CEREBROVASCULAR ACCIDENT (STROKE)

 Also referred to as a brain attack.

 Is a condition in which neurologic deficits results from decreased blood flow to a
localized area of the brain.

2 Major Categories
 Ischemic
o When blood supply to a part of the brain is suddenly interrupted by a thrombus
or embolus.

 Hemorrhage
o When a blood vessel breaks open, spilling blood into spaces surrounding
neurons.

 Major loss of blood supply to the brain can cause severe disability or death.
 Third leading cause of death.
 CVA occurs more frequently in men then women.

Risk Factors

 Hypertension
 DM
 Sickle cell disease
 Substance abuse
 Atherosclerosis
 Family hx. of obesity
 Sedentary lifestyle
 Hyperlipidemia
 Atrial fibrilliation
 Cardiac diseases
 Cigarette smoking
 TIA
 Previous transient Ischemic attack
 Women-oral contraceptive use, pregnancy, menopause
 Embolism
o The second most common cause of CVA.
o Most commonly affecting younger people.
o Most frequently caused by rheumatic heart disease and myocardial infarction.
o Symptoms occur at any time and progress rapidly.

Ischemic Stroke
 Results from cerebrovascular obstruction by thrombosis or emboli
 TIA
 Thrombotic stroke
 Embrolic stroke

Transient Ischemic Attack

 Refers to cerebral ischemia with temporary episodes of neurologic disfunction.
 Manifestations include contralateral weakness of the lower portion of the face,
fingers, hands, arms, legs and corner of the mouth, transient dysphagia, and sensory
impairment.
Stroke in evolution refers to development of a neurologic deficits.

Aphasia
 Due to ischemia of the left hemisphere
 Visual disturbances due to involvement of the posterior cerebral artery.

Thrombotic stroke
 Most frequent cause of CVA
 Cause by occlusion of large cerebral vessel by a thrombus
 Occur in older people who are resting or asleep.
 Characterized by gradual deterioration of the client’s condition.
 This may also occur among clients with diabetes mellitus and hypertension.

Lacunar stroke
 Affecting the smaller arteries

Stroke in Evolution
 Refers to development of a neurologic deficit
Completed Stroke
 Refers to a permanent neurologic deficit.
Embolic Stroke
 The second most common cause of CVA.
 Most commonly affecting younger people.
 Most frequently caused by rheumatic heart disease and myocardial infarction.
 Symptoms occur at any time and progress rapidly.

Hemorrhagic Stroke or Intracranial Hemorrhage

 Occurs when a cerebral blood vessel ruptures.
 May be due to hypertension, subarachnoid hemorrhage, rupture of aneurysm, A –
V malformation, hypocoagulation.

Manifestations depend on the location of the hemorrhage

∙ Include vomiting seizures, hemiplegia and loss of consciousness.

∙ Usually with some degree of weakness
∙ The deficit include

Hemiplegia
▪Paralysis of the left or right half of the body.
Hemiparesis
▪Weaknesses of the left or right half of the body.
Flaccidity
▪Absence of muscle tone (hypotonia)
Spasticity
▪Increase muscle tone (hypertonia)
Usually with some degree of weakness
Sensory perceptual deficit:
The client experience in vision, hearing, equilibrium, taste and sense of
smell.
The loss of these sensory abilities increases the risk for injury.

OTHER DEFICITS
 Hemianopia
o Loss of half of visual field of one or both eyes, when the same half is missing in
each eye, the condition is called homonymous hemianopia.

 Agnosia
o The inability to recognize one or more subjects that were previously familiar,
agnosia maybe visual, tactile, or auditory.

 Apraxia
o The inability carry out some motor pattern.
o Neglect Syndrome or unilateral neglect
o In which the client has a disorder of attention.
Communication Disorders:
 Aphasia
◦Inability to use or understand language;
◦Aphasia may be expressive, receptive or mixed.

 Expressive Aphasia
◦A motor speech problem in which can understand what is being sad but can
respond verbally only in short phrases; also called Broccas aphasia

 Receptive Aphasia’s sensory

◦speech problem in which one cannot understand the spoken (and often written)
word
 Wernicke aphasia.
◦Speech maybe fluent but with inappropriate content

Diagnostic Tests:
 Computed tomography (CT)
 Arteriography
 Transcranial Ultrasound Doppler (TCD)
 Positron emission tomography (PET)
 Single Photon Emission Computed Topography(SPECT)
 Lumbar Puncture

Prevention:
 Anti platelet agents are often used to treat clients with TIA’s or previous stroke
◦Aspirin, clopidogrel(Plavix), dypiridamole(Persantine), pentoxifylline(Trental)

 Anticoagulant drug therapy is often ordered for the thrombotic stroke during the
stroke in evolution phase but is contra indicated in completed stroke
◦Sodium Heparin or Warfarin sodium(Coumadine)

 Anti thrombotic
◦Both aspirin and dipyridamole

 Calcium channel blockers

◦ nimodipine(Nimotop)
◦ to reduce ischemic deficit

 Corticosteriods
◦Prednisone or Dexamethasone
 ◦to treat cerebral edema

 Hyperosmolar solutions
◦Manintol or diuretics such as furosemide

 Anticonvulsants to prevent seizures

◦phenytoin(Dilantin) and barbiturates

Health promotion:
 Maintaining normal weight through diet and exercise
 Regular health care to monitor for and treat cardiovascular disorders and to detect
and treat infections. Cholesterol level should screen regularly.
 Importance of stopping smoking and drug use

Assessment:
 Health history and physical assessment