The document discusses cerebrovascular accidents (CVAs), commonly known as strokes, which can be either ischemic, caused by blockage, or hemorrhagic, caused by a blood vessel rupture, leading to brain cell damage. It outlines the symptoms, diagnosis, and treatment options for strokes, emphasizing the urgency for timely intervention. Additionally, it details head injuries and traumatic brain injuries (TBIs), their classifications, symptoms, and effects, including concussions and various types of skull fractures.

1. Causes of brain damage

2.  Cerebrovascular accident
(CVA) is the medical term for a
stroke. A stroke is when blood
flow to a part of your brain is
stopped either by a blockage
or the rupture of a blood
vessel.
Cerebrovascular
Accident (CVA)

3.  There are two main types of
cerebrovascular accident, or
stroke: an ischemic stroke is
caused by a blockage;
a hemorrhagic stroke is caused by
the rupture of a blood vessel. Both
types of stroke deprive part of the
brain of blood and oxygen, causing
brain cells to die
Types of
cerebrovascular
accident

4.  An ischemic stroke is the most
common and occurs when a blood
clot blocks a blood vessel and
prevents blood and oxygen from
getting to a part of the brain. There
are two ways that this can happen.
One way is an embolic stroke,
which occurs when a clot forms
somewhere else in your body and
gets lodged in a blood vessel in the
brain. The other way is a
thrombotic stroke, which occurs
when the clot forms in a blood
vessel within the brain.
Ischemic stroke

5.  A hemorrhagic stroke occurs when
a blood vessel ruptures, or
hemorrhages, and then prevents
blood from getting to part of the
brain. The hemorrhage may occur
in any blood vessel in the brain, or
it may occur in the membrane
surrounding the brain.
Hemorrhagic
stroke

7.  The quicker you can get a diagnosis
and treatment for a stroke, the
better your prognosis will be. For
this reason, it’s important to
understand and recognize the
symptoms of a stroke.
 difficulty walking
 dizziness
 loss of balance and coordination
 difficulty speaking or
understanding others who are
speaking
 numbness or paralysis in the face,
leg, or arm, most likely on just one
side of the body
 blurred or darkened vision
 a sudden headache, especially
when accompanied by nausea,
vomiting, or dizziness
Symptoms of a
cerebrovascular
accident

8.  Blood tests: Your healthcare
provider may want to test your
blood for clotting time, blood
sugar levels, or infection. These
can all affect the likelihood and
progression of a stroke.
 Angiogram: An angiogram, which
involves adding a dye to your
blood and taking an X-ray of your
head, can help your doctor find
the blocked or hemorrhaged
blood vessel.
 Carotid ultrasound: This test uses
sound waves to create images of
the blood vessels in your neck.
This test can help your provider
determine if there’s abnormal
blood flow toward your brain.
Diagnosis of a
cerebrovascular
accident

9.  CT scan: A CT scan is often performed
soon after symptoms of a stroke
develop. The test can help your
provider find the problem area or
other problems that might be
associated with stroke.
 MRI scan: An MRI can provide a more
detailed picture of the brain
compared to CT scan. It’s more
sensitive than a CT scan in being able
to detect a stroke.
 Echocardiogram: This imaging
technique uses sound waves to
create a picture of your heart. It can
help your provider find the source of
blood clots.
 Electrocardiogram (EKG): This is an
electrical tracing of your heart. This
will help your healthcare provider
determine if an abnormal heart
rhythm is the cause of a stroke.

10.  Ischemic stroke treatment
 To treat an ischemic stroke, you
may be given a clot-dissolving drug
or a blood thinner. You may also be
given aspirin to prevent a second
stroke. Emergency treatment for
this type of stroke may include
injecting medicine into the brain or
removing a blockage with a
procedure.
Treatment for a
cerebrovascular
accident

11.  Hemorrhagic stroke treatment
 For a hemorrhagic stroke, you may
be given a drug that lowers the
pressure in your brain caused by
the bleeding. If the bleeding is
severe, you may need surgery to
remove excess blood. It’s also
possible that you will need surgery
to repair the ruptured blood
vessel.

12.  A head injury is a blow to the head
from a force outside the body.
Head injuries are common and are
often the result of an accident, a
fall, a sports injury, or an attack
(assault).
 When a head injury affects the
brain, it may also be referred to as
a traumatic brain injury (TBI). If
someone has had a brain injury, it
may take longer for them to
recover and in some cases they
may experience long term effects.
What is a head
injury?

13.  If someone’s brain has been
affected by the injury, the
symptoms they may
 experience can include:
 • losing consciousness (passing
out)
 • difficulty staying awake or
keeping their eyes open
 • headache
 • feeling sick and vomiting
 • dizziness
 • problems with
balance/coordination
 • unusual behaviour
 • problems with concentration and
memory
 • seizure or ‘fits’
What are the
symptoms?

14.  Head injuries and traumatic brain
injuries are often described by how
severe the injury is (i.e. minor,
moderate or severe)
 Health professionals might also
describe the injury using one of the
 following terms:
 • closed – when the brain has been
affected by a strong force, like a
 blow to the head, but without
fracturing the skull
 • penetrating – when something
pierces the skull, for example a
brick
 • crushing – when the head has
been squeezed
What are the
different types of
injury?

15.  Post-traumatic amnesia
 After a head injury, some people
may experience temporary
memory loss and find it difficult to
remember things. They may be
confused about why they are in
hospital or be unable to remember
the events surrounding their
accident, fall or injury

16.  • level of alertness (being awake,
talking)
 • size of pupils (the dark circle in
the centre of the eye, which reacts
to
 light)
 • limb movements
 • breathing rate
 • heart rate
 • blood pressure
 • temperature
 • oxygen level in the blood
Tests and
investigations

17.  A minor head injury is one where
there has been trauma to the head
but no or only mild injury to the
brain (e.g. concussion).
 Following the injury, a person may
lose consciousness (pass out) but
this will only last for a short period
of time (usually less than 30
minutes)
Minor head
injuries

18.  A concussion is a temporary (short-
lived) injury to the brain.
 The signs of a concussion can begin
to show almost immediately
following an
 injury, but may sometimes take
longer to appear. These can
include:
 • losing consciousness (passing
out)
 • headaches
 • feeling sick and vomiting
 • dizziness
 • unusual behavior
 • problems with concentration,
memory, balance and/or
coordination.
What is a
concussion?

19.  A moderate or severe head injury
is one where there has been
trauma to the head as well as a
more significant injury to the brain.
Moderate to
severe head
injuries

20.  A person with a moderate head
injury will have a GCS score of
between 9 and 12. They may
appear confused after the injury
and find it difficult to speak clearly
or follow instructions.
 A person with a severe head injury
will have a GCS score of 8 or lower.
They may be unresponsive after
the injury or appear to have very
little control over their speech or
movement.
 Both moderate and severe head
injuries may result in a prolonged
loss of consciousness. If someone
does not regain consciousness and
cannot be woken up, then this
termed a coma

21. Moderate and severe head injuries
might also involve:
• skull fractures
• bleeding (haemorrhage) around or
within the brain
• blood clots

22. A head injury can sometimes result in
a skull fracture, which is a break in the
bony structure of the skull that
surrounds the brain. The different
types of skull fractures include:
• closed – where the skin over the
fracture hasn't broken and the
surrounding tissue isn't damaged
• compound (open) – where the skin
and tissue over the fracture is broken
and the bone, and maybe the brain,
can be seen
• linear – where the fracture has not
caused the bones of the skull to move
or be displaced, and the fracture may
look like a straight line
• depressed – where part of the skull
has moved inwards
• basal – a fracture to the base of the
skull
Skull fracture

23.  When someone is in a coma, they
are deeply unconscious and cannot
be woken up. They do not speak or
respond to voices, or even pain.
They might require a ventilator to
help them breathe
Coma

24.  Sometimes a person who has
suffered a head injury is given a
controlled dose of anaesthetic to
put them into a medically induced
coma. This is done to reduce the
activity of the brain, limiting any
further damage and allowing it to
repair. Later on, the sedation drugs
can gradually be decreased to
allow the person to wake up.
Induced coma