Schematic Pathophysiology Cva 1233470514641540 2


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Schematic Pathophysiology Cva 1233470514641540 2

  1. 1. SCHEMATIC PATHOPHYSIOLOGY Predisposing Factors: Precipitating Factors: 1) Age ۞ 1) Hypertension ۞ 2) Heredity ۞ 2) Cigarette Smoking 3) Race 3) Diabetes Meliitus ۞ 4) Sex ۞ 4) Carotid or other Artery Disease ۞ 5) Prior Stroke, TIA or heart attack ۞ 5) Atrial Fibrillation 6) Socioeconomic Factors ۞ 6) Other heart disease 7) Sickle cell disease 8) Undesirable levels of cholesterol 9) Poor diet ۞ 10) Physical inactivity 11) Obesity 12) Alcohol Abuse 13) Drug Abuse Atherosclerosis Formation of Plaque deposits Thrombosis Hypertensio Occlusion by major vessel 83
  2. 2. If managed: If not managed Actual: Possible: Dx: Dx: PET scan, MRI, Cranial CT scan (6/16/08) Lysed or moved thrombus cerebral angiography, Capsuloganglionic bleed from the vessel lumbar puncture, EEG/ Lacunar infarct, ECG, skull x-ray, Bilateral Internal Carotid carotid ultrasonography Ateriosclerosis Doppler (6/16/08) Vascular wall becomes TX: aspirin within 24 weakened and fragile Mean flow velocities and hrs, thrombolytics pulsatility index of both within 3 hours, carotid anterior and posterior stenting, hypothermia, circulation within normal Leaking of blood from the anticoagulants, surgical limits fragile vessel wall decompression (hemicraniectomy), EEG/ECG, skull x-ray, carotid endartectomy carotid ultrasonography Guarded Prognosis Cerebral Hemorrhage Sx:, headache, unconsciousness, If managed: If not managed nausea/vomiting, Dx: CT scan, MRI, cerebral angiography, visual arteriography, disturbances lumbar puncture, skull x-ray Tx: chronic hypertensives, surgical decompression, evacuation and aspiration, administration of fresh frozen Mass of blood forms and plasma with fibrinogen or cryoprecipitate grows Decreased Hematoma evacuation ICP Formation of cavity surrounded by dense gliosis 84
  3. 3. < 30 ml 30-60 ml > 60 ml hemorrhage hemorrhage hemorrhage Good prognosis Intermediate Poor prognosis prognosis Vasospasm of tissue and arteries Blood seeps into the Formation of small ventricles and large clots CEREBRAL HYPOPERFUSION Sx: dizziness, Obstruction of CSF confusion, passageway headache Impaired distribution of oxygen and glucose Accumulation of CSF in the ventricles Tissue hypoxia and cellular starvation Ventricles dilate behind the point of obstruction Lodges unto other cerebral Cerebral Ischemia arteries Increased ICP Initiation of ischemic cascade If managed: If not managed Ventriculostomy, VP shunt, ICP Anaerobic metabolism by Monitoring mitochondria Alternative route Unrelieved for return of CSF obstruction Production of oxygen free in the circulation radicals and other reactive Generates large amounts Failure production of oxygen species of lactic acid adenosine triphosphatase Compression of brain tissues will Guarded Metabolic Acidosis Failure of energy dependent not occur Prognosis process (ion pumping) 85
  4. 4. Release of excitatory Damage to the blood neurotransmitter glutamate vessel endothelium Influx of calcium Activates enzymes that Failure of digest cell proteins, lipids mitochondria and nuclear material Further energy depletion Transient Ischemic Attack If managed: If not managed -t-PA (urokinase, streptokinase) -calcium channel Brain sustains an irreversible blockers cerebral damage Release of metalloprotrease (zinc and calcium-dependent enzymes) Guarded Prognosis Break down of collagen, hyaluronic acid and other elements of connective tissue Structural integrity loss of brain tissue and blood vessels Breakdown of the protective Blood Brain Barrier 86
  5. 5. Cerebral edema Vascular Congestion Compression of tissue Increased intracranial pressure Impaired perfusion and function Middle Anterior cerebral Posterior Internal Carotid Vertebrobasilar Anteroinferior Posteroinferior Cerebral Artery artery CerebraI Artery Artery System Cerebellar cerebellar Lateral Frontal Lobe Occipital lobe; Branches into Cerebellum and Cerebellum Cerebellum hemisphere, anterior and ophthalmic, PCA, brain stem frontal, parietal medial portion of anterior choroidal, and temporal temporal lobe ACA, MCA lobes, basal ganglia 87
  6. 6. Sx: Sx: Sx: Sx: Sx: Sx: contralateral Ipsilateral Sx: Contralateral Contralateral Mild Alternating hemiparesis ataxia, facial Ataxia, hemiparesis or hemiparesis, contralateral motor with facial paralysis, paralysis of the hemiplegia, foot and leg hemiparesis, weaknesses, asymmetry, ipsilateral loss larynx and soft unilateral deficits greater intention ataxic gait, contralateral of sensation in palate, neglect, altered than the arm, tremor, diffuse dysmetria, sensory face, sensation ipsilateral loss consciousness foot drop, gait sensory loss, contralateral alterations, changes on of sensation in , homonymous disturbances, pupillary hemisensory homonymous trunk and face, hemianopsia, contralateral dysfunction, impairments, hemianopsia, limbs, contralateral on inability to turn hemisensory loss of double vision, ipsilateral nystagmus, body, eyes toward alterations, conjugate homonymous periods of Horner’s nystagmus, affected side, deviation of gaze, hemianopsia, blindness, syndrome, dysarthria, vision changes, eyes toward nystagmus, nystagmus, aphasia if tinnitus, Horner’s dyslexia, affected side, loss of depth conjugate dominant hearing loss syndrome, dysgraphia, expressive perception, gaze, hemisphere is hiccups and aphasia, aphasia, cortical paralysis, involved, Mild coughing, agnosia, confusion, blindness, dysarthria, Horner’s vertigo, nausea memory deficits, amnesia, flat homonymous memory loss, syndrome, and vomiting vomiting affect, apathy, hemianopsia, disorientation, carotid bruits shortened perseveration, drop attacks, attention span, dyslexia, tinnitus, loss of mental memory hearing loss, acuity, apraxia, deficits, visual vertigo, incontinence hallucinations dysphagia, coma 88
  7. 7. If managed: If not managed: Palliative care- Frequent vital sign and neurovital signs, intubation, mechanical ventilation, Continued insufficiency of blood vasodilators, osmotic flow diuretics, ventriculostomy, ICP monitoring Further compression of tissues Poor cerebral perfusion Coma Poor improvement Cerebral Death Poor Prognosis Loss of neural feedback mechanisms Cessation of physiologic functions 89
  8. 8. Cardiovascular Pulmonary GUT Other systems GIT System System Relaxation of intestines and Sx: restlessness, Loss of cardiac Relaxation of abnormal muscle function sphincters thermoregulation, venous valves mental confusion, increased secretions, decreased urinary output. Sx: Sx: bradycardi hypotensio Loss of bowel Failure of accessory Loss of lung control Decreased muscles for breathing movement cardiac output Neurogenic bladder Loss of sphincter control Sx: apnea Cardiopulmonary arrest Systemic Failure DEATH 90