Cerebrovascular Accident(CVA


Cerebrovascular accidents include Ischemic stroke, Hemorrhagic stroke, Embolic stroke Cerebrovascular anomalies such as intracranial aneurysms and arteriovenous malformations (AVMs).

A stroke, or cerebrovascular accident, is defined as

Abrupt onset of a neurologic deficit that is attributable to a focal vascular cause.

The clinical manifestations of stroke are highly variable because of the complex anatomy of the brain and its vasculature.

Cerebral ischemia is caused by a reduction in blood flow that lasts longer than several seconds.

Neurologic symptoms are manifest within seconds because neurons lack glycogen, so energy failure is rapid.

When blood flow is quickly restored, brain tissue can recover fully and the patient's symptoms are only transient: this is called a transient ischemic attack (TIA).

Typically the neurologic signs and symptoms of a TIA last for 5 to 15 min but, by definition, must last <24 h.

If the cessation of flow lasts for more than a few minutes, infarction or death of brain tissue results.

Stroke has occurred if the neurologic signs and symptoms last for >24 h.

A generalized reduction in cerebral blood flow syncope


If low cerebral blood flow persists for a longer duration, then infarction in the border zones between the major cerebral artery distributions may develop.

In more severe instances, global hypoxia-ischemia causes widespread brain injury Hypoxic-ischemic encephalopathy.

Etiology of ischemic stroke 1.Cardioembolic 2.Atherosclerosis 3.Hypercoagulable states 4.Moya Moya disease 5.Binswangers disease 6.CADASIL 7.Arteritis 8.Venous sinus thrombosis 9.Drugs

Risk Factors
Hypertension Diabetes mellitus Oral contraceptives Pregnancy Menopause

Cigarette smoking Substance abuse Atherosclerosis Obesity Sedentary life-style Hyperlipidemia Atrial fibrillation Cardiac disease

Sources of emboli:
Embolic CVA ‡ Blood clot or clump of matter lodges in cerebral blood vessel ‡ Frequently in bifurcation of vessels

‡ Atrial fibrillation ‡ Carotid atherosclerotic plaque ‡ Bacterial endocarditis ‡ MI ‡ RHD ‡ Ventricular aneurysm

Hemorraghic stroke ‡ Intracranial hemorrhage ‡ Cerebral blood vessel rupture ‡ Most fatal

Causes: ‡ Hypertension ‡ Intracranial aneurysm ‡ Trauma ‡ Tumors ‡ AV malformation ‡ Anticoagulants ‡ Blood disorders

Manifestations Hemiplegia Hemiparesis Cranial nerve palsy Hemianopia Monoplegia/ paresis Seizures Aphasia Sensory deficit Cognitive disturbances Death

Complications Aspiration Recurrent infections Disuse atrophy Reduced quality of life Dependent edema Orthostatic hypotension Thrombus formation Osteoporosis Renal calculi Contractures Pressure ulcers

Investigations CT brain MRI Carotid doppler

CT shows Lft.MCA infarct Massive Midline shift present

Rt. Capsular hemorrhage No midline shift

Treatment Acute stroke 1.Golden hour < 3 hrs 2.t- PA for thrombolysis Anti platelets ± aspirin, clopidogrel Heparin venous infarct, embolic stroke Statins

Mass effect Anti edema measures mannitol, dexamethasone Control of hypertension Anti epileptics for seizure

Physiotherapy Occupational therapy Speech therapy Adequate nursing care

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