Cerebrovascular Accident
Cerebrovascular Accident
Cerebrovascular Accident
CVA
Cerebrovascular Accident
Results from ischemia to a part of the brain or hemorrhage
into the brain that results in death of brain cells.
Gender – Equal for men & women; women die more frequently
than men
Blood Supply
bifurcations
Increased turbulence of blood or a tortuous area
Cell death
Treatment:
Medications that prevent platelet aggregation
ASA, Plavix
Oral anticoagulants
Cerebrovascular Accident
Classifications
Hemorrhagic Stroke
Intracerebral Hemorrhage
Subarachnoid Hemorrhage
Aneurysm
Berry or Saccular
Cerebrovascular Accident
Classifications
Ischemic Stroke—inadequate blood flow to the brain from partial
or complete occlusions of an artery--85% of all strokes
>60% of strokes
50% are preceded by TIA
Hemorrhagic Stroke
15% of all strokes
Result from bleeding into the brain tissue
itself
Intracerebral
Subarachnoid
Cerebrovascular Accident
Hemorrhage Stroke
Intracerebral Hemorrhage
Rupture of a vessel
Hypertension – most important cause
Surgical Treatment:
Urinary incontinence
Sensory loss (discrimination, proprioception)
Contralateral grasp & sucking reflexes may be present
Apraxia – loss of ability to carry out familiar purposeful
movements in the absence of sensory or motor impairment
Personality change: flat affect, loss of spontaneity, loss of
interest in surroundings
Cognitive impairment
Cerebrovascular Accident
Clinical Manifestations
Posterior Cerebral Artery &
Vertebrobasilar Involvement
Alert to comatose
Unilateral or bilateral sensory loss
Contralateral or bilateral weakness
Dysarthria – impaired speech articulation
Dysphagia – difficulty in swallowing
Hoarseness
Ataxia, Vertigo
Unilateral hearing loss
Visual disturbances (blindness, homonymous
hemianopsia, nystagmus, diplopia)
Cerebrovascular Accident
Clinical Manifestations
Motor Function Impairment
Caused by destruction of motor neurons in the
pyramidal pathway (brain to spinal cord)
Mobility
Respiratory function
Gag reflex
Self-care activities
Cerebrovascular Accident
Clinical Manifestations
Right Brain – Left Brain Damage
Cerebrovascular Accident
Clinical Manifestations
Affect
Difficulty controlling emotions
Exaggerated or unpredictable emotional response
Intellectual Function
Memory and judgment
Left-brain stroke: cautious in making judgments
Right-brain stroke: impulsive & moves quickly to
decisions
Difficulties in learning new skills
Cerebrovascular Accident
Clinical Manifestations
Communication
Left hemisphere dominant for language skills in the
right-handed person & most left-handed persons --
Aphasia/Dysphasia
Involvement Expression & Comprehension
Receptive Aphasia (Wernicke’s area): sounds of speech
nor its meaning can be understood – spoken & written
Expressive Aphasia (Broca’s area): difficulty in
speaking and writing
Dysarthria: Affects the mechanics of speech due to
muscle control disturbances – pronunciation, articulation,
and phonation
Cerebrovascular Accident
Clinical Manifestations
Spatial-Perceptual Alterations – 4 categories:
touch or hearing
4. Apraxia: Inability to carry out learned sequential
movements on command
Homonymous Hemianopsia
Cerebrovascular Accident
Clinical Manifestations
Elimination
Regular exercise
No smoking
Prevention
Drug Therapy
Surgical Therapy
Rehabilitation
Cerebrovascular Accident
Diagnostic Studies
Done to confirm CVA and identify cause
PE: Neuro Assessment; Carotid bruit
Carotid doppler studies (ultrasound study)
Treatment of AV Malformations
Carotid Artery Disease
Carotid Artery Disease
Carotid artery disease is the leading cause of strokes.
Antiplatelet Agents
Aspirin
Plavix
Combination
GU – foley catheter
Patient Education:
Include family
Cerebrovascular Accident
Rehabilitation
Assess: Swallowing; Communication;
Complications; motor and sensory function
Bowel/Bladder
Stroke
National Stroke Association