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Cerebrovascular Accident A stroke, previously known medically as a cerebrovascular accident (CVA), is the rapidly developing loss of brain function(s)

due to disturbance in the blood supply to the brain. This can be due to ischemia (lack of blood flow) caused by blockage (thrombosis, arterial embolism), or a hemorrhage (leakage of blood). As a result, the affected area of the brain is unable to function, which might result in an inability to move one or more limbs on one side of the body, inability to understand or formulate speech, or an inability to see one side of the visual field. Classification Ischemic In an ischemic stroke, blood supply to part of the brain is decreased, leading to dysfunction of the brain tissue in that area. There are four reasons why this might happen: 1. Thrombosis (obstruction of a blood vessel by a blood clot forming locally) 2. Embolism (obstruction due to an embolus from elsewhere in the body, see below), 3. Systemic hypo perfusion (general decrease in blood supply, e.g., in shock) 4. Venous thrombosis. Hemorrhagic Intracranial hemorrhage is the accumulation of blood anywhere within the skull vault. A distinction is made between intra-axial hemorrhage (blood inside the brain) and extra-axial hemorrhage (blood inside the skull but outside the brain). Intra-axial hemorrhage is due to intraparenchymal hemorrhage or intraventricular hemorrhage (blood in the ventricular system). The main types of extra-axial hemorrhage are epidural hematoma (bleeding between the dura mater and the skull),subdural hematoma (in the subdural space) and subarachnoid hemorrhage (between the arachnoid mater and pia mater.

Types of stroke Transient ischaemic attack (TIA) or 'mini-stroke' is a short-term stroke that lasts for less than 24 hours. The oxygen supply to the brain is quickly restored and symptoms disappear. A transient stroke needs prompt medical attention because it indicates a serious risk of a major stroke Cerebral thrombosis is when a blood clot (thrombus) forms in an artery that supplies blood to the brain. Blood vessels that are furred up with fatty deposits (atheroma) make a blockage more likely. The clot prevents blood flowing to the brain and cells are starved of oxygen. Cerebral embolism is a blood clot that forms elsewhere in the body before travelling through the blood vessels and lodging in the brain. In the brain, it starve cells of oxygen. An irregular heartbeat or recent heart attack may make you prone to forming blood clots. Cerebral hemorrhage is when a blood vessel bursts inside the brain and bleeds (hemorrhages). With a hemorrhage, blood seeps into the brain tissue and causes extra damage.

Signs and symptoms


altered smell, taste, hearing, or vision (total or partial) drooping of eyelid (ptosis) and weakness of ocular muscles decreased reflexes: gag, swallow, pupil reactivity to light decreased sensation and muscle weakness of the face balance problems and nystagmus altered breathing and heart rate weakness in sternocleidomastoid muscle with inability to turn head to one side weakness in tongue (inability to protrude and/or move from side to side)

If the cerebral cortex is involved, the CNS pathways can again be affected, but also can produce the following symptoms:

aphasia (difficulty with verbal expression, auditory comprehension, reading and/or writing Broca's or Wernicke's area typically involved) dysarthria (motor speech disorder resulting from neurological injury) apraxia (altered voluntary movements) visual field defect memory deficits (involvement of temporal lobe) hemineglect (involvement of parietal lobe) disorganized thinking, confusion, hypersexual gestures (with involvement of frontal lobe) anosognosia (persistent denial of the existence of a, usually stroke-related, deficit)

If the cerebellum is involved, the patient may have the following:


trouble walking altered movement coordination vertigo and or disequilibrium hemiplegia and muscle weakness of the face numbness reduction in sensory or vibratory sensation initial flaccidity (hypotonicity), replaced by spasticity (hypertonicity), hyperreflexia, and obligatory synergies.

Risk Factors

Age High blood pressure weakens the walls of arteries Atherosclerosis narrowed artery channels Heart disease cause blot clot in the heart that may break off and migrate to the brain. Diabetes mellitus accelerated degeneration of small blood vessel Smoking increase the risk ofhypertension Polycythemia a raised level of red cells in the blood. Hyperlipidemia high level of fatty substances in the blood

Diagnostic Test A neurological examination (such as the Nihss), CT scans (most often without contrast enhancements) or MRI scans Arteriography SPECT and PET

Nursning intervention Patient care management goal: to support the patients vital functions, restore cerebral blood flow, minimize neurologic deficits, and prevent progression 1. Maintain a patent airway to promote adequate oxygenation 2. Administer oxygen therapy with possible intubation and mechanical ventilation to ensure adequate tissue perfusion 3. Maintain bed rest to minimize metabolic requirements 4. Provide I.V. fluids to support blood pressure and maintain volume 5. Administer dexamethasone to reduce cerebral edema 6. Administer anticoagulants and antiplatelet drugs for thrombotic conditions after hemorrhage has been ruled out 7. Administer sedatives, such as Phenobarbital, to decrease metabolic requirements 8. Assess the patients neurologic status; observe for CVA progression and level of consciousness (LOC) change as evidenced by decreasing numerical score on the GLASGOW COMA SCALE. 9. Correct cardiovascular abnormalities, such as atrial fibrillation, that may be contributing factors 10. Consider surgical procedures to correct circulatory impairment, prevent repeated hemorrhage, or relieve cerebral pressure 11. Begin bedside range-of-motion exercise to preserve mobility and prevent deformities 12. Teach the patient to identify risk factors and necessary life-style modifications, such as diet, stress reduction, and smoking cessation 13. Direct the family to community groups that provide support or rehabilitation

Prevention An important facet of rehabilitation is preventing the recurrence of stroke. Control of blood pressure is the single most important factor in the prevention of strokes. People should regularly have their blood pressure checked, and if it is found to be consistently elevated (diastolic, or lower blood pressure beat above 90 to 100, systolic or top beat above 140 to 150), a physician should be consulted. Diet, including the reduction of sodium (salt) intake, exercise, and weight loss, if necessary, are all non-drug treatments for lowering blood pressure. Other natural remedies include the consumption of artichoke, which lowers the fat content of the blood, garlic, now believed to lower cholesterol and blood pressure as well as reduce blood's clotting ability, and ginkgo, which improves circulation and strengthens arteries and veins. The use of folic acid, lecithin, and vitamins B6, B12, C, and E is recommended as supportive measures in reducing blood pressure. Multiple studies have found that aspirin acts as a blood-thinning, or clot-reducing, medication when taken in small doses. One aspirin tablet per day provides this anti-coagulant prevention. If necessary, a physician may also order medication to lower blood pressure. These medications include the following categories of drugs:

Beta blockers are used to reduce the force and speed of the heart-beat. Vasodilators are used to dilate the blood vessels. Diuretics reduce the total volume of circulating blood and thus the heart's work by removing fluid from the body. Lipid-lowering drugs increase the loss of cholesterol from the body or prevent the conversion of fatty acids to cholesterol. This lowers fat levels in the bloodstream.

Cerebrovascular Accident

Submitted by: Cheena M.Dolormente Submitted to: Archito L. Dela Cruz