other heart disease
7) Sickle cell disease
8) Undesirable levels of cholesterol
9) Poor diet
10) Physical inactivity
11) Obesity
Narrowing of 12) Alcohol Abuse
blood vessel 13) Drug Abuse
Atherosclerosis

Dec. Capacity of the Formation of Plaque deposits


vessel to carry blood
components Thrombosis

Occlusion by major vessel


Inc. Cardiac work Inc. Pressure in the
load blood vessel HPN
If not managed
If managed:

Possible:
Dx: cranial CT scan,
Doppler, PET scan, Lysed or moved thrombus
MRI, cerebral from the vessel
angiography, lumbar
puncture, EEG/ECG,
skull x-ray, carotid
ultrasonography Vascular wall becomes
weakened and fragile
TX: aspirin,
thrombolytics, carotid
stenting, hypothermia, Leaking of blood from the
anticoagulants, surgical fragile vessel wall
decompression
(hemicraniectomy),
carotid endartectomy

Guarded Prognosis

Cerebral Hemorrhage
Sx:, headache,
unconsciousness,
If not managed nausea/vomiting,
If managed:
Dx: CT scan, MRI, cerebral angiography, visual
arteriography, disturbances
lumbar puncture, skull x-ray
Tx: chronic hypertensives, surgical
decompression, evacuation and
aspiration, administration of fresh frozen
Mass of blood forms and
plasma with fibrinogen or cryoprecipitate
grows
Decreased
Hematoma evacuation
ICP

Formation of cavity surrounded by dense gliosis


< 30 ml 30-60 ml > 60 ml
hemorrhage hemorrhage hemorrhage

Good prognosis Intermediate Poor prognosis


prognosis

Vasospasm of
tissue and arteries
Blood seeps into the Formation of small
ventricles and large clots CEREBRAL
HYPOPERFUSION
Sx: dizziness,
confusion,
Obstruction of CSF headache
passageway
Impaired distribution of
oxygen and glucose
Accumulation of CSF in
the ventricles
Tissue hypoxia and
cellular starvation
Ventricles dilate behind Lodges unto
the point of obstruction other cerebral
arteries Cerebral Ischemia

Increased ICP
Initiation of ischemic
cascade

If managed: If not managed


Ventriculostomy,
VP shunt, ICP Anaerobic metabolism by
Monitoring mitochondria
Alternative route Unrelieved
for return of CSF obstruction
in the circulation Production of oxygen free
Generates large amounts Failure production of radicals and other reactive
of lactic acid adenosine triphosphatase oxygen species
Compression of
brain tissues will Guarded
Metabolic Acidosis Failure of energy dependent
not occur Prognosis
process
(ion pumping)
Release of excitatory Damage to the blood
neurotransmitter glutamate vessel endothelium

Influx of calcium

Activates enzymes that Failure of


digest cell proteins, lipids mitochondria
and nuclear material

Further energy
depletion

Transient Ischemic Attack

If managed: If not managed


-t-PA (urokinase,
streptokinase)
-calcium channel Brain sustains an irreversible
blockers cerebral damage

Alters cerebral metabolism


Guarded
Prognosis
Dec. Cerebral perfussion

Paralysis of body, Damage of hemisphere of brain


speech impairment,
change in heart beat
Cascade of biochemical
processes
Influx of
sodium
Ischemic cascade
edema
threaten cell

Membrane depolarization of Vascular Congestion


cell wall

Compression of tissue

Increased intracranial
pressure

Impaired perfusion and


function

Middle Anterior cerebral Posterior Internal Carotid Vertebrobasilar Anteroinferior Posteroinferior


Cerebral Artery artery CerebraI Artery Artery System Cerebellar cerebellar

Lateral Frontal Lobe Occipital lobe; Branches into Cerebellum and Cerebellum Cerebellum
hemisphere, anterior and ophthalmic, PCA, brain stem
frontal, parietal medial portion of anterior choroidal,
and temporal temporal lobe ACA, MCA
lobes, basal
ganglia
Sx:
Sx: Sx:
Contralateral Sx: Sx: Sx:
contralateral Ipsilateral Sx:
hemiparesis or Contralateral Mild Alternating
hemiparesis ataxia, facial Ataxia,
hemiplegia, hemiparesis, contralateral motor
with facial paralysis, paralysis of the
unilateral foot and leg hemiparesis, weaknesses,
asymmetry, ipsilateral loss larynx and soft
neglect, altered deficits greater intention ataxic gait,
contralateral of sensation in palate,
consciousness than the arm, tremor, diffuse dysmetria,
sensory face, sensation ipsilateral loss
, homonymous foot drop, gait sensory loss, contralateral
alterations, changes on of sensation in
hemianopsia, disturbances, pupillary hemisensory
homonymous trunk and face,
inability to turn contralateral dysfunction, impairments,
hemianopsia, limbs, contralateral on
eyes toward hemisensory loss of double vision,
ipsilateral nystagmus, body,
affected side, alterations, conjugate homonymous
periods of Horner’s nystagmus,
vision deviation of gaze, hemianopsia,
blindness, syndrome, dysarthria,
changes, eyes toward nystagmus, nystagmus,
aphasia if tinnitus, Horner’s
dyslexia, affected side, loss of depth conjugate
dominant hearing loss syndrome,
dysgraphia, expressive perception, gaze,
hemisphere is hiccups and
aphasia, aphasia, cortical paralysis,
involved, Mild coughing,
agnosia, confusion, blindness, dysarthria,
Horner’s vertigo, nausea
memory amnesia, flat homonymous memory loss,
syndrome, and vomiting
deficits, affect, apathy, hemianopsia, disorientation,
carotid bruits
vomiting shortened perseveration, drop attacks,
attention span, dyslexia, tinnitus,
loss of mental memory hearing loss,
acuity, apraxia, deficits, visual vertigo,
incontinence hallucinations dysphagia,
coma
If managed: If not managed:
Palliative care-
Frequent vital sign and
neurovital signs,
intubation, mechanical
ventilation, Continued insufficiency of blood
vasodilators, osmotic flow
diuretics,
ventriculostomy, ICP
monitoring
Further compression of tissues

good cerebral perfusion

Coma

good improvement

Cerebral Death

Good
Prognosis
Loss of neural feedback
mechanisms

Cessation of physiologic
functions
Cardiovascular Pulmonary GUT Other systems
GIT
System System

Relaxation of
intestines and Sx: restlessness,
Loss of cardiac Relaxation of abnormal
muscle function sphincters thermoregulation,
venous valves
mental confusion,
increased secretions,
decreased urinary
Sx: Sx: output.
bradycardi hypotensio
a n
Loss of bowel
Failure of accessory Loss of lung control
Decreased muscles for breathing movement
cardiac output Neurogenic bladder Loss of sphincter
control
Sx:
apnea

Cardiopulmonary arrest

Systemic Failure

DEATH