1. Cerebral Vascular Accident
M. DuBois Fennal, PhD, RN, CNS
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2. 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.
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3. 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)
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4. 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.
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5. 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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6. Risk Factors Hypertension Diabetes Mellitus Sickle Cell Disease
Substance abuse
Atherosclerosis
Family history
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7. Other Risk Factors Obesity Sedentary lifestyle Hyperlipidemia
Atrial fibrillation
Cardiac disease
Cigarette smoking
Transient Ischemic Attack
Oral contraceptives
Menopause
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8. 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
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9. The pathology of a brain attack depends on the etiology of the incident.
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10. Thrombotic Brain Attack
Cerebral thromboses: occurs when arteries supplying the brain or intercranial vessels are occluded by thrombi that arise from arterial occlusions.
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11. 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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12. Transient Ischemic attacks, cause thrombotic attacks
Transient Ischemic attacks, cause thrombotic attacks. Thrombotic particles causing intermittent blockage of the circulatio
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13. Embolic Attack
Involves fragments that break away from a thrombus formed outside of the brain
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14. Hemorrhagic Attack
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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15. Lacunar Stroke Those attacks that are smaller than 1 cm in diameter
Involve small perforating arteries
Associated with hypertension and diabetes
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16. 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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17. 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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18. 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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19. 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.
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20. Clinical Manifestations
Hemiplegia
Hemaparesis
Flaccidy
Spasticity
Rigidity
Drowiness, Aphasia, Apraxia, Agnosis
Homonymous Hemianopia
Stupor, coma, dysphagia, dysarthia
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21. Test Arteriogram Ultrasound doppler CT Scan MRI Lumbar Puncture
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22. Pharmocology Thrombolytic Agents
Tissue Plasminogen Activator (activated Tissue Poasminogen) except in hemorrhagic strokes
Anti-platelets
Heparin
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23. Medical Management Get the patient into the system
Window of opportunity is 3 hours
Reverse the CVA or prevent further damage
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24. Nursing Management Prevent complications Assessment
Administration and monitoring of medication outcomes
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25. Nursing Diagnosis
Depend on where the patient is in the evolution of the brain attack and the symptoms.
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