Cerebral Vascular Accident M. DuBois Fennal, PhD, RN, CNS 05/19/16 1

Definition 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. 05/19/16 2

Etiology 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) 05/19/16 3

Incidence 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. 05/19/16 4

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 05/19/16 5

Risk Factors Hypertension Diabetes Mellitus Sickle Cell Disease Substance abuse Atherosclerosis Family history 05/19/16 6

Other Risk Factors Obesity Sedentary lifestyle Hyperlipidemia Atrial fibrillation Cardiac disease Cigarette smoking Transient Ischemic Attack Oral contraceptives Menopause 05/19/16 7

Pathophysiology 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 05/19/16 8

The pathology of a brain attack depends on the etiology of the incident. 05/19/16 9

Thrombotic Brain Attack Cerebral thromboses: occurs when arteries supplying the brain or intercranial vessels are occluded by thrombi that arise from arterial occlusions. 05/19/16 10

Cerebral emboli and cerebral thrombi are the most common pathology of occlusion, however, atherosclerosis plays a major role in the pathology as well. 05/19/16 11

Transient Ischemic attacks, cause thrombotic attacks Transient Ischemic attacks, cause thrombotic attacks. Thrombotic particles causing intermittent blockage of the circulatio 05/19/16 12

Embolic Attack Involves fragments that break away from a thrombus formed outside of the brain 05/19/16 13

Hemorrhagic Attack Intercranial hemorrage: third most common cause of CVA It involves bleeding into the brain, displacement of structures, and compression of vital centers. 05/19/16 14

Lacunar Stroke Those attacks that are smaller than 1 cm in diameter Involve small perforating arteries Associated with hypertension and diabetes 05/19/16 15

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. 05/19/16 16

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. 05/19/16 17

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. 05/19/16 18

Signs and Symptoms 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. 05/19/16 19

Clinical Manifestations Hemiplegia Hemaparesis Flaccidy Spasticity Rigidity Drowiness, Aphasia, Apraxia, Agnosis Homonymous Hemianopia Stupor, coma, dysphagia, dysarthia 05/19/16 20

Test Arteriogram Ultrasound doppler CT Scan MRI Lumbar Puncture 05/19/16 21

Pharmocology Thrombolytic Agents Tissue Plasminogen Activator (activated Tissue Poasminogen) except in hemorrhagic strokes Anti-platelets Heparin 05/19/16 22

Medical Management Get the patient into the system Window of opportunity is 3 hours Reverse the CVA or prevent further damage 05/19/16 23

Nursing Management Prevent complications Assessment Administration and monitoring of medication outcomes 05/19/16 24

Nursing Diagnosis Depend on where the patient is in the evolution of the brain attack and the symptoms. 05/19/16 25