1. CEREBROVASCULAR ACCIDENT (CVA)
Tanja Čujić
Iva Ferček
Petra Črnac
Mentor: A. Žmegač Horvat

2. WHO: CVA - neurological deficit of cerebrovascular cause that persists beyond 24 hours or is interrupted by death within 24 hours
Classification
ischemic (80%): thrombotic, embolic
hemorrhagic

3. Embolic stroke blockage of an artery by an embolus An embolus is...
thrombus
fat
air
cancer cells
clumps of bacteria
amniotic fluid

4. embolus - arises from elsewhere, most
commonly from the heart
source must be identified
symptoms - maximal at start
symptoms may be transient

5. Paradoxical embolism
atrial septal defect

6. Cardiac causes atrial fibrillation rheumatic disease
artificial heart valves
dilated cardiomyopathy
Libman-Sacks endocarditis
infective endocarditis
marantic endocarditis
left atrial myxoma

7. Pathophysiology depletion of oxygen and glucose
failure of energy-dependent processes
major cause of neuronal injury: GLUTAMATE
influx of calcium
failure of mitochondria

8. Symptoms location and extension hemiplegia or muscle weakness numbness
reduction of sensation
Prognosis: disability
emotional problems
Prevention better than cure!

9. THROMBOTIC STROKE part of the brain supplied by the clotted
blood vessel is deprived of blood and
oxygen
blockage of an artery in the brain by a
clot (thrombosis) - most common cause
of stroke
cells of that part of the brain die

11. RISK FACTORS: high blood pressure (hypertension) high cholesterol
diabetes
smoking

12. TIA
mini-stroke
short-lived episode (less than 24 hours) of neurological dysfunction caused by a loss of blood supply
some develop slowly, others rapidly

13. TIA vs stroke all TIAs resolve within 24 hours
strokes take longer to resolve
with strokes, complete function may never return → more permanent and serious problem
TIAs can occur once, multiple times, or precede a permanent stroke

15. although most TIAs last only a few minutes, all TIAs should be evaluated with the same urgency as a stroke in an effort to prevent recurrences and/or strokes
a TIA should be considered an emergency because there is no guarantee that the situation will resolve and function will return

16. TIA can cause: temporary visual loss
problems with movement or sensation on one side of the body
paralysis of the arm, leg, and face, all on one side
double vision, dizziness
loss of speech, understanding and balance

17. References: www.medicinenet.com/stroke/article.htm
doctor2008.wordpress.com

18. HEMORRHAGIC STROKE

19. Subarachnoid hemorrhage
What is it?
A disruption in the normal blood supply to the brain due to the rupture of blood vessels with intracerebral or subarachnoid hemorrhage
15% to 20% of strokes
Lobar hemorrhage

20. Pathophysiology
A small blood vessel inside the brain becomes weak and bursts
Blood seeps into the brain tissue
The flow of blood after the blood vessel ruptures directly damages brain cells
An expanding hematoma causes compression of tissue which results in tissue injury

21. The three major causes of hemorrhagic stroke:
Hypertensive basal ganglionic hemorrhage
Berry aneurysm
The three major causes of hemorrhagic stroke:
High blood pressure (hypertension) → HYPERTENSIVE INTRACEREBRAL HEMORRHAGE
Ruptured arterial aneurysms
ARTERIOVENOUS MALFORMATIONS (AVMs)
Also very common in head trauma

22. Risk factors Advanced age Cigarette smoking (active and passive)
Heavy alcohol consumption and drug use
Diabetes mellitus
Lack of physical activity, obesity and unhealthy diet
Some apply only to women (pregnancy, childbirth, menopause)
Arteriovenous malformation

23. Symptoms
Sudden start (seconds or minutes)
Depend on the area of the brain affected
The most common signs of a stroke are:
weakness down one side of the body, ranging from numbness to paralysis that can affect the arm and leg
weakness down one side of the face, causing the mouth to droop
speech may be difficult or become difficult to understand
swallowing may be affected
loss of muscle coordination or balance
brief loss of vision
severe headache
confusion

24. Diagnosis Medical history Physical examination
Face-arm-speech test (FAST) for early recognition:
Facial weakness: can the person smile? Has the mouth or eye drooped?
Arm weakness: can the person raise both arms?
Speech problems: can the person speak clearly and understand you?
Test these symptoms
CT scan of a patient who has had a left middle cerebral artery stroke. The arrow indicates the location of the stroke.

25. CAT scan of the brain is often done to show bleeding into the brain
CT and MRI are both considered first-choice options for identifying hematomas (arrowheads) caused by hemorrhagic stroke
CAT scan of the brain is often done to show bleeding into the brain
Patients with intracerebral hemorrhage require neurosurgical evaluation to detect and treat the cause of the bleeding

26. Treatment The first few days after a stroke:
Patients are monitored and their blood pressure, blood sugar, and oxygenation are kept at optimum levels
The next phase of treatment:
Recovery through rehabilitation
Part of the stroke patient's routine:
Daily rehabilitation exercises and a correct diet

27. Important!
Prevention (treat high blood pressure, diabetes, high cholesterol, and heart disease if present, follow a low-fat diet, quit smoking, exercise regularly...)
Anticoagulants and antithrombotics, key in treating ischemic stroke, can make bleeding worse and cannot be used in intracerebral hemorrhage

28. References www.wikipedia.org www.netdoctor.co.uk www.medterms.com