Transcript Cerebral Vascular Accident

Cerebral Vascular
Accident
M. DuBois Fennal, PhD, RN, CNS
05/19/16
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Definition
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A cerebral vascular accident
(CVA), Stroke, or Brain Attack: An
event that occurs as the result of
ischemia to the brain, a clot that
blocks a blood vessel to the brain,
or bleeding in the brain caused by
a ruptured blood vessel.
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Etiology
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A brain attack is caused either by
ischemia (ischemic strokes) to the
brain, a clot that causes a block in
a blood vessel in the brain
(thrombotic stroke), or by bleeding
that occurs as a result of a
ruptured blood vessel to the brain
(Hemorrhagic stroke)
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Incidence
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Third leading cause of death in the
United States
500,000 cases each year
160,000 deaths per year
Occurs most often in individuals
over 65 years of age
28% of brain attacks occur in
individuals under sixty-five years of
age.
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Occur more frequently in men than
in women
Higher incidence of occurrence in
African-Americans. (2.5 times >).
25% of clients who survive a brain
attack are left with some type of
functional impairment.
Incidence of hemorrhagic brain
attacks is highest in Asians
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Risk Factors
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Hypertension
Diabetes Mellitus
Sickle Cell Disease
Substance abuse
Atherosclerosis
Family history
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Other Risk Factors
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Obesity
Sedentary lifestyle
Hyperlipidemia
Atrial fibrillation
Cardiac disease
Cigarette smoking
Transient Ischemic Attack
Oral contraceptives
Menopause
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Pathophysiology
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May occur suddenly or be of
gradual onset
Deficits found on examination will
depend on where the blood supply
has been decreased
An infarct is the result of loss of
blood supply to a part of the brain
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The pathology of a brain attack
depends on the etiology of the
incident.
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Thrombotic Brain Attack
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Cerebral thromboses: occurs when
arteries supplying the brain or
intercranial vessels are occluded
by thrombi that arise from arterial
occlusions.
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Cerebral emboli and cerebral
thrombi are the most common
pathology of occlusion, however,
atherosclerosis plays a major role
in the pathology as well.
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Transient Ischemic attacks, cause
thrombotic attacks. Thrombotic
particles causing intermittent
blockage of the circulatio
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Embolic Attack
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Involves fragments that break
away from a thrombus formed
outside of the brain
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Hemorrhagic Attack
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Intercranial hemorrage: third most
common cause of CVA
It involves bleeding into the brain,
displacement of structures, and
compression of vital centers.
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Lacunar Stroke
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Those attacks that are smaller than
1 cm in diameter
Involve small perforating arteries
Associated with hypertension and
diabetes
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In ischemic infarctions the affected
area becomes discolored and soft
six to twelve hours after the infarct.
Necrosis or death of the tissue
occur 48 – 72 hours after the
inarct.
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In hemorrhagic infarcts, after
bleeding in the area occurs, blood
flow may be re-established by
movement of the fragment or
decrease pressure from
compression of vessels.
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In a cerebral hemorrhage bleeding
continues into the brain tissue, structures
are displaced, edema and ischemia
ensue, rupture may occur.
Cerebral hemorrhage is resolve through
reabsorption. It is believed that
macrophages and astrocytes clear away
the blood, leaving a cavity surrounded by
a dense gliosis.
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Signs and Symptoms
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Sudden excruciating headache
Sudden unconsciousness
Sudden weakness or numbness of
the face, arms, legs, especially on
one side of the body
Sudden trouble seeing in one or
both eyes
Trouble walking, dizziness, loss of
balance.
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Clinical Manifestations
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Hemiplegia
Hemaparesis
Flaccidy
Spasticity
Rigidity
Drowiness, Aphasia, Apraxia, Agnosis
Homonymous Hemianopia
Stupor, coma, dysphagia, dysarthia
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Test
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Arteriogram
Ultrasound doppler
CT Scan
MRI
Lumbar Puncture
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Pharmocology
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Thrombolytic Agents
Tissue Plasminogen Activator
(activated Tissue Poasminogen)
except in hemorrhagic strokes
 Anti-platelets
 Heparin
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Medical Management
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Get the patient into the system
Window of opportunity is 3 hours
Reverse the CVA or prevent further
damage
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Nursing Management
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Prevent complications
Assessment
Administration and monitoring of
medication outcomes
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Nursing Diagnosis
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Depend on where the patient is in
the evolution of the brain attack
and the symptoms.
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