Introduction

Cerebrovascular accident (CVA) also known as a stroke is described as a group of

conditions involving the death of brain tissue due to disruption of its vascular supply. According

to Hinkle, Cheever (2018), a stroke is a sudden loss of function resulting from disruption of the

blood supply to a part of the brain. Strokes can be divided into two major categories: ischemic

(approximately 87%) and hemorrhagic (13%). Ischemic stroke, being the most common type of

the two results when arteries supplying brain tissue are blocked. It is often caused by cerebral

thrombosis and cerebral embolism. Usually the plaque consists of cholesterol, calcium, fat, and

cellular waste products. For hemorrhagic strokes, it results from bleeding of arteries supplying

brain tissue.

Hemorrhage strokes accounts for 13% of strokes. As stated by Hinkle and Cheever

(2018), it is primarily caused by intracranial and subarachnoid hemorrhage. Intracerebral

hemorrhage, or bleeding into the brain tissue, is most common in patient with hypertension and

cerebral atherosclerosis. A subarachnoid hemorrhage may occur as a result of arteriovenous

malformations, intracranial aneurysm, trauma, or hypertension. The most common cause is

leaking in the area of the circle of Willis and a congenital AVM of the brain.

Ischemic strokes are usually caused by large artery thrombosis, small penetrating artery

thrombosis, cardiogenic embolic, and cryptogenic. Its main presenting symptoms are numbness

or weakness of the face, arm or leg, especially on one side of the body. They recover usually at 6

months. As for hemorrhagic strokes they are usually caused by intracerebral hemorrhage,

subarachnoid hemorrhage, cerebral embolism, and arteriovenous malformation. Its main

presenting symptoms are “exploding headache” and a decreased level of consciousness. Its time

to heal is usually slower at about 18 months.

 Cerebrovascular Accident comes in four stages TIA, RIND, SIE, and CS. A transient

ischemic attack (TIA) is a stroke that lasts only a few minutes. It happens when the blood supply

to part of the brain is briefly blocked. Symptoms of a TIA are like other stroke symptoms, but do

not last as long. They happen suddenly and include numbness or weakness, especially on one

side of the body. Reversable ischemic neurological deficit is a type of stroke due to the occlusion

of blood supply to the brain leading to ischemia and neurological deficits which recover from 24

hours and up to a few weeks. Stroke in evolution is where progression or an in- crease of severity

of the neurological signs has occurred within recent minutes. 1 This diagnosis is made from

analysis of the patient's history and by repeated examination. Lastly, complete stroke a

neurologic deficit due to occlusive cerebrovascular disease which may persist for hours or days. l

Cerebral infarction may be presumed if the neural deficit lasts for several days and can cause

death.

The risk factors predisposing of stroke are heart diseases, age and gender, race (African

American) and ethnicity, personal or family history of stroke or transient ischemic attack,

previous stroke, cardiomegaly and brain aneurysm or arteriovenous malformations. The

precipitating factors of stroke are hypertension, diabetes mellitus, obesity, sedentary lifestyle,

high cholesterol, smoking, falls and alcoholic. Signs and symptoms of CVA includes Balance,

Eyes, Face drooping, Arm weakness, Speech difficulty, and Time to call.

Complications of CVA include Brain edema swelling of the brain after a stroke.

Pneumonia causes breathing problems, a complication of many major illnesses. Common

swallowing problems after stroke can sometimes result in things ‘going down the wrong pipe’,

leading to aspiration pneumonia. Urinary tract infection and/or bladder control. Seizures

abnormal electrical activity in the brain causing convulsions. Clinical depression a treatable
illness that often occurs with stroke and causes unwanted emotional and physical reactions to

changes and losses. Bedsores pressure ulcers that result from decreased ability to move and

pressure on areas of the body because of immobility. Limb contractures shortened muscles in an

arm or leg from reduced range of motion or lack of exercise. Shoulder pain stems from lack of

support of an arm due to weakness or paralysis. This usually is caused when the affected arm

hangs resulting in pulling of the arm on the shoulder. Deep venous thrombosis blood clots form

in veins of the legs because of immobility from stroke.

According to Who (2016), cerebrovascular accidents are the second leading cause of

death and the third leading cause of disability. Globally, 70% of strokes and 87% of stroke-

related deaths and disability-adjusted life years occur in low- and middle-income countries. In

the Philippines, stroke second leading cause of death. It has a prevalence of 0·9%; ischemic

stroke comprises 70% while hemorrhagic stroke comprises 30%. Age-adjusted hypertension

prevalence is 20·6%, diabetes 6·0%, dyslipidemia 72·0%, smoking 31%, and obesity 4·9%. The

neurologist-to-patient ratio is 1:330·000, with 67% of neurologists practicing in urban centers.

Health care is largely private, and the cost is borne out-of-pocket by patients and their families.

Challenges include delivering adequate support to the rural communities and to the

underprivileged sectors.

The purpose of this study is to instill knowledge to the listeners about cerebrovascular

accident or stroke. Particularly about hemorrhagic strokes. With this information, the listeners

will be able to recognize different types of cerebrovascular accidents along with its sign and

symptoms and its management.

 Definition of Terms
Arteriovenous malformations – It is an abnormality in embryonal development that
leads to tangle of arteries and veins in the brain that lacks a capillary bed
Atherosclerosis – It is the hardening of the arteries. It is the most common disease of the
arteries
Brain Aneurism – Is a dilation of the walls of a cerebral artery that develops as a result
of weakness in the arterial wall.
Diabetes Mellitus – It’s a group of metabolic diseases characterized by hyperglycemia
resulting from defects in insulin secretion, insulin action, or both.
Hypertension – Is defined by the American Society of Hypertension and the
International Society of Hypertension as a systolic blood pressure (SBP) of 140mm Hg or a
diastolic blood pressure of 90 mm Hg or higher.
Intracerebral Hemorrhage – It is bleeding inside the brain. Degenerative changes from
these diseases cause rupture of the blood vessel.
Subarachnoid Hemorrhage – There is bleeding between the brain and skull or bleeding
within the subarachnoid space.
Transient ischemic attack – It is a neurologic deficit typically lasting for 1 to 2 hours. A
TIA is manifested by a sudden loss of motor, sensory, or visual function.
Thrombosis - is the formation of a blood clot, known as a thrombus, within a blood
vessel. It prevents blood from flowing normally through the circulatory system.
Embolism - The obstruction of a blood vessel by a foreign substance or a blood clot that
travels through the bloodstream, lodging in a blood vessel, plugging the vessel. ... Blood clots are
the most common causes of embolisms.
Hemorrhagic Stroke - stroke caused by the rupture of a blood vessel in or on the surface
of the brain with bleeding into the surrounding tissue.
Aneurysm - A localized widening (dilatation) of an artery, a vein, or the heart. At the
point of an aneurysm, there is typically a bulge. The wall of the blood vessel or organ is
weakened and may rupture.
 Hemiparesis - unilateral paresis, is weakness of one entire side of the body (hemi- means
"half").
Hemiplegic - In its most severe form, complete paralysis of half of the body.
Cheyne Stoke - A cyclic breathing marked by a gradual increase in the rapidity of
respiration followed by a gradual decrease and total cessation for from 5 to 50 seconds and found
especially in advanced kidney and heart disease, asthma, and increased intracranial pressure.