CEREBROVASCULAR DISORDER (CVD

)

DEFINITION

“Cerebrovascular Disorder” is an umbrella term that refers to a functional abnormality of the central nervous system (CNS) that occurs when the normal blood supply to the brain is disrupted.

TYPES OF CVA

 Ischemic

Stroke- Cerebrovascular accidents (CVA) or “brain attack’’ is a sudden loss of function resulting from disruption of the blood supply to a part of the brain. The term “brain attack” is being used to suggest to health care practitioners and the public that a stroke is an urgent health care issue similar to a heart attack.

Ischemic stroke subdivided into five different types based on the cause:

Large artery thrombotic stokes- are caused by atherosclerotic plagues in the large blood vessels of the brain. Thrombus formation and occlusion at the site of the atherosclerosis result in ischemia and infarction (deprivation of blood supply) Small penetrating artery thrombotic strokes- affect one or more vessels and are the most common type of ischemic stroke.Small artery thrombotic strokes are also called lacunar strokes because of the cavity that is created after the death of infracted brain tissue.

 

Cardiogenic embolic strokes- are associated with cardiac dysrhythmias, usually atrial fibrillation. Embolic strokes can also be associated with valvular heart disease and thrombi in the left ventricle.Emboli originate from the heart circulate to the cerebral vasculature, most commonly the left middle cerebral Artery,resulting in a stroke.Embolic strokes may be prevented by the use of anticoagulation therapy in patients with atrial fibrillation. Cryptogenic strokes-no known cause. Strokes from other causes-such as illicit drug use coagulopathies, migraine and spontaneous dissection of the carotid or vertebral arteries.

 Hemorrhagic

stroke- is primarily caused by intracranial or subarachnoid hemorrhage.Hemorrhagis strokes are caused by bleeding into the brain tissue, the ventricles, or the subarachnoid space. Primary intracerebral hemorrhage from a spontaneous rupture of small vessels accounts for approximately 80% of hemorrhagic strokes and is caused chiefly by uncontrolled hypertension.Subarachnoid hemorrhage results from a ruptured intracranial aneurysm (a weakening in the arterial wall) in about half the causes. Another common cause of intracerebral hemorrhage in the elderly is cerebral amyloid angiopathy, which involves damage caused by the deposit of beta-amyloid protein in the small and medium sized blood vessels of the brain. Secondary intracerebral hemorrhage is associated with arteriovenous malformations (AVMs), intracranial aneurysms, intracranial neoplasms, or certain medications (e.g., anticoagulants, amphetamines).

SIGNS AND SYMPTOMS

Ischemic Stroke
 Numbness

or weakness of the face, arm, or leg, especially on one side of the body.  Confusion or change in mental status  Trouble speaking or understanding speech  Visual disturbances  Difficulty walking, dizziness,or loss of balance or coordination  Sudden severe headache

 Visual

field Deficits

Homonymous

hemianopsia Loss of peripheral vision Diplopia
 Motor

Deficits

Hemiparesis Hemiplegia Ataxia Dysarthria Dysphagia

 Sensory

Deficits  Paresthesia  Verbal Deficits  Expressive aphasia  Receptive aphasia  Global aphasia  Cognitive Deficits  Short and long term memory loss  Decreased attention span  Impaired ability to concentrate  Poor abstract reasoning  altered judgment

 Emotional

Deficits  loss self control  Emotional lability  Decreased tolerance to stressful situations  Depression  Withdrawal  Fear, hostility and anger  Feeling of isolation

Hemorrhagic Stroke
 Severe

headache (exploding headache)  Vomiting  Early sudden change in level of consciousness  Possible focal seizures due to frequent braine stem involvement  Pain and rigidity of the back of the neck (nuchal rigidity)  Visual disturbances (loss, diplopia, ptosis) occur if the aneurysm is adjacent to the oculomotor nerve.  Tinnitus  Dizziness  Hemiparesis

EMERGENCY MANAGEMENT

 Sudden

onset of neurological symptoms which last longer than 24 hours, due to either blockage of the brain artery or bleeding into or around the brain.  Stroke is a medical emergency  Patient with suspected or actual stroke should be triaged to ATS  Use FAST criteria to identify stroke  Patient with prolonged TIA symptoms(>60mins) should be triaged as stroke  Use ABCD risk stratification to identify patients with high risk of stroke

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