BATAAN PENINSULA STATE UNIVERSITY COLLEGE OF NURSING BALANGA, CAMPUS

CEREBROVASCULAR ACCIDENT

I.INTRODUCTION Cerebrovascular accident, or stroke, is, in general terms, a disturbance in cerebral circulation. A focal neurologic disorder, it maybe secondary to a pathologic process within the cerebral bloods vessels such as thrombosis, embolus, rupture of a blood vessel, or basic vascular disease such as artherosclerosis, arteritis, trauma, aneurysm or developmental malformation. A stroke happens when the blood supply to the brain is disturbed in some way. As a result, brain cells are starved of oxygen. This causes some cells to die and leaves other cell damage. MAJOR TYPES OF STROKE: ISCHEMIC STROKE- when blood clots one of the arteries (blood vessels) that carries blood to the brain. Ischemic stroke are subdivided into 5 different types based on the cause: a. Large artery thrombotic stroke are caused by artherosclerotic plaques in the large blood vessels of the brain. b. Small penetrating artery thrombotic stroke affect one or more vessels and are the most common type of ischemic stroke. c. Cardiogenic embolic stroke are associated with cardio dysrhythmias, usually arterial fibrillation. Also associated with valvular heart disease and thrombi in the left ventricle. d. Cryptogenic or no known cause, and stroke from other causes, such as, illicit drugs use, coagulopathies, migraine, and spontaneous dissection of the carotid or vertebral arteries. HEMORRAHAGIC STROKE- is caused by bleeding into the brain tissue, the ventricles, or the subarachnoid space. a. Intra cerebral hemorrhage or bleeding into the brain substance is most common in patient, with hypertension, and cerebral arherosclerosis, because degenerative changes from the disease cause rupture of the blood vessel. b. Intracranial (cerebral) aneurysm is a dilation of the walls of the cerebral artery that develops as a result of weakness in the arterial wall.

c. Subarachnoid hemorrhage (hemorrhage into the subarachnoid space) may occur as a result on of an AVM, intracranial aneurysm, .trauma of hypertension. d. Arteriovenous malformations an AVM is caused by abnormality in embryonal development that leads to a tangle of arteries and veins in the brain that lacks a capillary bed. Symptoms of a stroke: A stroke is always serious and can be life-threatening. The symptoms that occur following a stroke depend on the area of the brain that has been affected and the extent of the damage. Some of symptoms that can occur include: Sudden severe headache. There may be a partial or complete loss of voluntary movements and/or feelings in leg and/or arm. A stroke can result in speech problems and weak muscles of the face, which can cause drooling. Numbness of tingling is very common. A stroke involving the base of the brain can affect balance, vision, and swallowing functions. A stroke can cause difficulty in breathing and even unconsciousness. Confusion or change in mental status. What are the risk factors? High blood pressure does not cause any symptoms, so everyone over the age of 40 should have an annual blood pressure. Smokers have double the risk of stroke as non-smoker. Diabetes affects 1 in 20 older people and can increase the risk of having a stroke. Good control of diabetes is important and requires attention to diet, regular urine, tests or blood tests and probably some medication. Too much alcohol increases the risk of stroke. The recommended safe limits for alcohol consumption are 21 units each week for women and 28 units for men. One unit of alcohol is equivalent a measure of spirits, a 125 ml glass of wine or half a pint of beer. People who drink more than this run a higher risk of stroke, liver disease and dementia.

II. ANATOMY AND PHYSIOLOGY THE CENTRAL NERVOUS SYSTEM The central nervous system (CNS) represents the largest part of the nervous system, including the brain and the spinal cord. Together with the peripheral, it has a fundamental role in the control of the behavior. The CNS is contained within the dorsal cavity, with the brain within the cranial cavity. The CNS is covered by the meninges. The BRAIN is also protected by the skull, and the spinal cord is also protected by the vertebrae.

Anatomy of the brain The brain is divided into three major areas: the cerebrum, the brain stem, and the cerebellum. The cerebrum is composed of two hemispheres, the thalamus, the hypothalamus and the basal ganglia. The brain stem includes the midbrain, pons, medulla, and the connections, for cranial nerves II (optic) and IV (trochlear) through XII (hypoglossal). The cerebellum is located under the cerebrum and behind the brain stem. The brain accounts for approximately 2 % of the total body weight; it weighs approximately 1,400 g in an average young adult.

The thalamus encloses the third ventricles and is the relay station for sensory impulses passing to the sensory cortex for interpretation. The hypothalamus makes up the floor of the third ventricles and is the most important regulatory center of the autonomic nervous system. The brain stem is the short region inferior to the hypothalamus that merges with the spinal cord. The midbrain is most superior and is primarily fiber tracts. The pons is inferior to the midbrain and has fiber tracts and nuclei involved in respiration. The medulla oblongata is the most inferior part of the brain stem. It contains autonomic nuclei involved in the regulation of the vital life activities (breathing, heart rate, blood pressure, etc.) The cerebral hemispheres Frontal- the largest lobe. The major functions of this lobe are concebtration abstract thought, information storage, or memory or motor function. Parietal- a predominantly sensory lobe. The primary sensory cortex, which analyzes sensory information and relays the interpretation of this information to the thalamus, and the cortical areas, is located in the parietal lobe. It is also essential to an individuals awareness of the body in space, as well as orientation in space and spatial relations. Temporal- contains the auditory receptive areas. Contains a vital area called the interpretative area that provides integration of somatization, viual,