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Cerebral Vascular Disease
          (CVD)




        Speaker: 马圣念
What is the CVD?
Cerebrovascular disease is a group of brain
dysfunctions related to disease of the blood
vessels supplying the brain.
Hypertension is the most important cause
It damages the blood vessel lining,
endothelium, exposing the underlying
collagen.
Anatomy of Cerebral
    Vascular 1

                 -Internal Carotid
                 Artery System

                 -Vertebral Basilar
                 Arterial System

                 -Willis Circulation
Anatomy of Cerebral
    Vascular 2
Anatomy of Cerebral
    Vascular 3

              The weight of the brain:
              2%~3%

              Blood supply of the brain:
              15%~20%


         There is no reserve energy in brains.
Anatomy of Cerebral
    Vascular 4
Etiology of CVD
• High Blood Pressure
• High Blood Cholesterol
• High Body Mass Index
  (BMI)
Risk Factors of CVR
    Non modifiable       Modifiable
•   Age              •   Hypertension
•   Male sex         •   Diabetes
•   Race             •   Smoking
•   Heredity         •   Hyperlipidemia
                     •   Excess Alcohol
                     •   Heart disease (AF)
                     •   Hypercoagulability
Epidemiology of CVD
Classification of CVD
           • Cerebral Infarction, CI
            (or called Cerebral Ischemic Stroke)

           • Intracerebral
             Hemorrhage, ICH
           • Subarachnoid
             Hemorrhage
           • Transient Ischemic
             Attack, TIA
Cerebral Infarction, CI
A Cerebral Infarction is the ischemic kind
of stroke due to a disturbance in the blood
vessels supplying blood to the brain.
• Middle Cerebral
Artery (MCA)

• Internal Carotid
Artery (ICA)
Infarction Stages 1




           Immediate (<24 hours)
 No Change : gross, micro  Na/K loss, Ca+ influx.
Infarction Stages 2




         Acute stage (< 1week)
      Oedema, loss of grey/white matter border.
  Inflammation, Red neurons, necrosis, neutrophils
Cerebral Edema




Normal      Edema
Cerebral Edema
Infarction Stages 3




        Late stage (> 1 weeks)
       Removal of tissue by macrophages
Fluid filled cysts with dark grey margin (gliosis)
Principle of Diagnosis
• The middle aged people and the elder
• Hypertension, Hyperlipidemia, Diabetes, TIA
  History
• Disease onsets in quiet situation
• Symptoms gradually worsened
• Hemiplegia, Aphasia, etc
• CT, MRI test
Principle of Therapy
•   Early thrombolytic
•   Adjustment of blood pressure
•   Prevention of brain edema
•   Anticoagulant therapy
•   Vascular dilatation
•   Brian nutrition therapy
•   Surgeon therapy
•   Interventional therapy
Principle of Nursing
•   Medication Nursing
•   Prevention of Asphyxia
•   Mental Nursing
•   Health Education
Intracerebral
   Hemorrhage, ICH
A Cerebral Hemorrhage (or intracerebral
hemorrhage, ICH), is a subtype
of intracranial hemorrhage that occurs
within the brain tissue itself. Intracerebral
hemorrhage can be caused by brain trauma,
or it can occur spontaneously in hemorrhagic
stroke. Non-traumatic intracerebral
hemorrhage is a spontaneous bleeding into the
brain tissue.
• Middle Cerebral
Artery (MCA)

• Lenticulostriate
artery
Brain Herniation

                   -Cardiac arrest (no pulse)
                   -Coma
                   -Irregular breathing
                   -Irregular pulse
                   -Loss of all brainstem
                   reflexes (blinking, gagging,
                   pupils reacting to light)
                   -Progressive loss of
                   consciousness
                   -Respiratory arrest (no
                   breathing)
Brain Herniation
     (abnormal posturing)




• Decorticate posturing: with elbows, wrists and fingers flexed, and legs
  extended and rotated inward
• Brain herniation frequently presents with abnormal posturing. a
  characteristic positioning of the limbs indicative of severe brain damage.
Principle of Diagnosis
• Over age-50 who has history of hypertenxion
• Accidence in the emotional or physical
  activtise
• Emerging the symptoms of intracranial
  pressure rising and disturbance of
  consciousness
• CT, MRI test
Principle of Therapy
•   No movement, O2
•   Adjustment of blood pressure
•   Control of brain edema
•   Application of hemostatic
•   Surgeon therapy
Principle of Nursing
•   Basic Nursing
•   Prevention of Asphyxia
•   Complications: Brain Herniation
•   Complications: Upper Gastrointestinal
    Bleeding
Subarachnoid
       Hemorrhage
 A subarachnoid hemorrhage (SAH)
is bleeding into the subarachnoid space
Principle of Diagnosis
• More among the youth, Female>Male
• Accidence in the emotional or physical
  activtise
• CSF test
• CT, MRI test
UNESCO Training the Trainers in Information Literacy Workshop, September 3-5, Ankara-Turkey   38
Principle of Therapy
•   No movement, O2
•   Adjustment of blood pressure
•   Application of hemostatic
•   Surgeon therapy
Principle of Nursing
•   Basic Nursing
•   Prevention of Asphyxia
•   Complications: Brain Herniation
•   Complications: Upper Gastrointestinal
    Bleeding
Transient Ischemic
     Attack, TIA
A transient ischemic attack (often
colloquially referred to as “mini stroke”) is a
change in the blood supply to a particular area
of the brain, resulting in brief neurologic
dysfunction that persists, by definition, for less
than 24 hours.
Three-Theory Etiology
Typical Symptom
•   Temporary loss of vision
•   Difficulty speaking (aphasia)
•   Weakness on one side of the body
•   Numbness or tingling, usually on one side of
    the body.
Principle of Diagnosis
• Short onset-period
• Based on health history
• CT, DSA test
Principle of Therapy
• Application of hemostatic
• Calcium Channel Blockers (CCBs)
• Surgeon therapy
Principle of Nursing
•   Basic Nursing (risk of injury)
•   Medication Nursing
•   Appropriate Exercises Recommendation
•   Complications: Stroke
Thank you
for attention


                马圣念

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CVD

  • 1. Cerebral Vascular Disease (CVD) Speaker: 马圣念
  • 2. What is the CVD? Cerebrovascular disease is a group of brain dysfunctions related to disease of the blood vessels supplying the brain. Hypertension is the most important cause It damages the blood vessel lining, endothelium, exposing the underlying collagen.
  • 3. Anatomy of Cerebral Vascular 1 -Internal Carotid Artery System -Vertebral Basilar Arterial System -Willis Circulation
  • 4. Anatomy of Cerebral Vascular 2
  • 5. Anatomy of Cerebral Vascular 3 The weight of the brain: 2%~3% Blood supply of the brain: 15%~20% There is no reserve energy in brains.
  • 6. Anatomy of Cerebral Vascular 4
  • 7. Etiology of CVD • High Blood Pressure • High Blood Cholesterol • High Body Mass Index (BMI)
  • 8. Risk Factors of CVR Non modifiable Modifiable • Age • Hypertension • Male sex • Diabetes • Race • Smoking • Heredity • Hyperlipidemia • Excess Alcohol • Heart disease (AF) • Hypercoagulability
  • 10. Classification of CVD • Cerebral Infarction, CI (or called Cerebral Ischemic Stroke) • Intracerebral Hemorrhage, ICH • Subarachnoid Hemorrhage • Transient Ischemic Attack, TIA
  • 11. Cerebral Infarction, CI A Cerebral Infarction is the ischemic kind of stroke due to a disturbance in the blood vessels supplying blood to the brain.
  • 12. • Middle Cerebral Artery (MCA) • Internal Carotid Artery (ICA)
  • 13. Infarction Stages 1 Immediate (<24 hours) No Change : gross, micro  Na/K loss, Ca+ influx.
  • 14. Infarction Stages 2 Acute stage (< 1week) Oedema, loss of grey/white matter border. Inflammation, Red neurons, necrosis, neutrophils
  • 17. Infarction Stages 3 Late stage (> 1 weeks) Removal of tissue by macrophages Fluid filled cysts with dark grey margin (gliosis)
  • 18. Principle of Diagnosis • The middle aged people and the elder • Hypertension, Hyperlipidemia, Diabetes, TIA History • Disease onsets in quiet situation • Symptoms gradually worsened • Hemiplegia, Aphasia, etc • CT, MRI test
  • 19. Principle of Therapy • Early thrombolytic • Adjustment of blood pressure • Prevention of brain edema • Anticoagulant therapy • Vascular dilatation • Brian nutrition therapy • Surgeon therapy • Interventional therapy
  • 20. Principle of Nursing • Medication Nursing • Prevention of Asphyxia • Mental Nursing • Health Education
  • 21. Intracerebral Hemorrhage, ICH A Cerebral Hemorrhage (or intracerebral hemorrhage, ICH), is a subtype of intracranial hemorrhage that occurs within the brain tissue itself. Intracerebral hemorrhage can be caused by brain trauma, or it can occur spontaneously in hemorrhagic stroke. Non-traumatic intracerebral hemorrhage is a spontaneous bleeding into the brain tissue.
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  • 24. • Middle Cerebral Artery (MCA) • Lenticulostriate artery
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  • 26. Brain Herniation -Cardiac arrest (no pulse) -Coma -Irregular breathing -Irregular pulse -Loss of all brainstem reflexes (blinking, gagging, pupils reacting to light) -Progressive loss of consciousness -Respiratory arrest (no breathing)
  • 27. Brain Herniation (abnormal posturing) • Decorticate posturing: with elbows, wrists and fingers flexed, and legs extended and rotated inward • Brain herniation frequently presents with abnormal posturing. a characteristic positioning of the limbs indicative of severe brain damage.
  • 28. Principle of Diagnosis • Over age-50 who has history of hypertenxion • Accidence in the emotional or physical activtise • Emerging the symptoms of intracranial pressure rising and disturbance of consciousness • CT, MRI test
  • 29. Principle of Therapy • No movement, O2 • Adjustment of blood pressure • Control of brain edema • Application of hemostatic • Surgeon therapy
  • 30. Principle of Nursing • Basic Nursing • Prevention of Asphyxia • Complications: Brain Herniation • Complications: Upper Gastrointestinal Bleeding
  • 31. Subarachnoid Hemorrhage A subarachnoid hemorrhage (SAH) is bleeding into the subarachnoid space
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  • 37. Principle of Diagnosis • More among the youth, Female>Male • Accidence in the emotional or physical activtise • CSF test • CT, MRI test
  • 38. UNESCO Training the Trainers in Information Literacy Workshop, September 3-5, Ankara-Turkey 38
  • 39. Principle of Therapy • No movement, O2 • Adjustment of blood pressure • Application of hemostatic • Surgeon therapy
  • 40. Principle of Nursing • Basic Nursing • Prevention of Asphyxia • Complications: Brain Herniation • Complications: Upper Gastrointestinal Bleeding
  • 41. Transient Ischemic Attack, TIA A transient ischemic attack (often colloquially referred to as “mini stroke”) is a change in the blood supply to a particular area of the brain, resulting in brief neurologic dysfunction that persists, by definition, for less than 24 hours.
  • 43. Typical Symptom • Temporary loss of vision • Difficulty speaking (aphasia) • Weakness on one side of the body • Numbness or tingling, usually on one side of the body.
  • 44. Principle of Diagnosis • Short onset-period • Based on health history • CT, DSA test
  • 45. Principle of Therapy • Application of hemostatic • Calcium Channel Blockers (CCBs) • Surgeon therapy
  • 46. Principle of Nursing • Basic Nursing (risk of injury) • Medication Nursing • Appropriate Exercises Recommendation • Complications: Stroke