Cerebrovascular Accident CVA (Stroke), Angin Ahmar (malay)

Cerebrovascular AccidentCerebrovascular Accident
CVACVA

 Results from ischemia to a part of the brain orResults from ischemia to a part of the brain or
hemorrhage into the brain that results in death of brainhemorrhage into the brain that results in death of brain
cellscells..
 #1 leading cause of disability#1 leading cause of disability
 25% with initial stroke die within 1 year25% with initial stroke die within 1 year
 50-75% will be functionally independent50-75% will be functionally independent
 25% will live with permanent disability25% will live with permanent disability
 Physical, cognitive, emotional, & financial impactPhysical, cognitive, emotional, & financial impact

Risk FactorsRisk Factors
 AgeAge – Occurrence doubles each decade >55 years– Occurrence doubles each decade >55 years
 GenderGender – Equal for men & women;– Equal for men & women;
 HeredityHeredity – family history, prior transient– family history, prior transient
ischemic attack, or prior stroke increases riskischemic attack, or prior stroke increases risk

Risk FactorsRisk Factors
High blood pressure Diabetes
Cigarette smoking Obesity
High blood cholesterol Physical Inactivity
Heart Disease

CVA – Risk FactorsCVA – Risk Factors

PathophysiologyPathophysiology
 AtherosclerosisAtherosclerosis: major cause of CVA: major cause of CVA
 Thrombus formation & emboli developmentThrombus formation & emboli development
 Abnormal filtration of lipids in the intimal layer of the arterialAbnormal filtration of lipids in the intimal layer of the arterial
wallwall
 Plaque develops & locations of increased turbulence of blood -Plaque develops & locations of increased turbulence of blood -
bifurcationsbifurcations
 Increased turbulence of blood or a tortuous areaIncreased turbulence of blood or a tortuous area
 Calcified plaques rupture or fissureCalcified plaques rupture or fissure
 Platelets & fibrin adhere to the plaquePlatelets & fibrin adhere to the plaque
 Narrowing or blockage of an artery by thrombus or emboliNarrowing or blockage of an artery by thrombus or emboli
 Cerebral Infarction: blocked artery with blood supply cutCerebral Infarction: blocked artery with blood supply cut
off beyond the blockageoff beyond the blockage

CVA SIGN & SYMPTOMS?CVA SIGN & SYMPTOMS?
 Sudden numbness or weakness of face, arm, or leg,Sudden numbness or weakness of face, arm, or leg,
especially on one side of the body.especially on one side of the body.
 Sudden confusion or trouble speaking or understandingSudden confusion or trouble speaking or understanding
speech.speech.
 Sudden trouble seeing in one or both eyes.Sudden trouble seeing in one or both eyes.
 Sudden trouble walking, dizziness, or loss of balance orSudden trouble walking, dizziness, or loss of balance or
coordinationcoordination
 Sudden severe headache with no known cause.Sudden severe headache with no known cause.

Transient Ischemic AttackTransient Ischemic Attack
 Temporary focal loss of neurologic functionTemporary focal loss of neurologic function
 Caused by ischemia of one of the vascular territories ofCaused by ischemia of one of the vascular territories of
the brainthe brain
 Microemboli with temporary blockage of blood flowMicroemboli with temporary blockage of blood flow
 Lasts less than 24 hrs – often less than 15 minsLasts less than 24 hrs – often less than 15 mins
 Most resolve within 3 hoursMost resolve within 3 hours
 Warning sign of progressive cerebrovascular diseaseWarning sign of progressive cerebrovascular disease

Transient Ischemic AttackTransient Ischemic Attack
 Diagnosis:Diagnosis:
 CT without contrastCT without contrast
 Confirm that TIA is not related to brain lesionsConfirm that TIA is not related to brain lesions
 Cardiac EvaluationCardiac Evaluation
 Treatment:Treatment:
 Medications that prevent platelet aggregationMedications that prevent platelet aggregation
 ASA, PlavixASA, Plavix
 Oral anticoagulantsOral anticoagulants

ClassificationsClassifications
 Ischemic StrokeIschemic Stroke
 ThromboticThrombotic
 EmbolicEmbolic
 Hemorrhagic StrokeHemorrhagic Stroke
 Intracerebral HemorrhageIntracerebral Hemorrhage
 Subarachnoid HemorrhageSubarachnoid Hemorrhage
 AneurysmAneurysm

Thrombotic StrokeThrombotic Stroke

Embolic StrokeEmbolic Stroke

Hemorrhage StrokeHemorrhage Stroke
Intracerebral HemorrhageIntracerebral Hemorrhage
 Rupture of a vesselRupture of a vessel
 Hypertension – most important causeHypertension – most important cause
 Others: vascular malformations, coagulationOthers: vascular malformations, coagulation
disorders, anticoagulation, trauma, brain tumor,disorders, anticoagulation, trauma, brain tumor,
ruptured aneurysmsruptured aneurysms
 Sudden onset of symptoms with progressionSudden onset of symptoms with progression
 Neurological deficits, headache, nausea, vomiting,Neurological deficits, headache, nausea, vomiting,
decreased LOC, and hypertensiondecreased LOC, and hypertension
 Prognosis: poor – 50% die within weeksPrognosis: poor – 50% die within weeks
 20% functionally independent at 6 months20% functionally independent at 6 months

Hemorrhage StrokeHemorrhage Stroke
Intracerebral HemorrhageIntracerebral Hemorrhage

Hemorrhagic-SubarachnoidHemorrhagic-Subarachnoid
 Hemorrhagic Stroke–Subarachnoid HemorrhageHemorrhagic Stroke–Subarachnoid Hemorrhage
 Intracranial bleeding into the cerebrospinal fluid-Intracranial bleeding into the cerebrospinal fluid-
filled space between the arachnoid and pia materfilled space between the arachnoid and pia mater
membranes on the surface of the brainmembranes on the surface of the brain

Clinical ManifestationsClinical Manifestations
 Motor Function ImpairmentMotor Function Impairment
 Caused by destruction of motor neurons in theCaused by destruction of motor neurons in the
pyramidal pathway (brain to spinal cord)pyramidal pathway (brain to spinal cord)
 MobilityMobility
 Respiratory functionRespiratory function
 Swallowing and speechSwallowing and speech
 Gag reflexGag reflex
 Self-care activitiesSelf-care activities

Right Brain – Left Brain DamageRight Brain – Left Brain Damage

 AffectAffect
 Difficulty controlling emotionsDifficulty controlling emotions
 Exaggerated or unpredictable emotional responseExaggerated or unpredictable emotional response
 Depression / feelings regarding changed bodyDepression / feelings regarding changed body
image and loss of functionimage and loss of function

 Intellectual FunctionIntellectual Function
 Memory and judgmentMemory and judgment
 Left-brain stroke: cautious in makingLeft-brain stroke: cautious in making
judgmentsjudgments
 Right-brain stroke: impulsive & moves quicklyRight-brain stroke: impulsive & moves quickly
to decisionsto decisions
 Difficulties in learning new skillsDifficulties in learning new skills

Treatment GoalsTreatment Goals
 Prevention – Health Maintenance Focus:Prevention – Health Maintenance Focus:
 Healthy dietHealthy diet
 Weight controlWeight control
 Regular exerciseRegular exercise
 No smokingNo smoking
 Limit alcohol consumptionLimit alcohol consumption
 Route health assessmentRoute health assessment
 Control of risk factorsControl of risk factors

 PreventionPrevention
 Drug TherapyDrug Therapy
 Surgical TherapySurgical Therapy
 RehabilitationRehabilitation

 Drug TherapyDrug Therapy
 Measures to prevent the development of aMeasures to prevent the development of a
thrombus or embolus for “At Risk” patients:thrombus or embolus for “At Risk” patients:
Antiplatelet AgentsAntiplatelet Agents
 AspirinAspirin
 PlavixPlavix
 CombinationCombination

Warning Signs of StrokeWarning Signs of Stroke
 Sudden weakness, paralysis, or numbness of theSudden weakness, paralysis, or numbness of the
face, arm, or leg, especially on one side of theface, arm, or leg, especially on one side of the
bodybody
 Sudden dimness or loss of vision in one or bothSudden dimness or loss of vision in one or both
eyeseyes
 Sudden loss of speech, confusion, or difficultySudden loss of speech, confusion, or difficulty
speaking or understanding speechspeaking or understanding speech
 Unexplained sudden dizziness, unsteadiness, lossUnexplained sudden dizziness, unsteadiness, loss
of balance, or coordinationof balance, or coordination
 Sudden severe headacheSudden severe headache

RehabilitationRehabilitation
 Assess: Swallowing; Communication;Assess: Swallowing; Communication;
Complications; motor and sensory functionComplications; motor and sensory function
 Action: Coordinate resources:Action: Coordinate resources:
 Speech Therapy—assess swallowingSpeech Therapy—assess swallowing
 Physical Therapy—ambulation/strengtheningPhysical Therapy—ambulation/strengthening
 Bowel/BladderBowel/Bladder
 Appropriate self-help resourcesAppropriate self-help resources

RehabilitationRehabilitation
 Comprehensive plan –Comprehensive plan –
 Physical Medicine & Rehabilitation / Inpatient RehabPhysical Medicine & Rehabilitation / Inpatient Rehab
 Learn techniques to self-monitor & maintain physicalLearn techniques to self-monitor & maintain physical
wellnesswellness
 Demonstrate self-care skillsDemonstrate self-care skills
 Exhibit problem-solving skills with self-careExhibit problem-solving skills with self-care
 Avoid complications of strokeAvoid complications of stroke
 CommunicationCommunication
 Maintain nutrition & hydrationMaintain nutrition & hydration
 Use community resourcesUse community resources
 Family cohesivenessFamily cohesiveness

SEKIAN TERIMA KASIHSEKIAN TERIMA KASIH

Cerebrovascular Accident CVA (Stroke), Angin Ahmar (malay)

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