Stroke, or cerebrovascular accident (CVA), is a serious condition characterized by an interruption of blood supply to the brain, leading to potential permanent neurological deficits. It primarily comprises ischemic strokes (80% of cases) and hemorrhagic strokes, with various diagnostic evaluations and emergency treatments available, including clot-busting medications and surgical interventions. The document also discusses the complications, nursing diagnoses, and considerations for stroke care and rehabilitation.

1. ‘STROKE’

2. CVA / stroke
• An interruption of blood supply to a vital
center in the brain
• Also called “brain attack”, cerebral infarction,
cerebral hemorrhage, ischemic stroke or
stroke

3. DEFINITION
• “Cerebrovascular Accident (CVA) or Stroke” is
a term used to describe neurological changes
lasting more than 24 hours caused by an
interruption in the blood supply to a part of
the brain.
• If the blood flow ceases for an extended
period of time, the cerebral tissues involved
die causing permanent neurological deficits.

4. EPIDEMIOLOGY
• STROKE is one of the leading causes of death
and disability in INDIA.
• The estimated adjusted prevalence rate of
stroke range, 84-262/100,000 in rural and 334-
424/100,000 in urban area.

6. TYPES OF CVA

7. TYPES OF CVA

8. TYPES OF CVA
a) Ischemic stroke
– About 80 percent of strokes are ischemic strokes.
– Occur when the arteries to your brain become
narrowed or blocked, causing severely reduced
blood flow (ischemia).
– The most common ischemic strokes include:
• Thrombotic stroke – occurs when a blood clot (thrombus)
forms in one of the arteries that supply blood to the brain.
• Embolic stroke – occurs when a blood clot or other debris
forms away from the brain.

9. TYPES OF CVA
b) Hemorrhagic stroke
– Occurs when a blood vessel in your brain leaks or ruptures.
– Brain hemorrhages can result from many conditions that
affect your blood vessels.
– Types include :
• Intracerebral hemorrhage – a blood vessel in the brain
bursts and spills into the surrounding brain tissue,
damaging brain cells.
• Subarachnoid hemorrhage – an artery on or near the
surface of the brain bursts and spills into the space
between the surface of the brain and the skull

10. TYPES OF CVA
• c) Transient ischemic attack (TIA)
– A temporary decrease in blood supply to part of
the brain causes TIAs, which may last as little as
five minutes.
– Sometimes known as a ministroke.

12. Diagnostic evaluation
• History and complete physical and neurological assessment
• Carotid ultrasound – to detect carotid stenosis.
• CT scan – to determine cause and location of stroke.
• MRA or CT angiogram – noninvasive evaluation of
cerebrovascular structures.
• Cerebral angiography – to determine extent of
cerebrovascular insufficiency and to evaluate for structural
abnormalities.
• PET, MRI with diffusion – weighted images to localize
ischemic damage.

13. Brain functions

14. CLINICAL MANIFESTATIONS

15. CLINICAL MANIFESTATIONS

16. Stroke recognition

17. complications
Paralysis or loss of muscle movement
Difficulty talking or swallowing
Memory loss or thinking difficulties.
Emotional problems
Changes in behavior and self-care ability

18. MEDICAL MANAGEMENT
a) Ischemic stroke
• Emergency treatment with medications.
Therapy with clot-busting drugs must start within 4.5 hours
if they are given into the vein.
– Intravenous injection of tissue plasminogen activator
(tPA)
• Emergency endovascular procedures.
– Medications delivered directly to the brain.
– Removing the clot with a stent retriever.
– Carotid endarterectomy.
– Angioplasty and stents

19. surgICAL MANAGEMENT
b) Haemorrhagic stroke
Surgical blood vessel repair.
Surgery may be used to repair blood vessel
abnormalities associated with hemorrhagic strokes

20. Surgical MANAGEMENT
• Endarterectomy
- removal of
atherosclerotic
plaque from
carotid artery

21. Surgical MANAGEMENT
• Surgical Clipping
- Brain aneurysm
clipping is a type
of microsurgery
in which a metal
surgical clip is
used to close off
an aneurysm in
the brain

22. • Anticoagulation after hemorrhage is ruled out.
• Antiplatelet agents
• Antispasmodic agents for spastic paralysis.
• A rehabilitation program, including physical
therapy, occupational therapy, speech therapy
(as soon as stable), and counseling as needed.
• Treatment of post-stroke depression with
antidepressants such as selective serotonin
reuptake inhibitors.
Subsequent Treatment

23. NURSING DIAGNOSIS
Ineffective tissue perfusion (cerebral)
Disturbed sensory perception
Impaired physical mobility
Risk for injury
Self-care deficit
Impaired verbal communication
Impaired swallowing

24. NURSING considerations
Maintain patent airway.
Monitor for changes in the client’s level of
consciousness (increased intracranial pressure
sign).
o Elevate the client’s head to reduce ICP and to
promote venous drainage. Avoid extreme flexion or
extension, maintain the head in a midline neutral
position and elevate the head of bed to 30 degrees.
o Institute seizure precautions

25. NURSING considerations
 Maintain a non-stimulating environment.
 Assist with communication skills if the client’s speech is
impaired.
 Assist with safe feeding
 Maintain skin integrity.
o Encourage PROM every 2 hr to the affected extremities and
AROM every 2 hr to the unaffected extremities.
 Elevate the affected extremities to promote venous
return and to reduce swelling.
 Maintain a safe environment to reduce the risks of falls.

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