1. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Cerebrovascular Accident (CVA) Chapter 7

2. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Classifications Cerebrovascular accident (CVA) or stroke –Specific neurological deficit that occurs suddenly as a result of vascular disease of a hemorrhagic or ischemic nature –Classified according to their cause: Cerebral embolism Cerebral infarction Cerebral hemorrhage Cerebral thrombosis 2

3. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Cerebral Embolism Stroke that occurs as a result of a wandering clot or embolus that may become lodged in a cerebral artery, reducing or cutting off blood supply –Cerebral deficit occurs rapidly and damage is worse in the beginning –Occurs most often in awake patients –Starts with a mild headache 3

4. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Cerebral Hemorrhage Occurs when an artery ruptures and fills the cranium with blood, resulting in increased cranial pressure –Pressure can cause brain displacement and death –Cerebral edema (brain swelling) develops and adds to the death rate for this type of CVA 4

5. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Cerebral Hemorrhage The two main sources of cerebral hemorrhage are a ruptured aneurysm and hypertensive vascular disease –Usually occurs as a result of an abrupt change in systolic blood pressure –Stress from dental procedures can cause change in systolic blood pressure 5

6. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Cerebral Hemorrhage –Occurs most often in older patients, but can occur in younger patients Signs and symptoms occur very quickly and then increase in severity over a short period of time –Often begins with severe headache that is localized at first, and then spreads 6

7. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Cerebral Hemorrhage –Other symptoms include nausea, vomiting, chills, sweating, and dizziness One-third of patients lose consciousness within a few minutes and prognosis is poor 7

8. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Cerebral Infarction Occurs as a result of some problem in the arterial blood supply from the heart to the brain –Usually as a result of atherosclerosis Thickening of the arteries can cause a decrease in the amount of oxygenated blood reaching the brain –Slow developing stroke 8

9. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Cerebral Infarction –Patient usually awakens in the morning with neurologic deficits from the ischemia 9

10. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Cerebral Thrombosis Occurs when there is an obstruction of the cerebral artery by a clot that forms within that artery –Differs from an embolism where a clot forms in another part of the body –Atherosclerosis is a cause of this CVA –Happens during sleep 10

11. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Cerebral Thrombosis –Stuttering and other gradual deficits occur over one to three days 11

12. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Transient Ischemic Attack (TIA) Neurological deficit that occurs over short period of time Not a stroke Can be difficult to determine whether the patient is suffering from a CVA or from a TIA –Duration of episode differs TIA lasts only a few minutes; then signs and symptoms cease 12

13. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Transient Ischemic Attack (TIA) Patients may experience numbness or weakness in the extremities (pins and needles) Consciousness is not impaired –Patient may appear somewhat confused Dental team needs to be aware that a history of repeated TIAs can increase chances of CVA 13

14. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Signs and Symptoms Some similar signs and symptoms: –Headache is usually the first symptom –Unconsciousness may occur –Paralysis may occur in the extremities –Patients may appear confused –Speech is usually impaired due to paralysis of facial muscles 14

15. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Signs and Symptoms –Pupils are of unequal size –Patient may have difficulty breathing F.A.S.T.: American Red Cross mnemonic for determining whether a patient may be experiencing a CVA –Face –Arm –Speech –Time 15

16. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Recognizing a CVA: F.A.S.T. Emergency Basics Box 7-2: Recognizing a CVA: F.A.S.T. 16

17. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Treatment Emergency treatment is the same regardless of the cause of the CVA –Stop all dental treatment –Slightly elevate the patient’s head –Monitor vital signs –Administer oxygen –Call EMS 17

18. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Treatment –Keep the patient calm and quiet –Be prepared to provide basic life support –Do not give any medications that could alter neurological activity Do not say anything upsetting, as the patient may still be conscious 18

19. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Summary CVA is not a common occurrence in the dental office, but the dental team should be prepared Dental team should be aware that certain people are prone to CVAs –Patients with diabetes, hypertension, or cardiac disease –Patients with a history of TIAs 19