The document discusses cerebrovascular accidents (strokes), detailing their causes, symptoms, and risk factors, both modifiable and non-modifiable. It compares ischemic and hemorrhagic strokes and covers guidelines for prevention and treatment, including medications and diagnostic procedures. Additionally, it emphasizes the importance of lifestyle changes and preventive measures to mitigate stroke risk.

1. PRESENTED BY-
GEETA JOSHI
STATE COLLEGE
OF NURSING

2. Cerebrovascular accident or
Brain attack is sudden loss of
function resulting from
disruption of blood supply to a
part of the brain.

3. ETIOLOGY
MODIFIABLE RISK FACTORS-
• Hypertension
• Smoking & alcoholism
• Diabetes mellitus
• Cardiovascular disease
• Asymptomatic carotid stenosis
• Transient ischemic attacks
• Sickle cell anemia
• Dyslipidemia
• Obesity
• Poor diet ( increased fat & sodium,
decreased Potassium)
• Physical inactivity
• Postmenopausal hormone therapy
NON- MODIFIABLE RISK FACTORS
• Older age
• Gender (males)
• Heredity
• Prior stroke or heart attack

4. S.
NO
COMPARISION ISCHEMIC STROKE HEMORRHAGIC STROKE
1. CAUSE •Large artery
thrombosis
• small penetrating
artery thrombosis
• Cardiogenic embolic
• cryptogenic
•others
•Intracerebral
hemorrhage
•Subarachnoid
hemorrhage
•Cerebral aneurysm
•Arteriovenous
malformation
2. SYMPTOMS Numbness or
weakness on one side
of face especially arm
& legs.
Exploding headache.
Decreased LOC
3. FUNCTIONAL
RECOVERY
Plateau at 6 months Plateau at 18 months

5. 1.Large artery thrombotic strokes-
caused by atherosclerotic plaques in
large arteries of brain , resulting in
thrombus formation & occlusion.
2.Small penetrating artery thrombotic
strokes- also called Lacunar stroke,
most common.

6. 1.Embolic strokes- caused by
valvular heart disease & thrombi
in left ventricle, can be prevented
by use of anticoagulants.
2.Cryptogenic strokes- no known
cause.
3.Others- illicit drug use,
coagulopathy, migraine &

8. •Due to obstruction of a blood vessel
•Disruption in cerebral blood flow
•Cellular metabolic events
•Failure of neurons to maintain aerobic respiration
•Mitochondria switch to anaerobic respiration
•Production of lactic acid in large amounts
•Change in ph (ACIDOSIS)
•Inability of neuron to produce adequate energy
•Insufficient fuel for depolarisation
•Cessation of membrane pumps
•Accumulation of calcium & release of glutamate
•Activation of damaging pathways.

9. •Numbness or weakness of face, arm or
leg, especially on one side of body.
•Confusion
•Change in mental status
•Trouble speaking or
understanding speech
•Visual disturbances
•Difficulty in walking,
dizziness or loss of balance
•Sudden severe headache

10. •Hemiplegia, hemiparesis,
flaccid paralysis
•Dysarthria, dysphasia, aphasia
(expressive,
•receptive or global)
•Apraxia
•Hemianopsia
•Disturbed visual spatial
relationships
•agnosia

11. SENSOR
Y
DEFICIT
S
VERBAL
DEFICIT
S
MOTOR
DEFICIT
S
EMOTIO
NAL
DEFICIT
S
COGNIT
IVE
DEFICIT
S
VISUAL
FIELD
DEFECT
S

12. •Careful history
•Complete physical & neurologic examination
•NCCT (non contrast computed tomography)-
whether ischemic or hemorrhagic
•ECG
•Carotid ultrasound
•CT angiography
•MRI or MRA
•Transcranial Doppler flow studies
•Echocardiography
•SPECT

13. •Platelet inhibiting medications-
aspirin, clopidogrel
•Statins- 3- hydroxy 2-methyl
glutaryl- coenzyme A , e.g.
simvastatin
• Anti- hypertensive drugs- ACE
inhibitors, thiazides
• Thrombolytic therapy- t-PA –
Tissue plasminogen activator
•Anticoagulant therapy- INR above
1.7

14. •DOSAGE- 0.9mg/kg with
max. dose 90mg.
•10% of the dose is
administered IV bolus over 1
minute.
•Remaining 90%is
administered over 1 hour.
•Obtain vital signs every 15
min for first 2 hours.

15. Anticoagulant
administration- heparin
Osmotic diuretics-
mannitol
Elevation of the head
Endotracheal intubation
Neurologic assessment
Hemodynamic monitoring

16. •Endarterectomy- removal of
atherosclerotic plaque from carotid
artery.
•Carotid stenting
•with angioplasty.
•Carotid stenting
•without angioplasty.

17. Acute pain R/t Hemiplegia & disuse
Impaired physical motility R/t loss of balance &
coordination
Self care deficit R/t stroke sequalae
Disturbed sensory perception R/t altered sensory
reception
Impaired urinary elimination R/t flaccid bladder
Disturbed thought process R/t brain damage

18. PREVENTIVE MEASURES-
•Leading a healthy lifestyle.
•Quitting smoking.
•Maintaining a healthy weight.
•Daily exercise
•Following a healthy diet.
•DASH (dietary approaches to stop
hypertension)- high in fruits & vegetables,
low fat dairy products, low in animal
proteins.