This document provides information on cerebrovascular accidents (strokes). It defines a stroke as occurring when blood supply to the brain is interrupted, usually due to a blood clot or burst blood vessel. Strokes can be ischemic, caused by a clot cutting off blood flow, or hemorrhagic, caused by a ruptured blood vessel. Warning signs include sudden weakness, numbness, trouble speaking, and loss of vision. Acting FAST (Facial drooping, Arm weakness, Speech difficulties, Time to call for help) can help identify a stroke and get immediate medical attention, as rapid treatment improves outcomes. Risk factors include age, race, family history, high blood pressure, diabetes, smoking and more.

1. CEREBROVASCULA
R

2. CEREBROVASCULAR ACCIDENT/STROKE
• Also called “brain attack”, cerebral infarction, cerebral
hemorrhage, ischemic stroke or stroke
• A stroke is caused by the interruption of the blood
supply to the brain, usually because a blood vessel
bursts or is blocked by a clot. This cuts off the supply
of oxygen and nutrients, causing damage to the brain
tissue.

3. DIRECT CAUSES:
• CEREBRAL THROMBOSIS
– a blood clot or plaque blocks an artery that supplies a vital
brain center
• CEREBRAL HEMORRHAGE/ANEURYSM
– an artery in the brain bursts, weakens the aneurysm
wall; severe rise in BP causing hemorrhage and
ischemia
• CEREBRAL EMBOLISM
– a blood clot breaks off from a thrombus elsewhere in the
body, lodges in a blood vessel in the brain and shuts off
blood supply to that part of the brain

4. TYPES:
• ISCHEMIC STROKE
– Occurs when a clot or a mass clogs a blood vessel, cutting off the blood
flow to brain cells. The underlying condition for this type of obstruction
is the development of fatty deposits lining the vessel walls. This
condition is called atherosclerosis.
– Almost 85% of strokes are ischemic
ATHEROSCLEROSIS
- “hardening of the arteries”
- “athero” – gruel or paste
- “sclerosis” – hardness
- It’s the process in which deposits of fatty substances,
cholesterol, cellular waste products, calcium and other
substances build up in the inner lining of an artery. This buildup
is called plaque.

6. TYPES:
• HEMORRHAGIC STROKE
– Results from a weakened vessel that ruptures and bleeds into the
surrounding brain. The blood accumulates and compresses the
surrounding brain tissue.
– About 15% of all strokes but responsible for 30% of stroke deaths
2 TYPES
 SUBARACHNOID HEMORRHAGE (SAH)
 occurs when a blood vessel on the surface of the brain ruptures and bleeds
into the space between the brain and the skull
 INTRACEREBRAL HEMORRHAGE (ICH)
 Occurs when a blood vessel bleeds into the tissue deep within the brain.

7. – 2,000,000 brain cells die every minute during
stroke, increasing risk of permanent brain
damage, disability or death.
– Recognizing symptoms and acting fast to get
medical attention can save life and limit
disabilities.
POINTS TO CONSIDER

8. STAGES OF CVA
Transient Ischemic Attack
• sudden and short-lived attack
• Is a "mini stroke" that occurs when a blood clot blocks an artery for a
short time.
• What is the difference between stroke and TIA?
• There's no way to tell if symptoms of a stroke will lead to a TIA or a
major stroke. It's important to call 9-1-1 immediately for any stroke
symptoms.
Reversible ischemic neurologic deficit (RIND) similar to TIA,
but symptoms can last up to a week
Stroke in evolution (SIE)
• Gradual worsening of symptoms of brain ischemia
Completed stroke (CS) – symptoms of stroke stable over a
period and rehab can begin

9. Signs and Symptoms
In embolism
• Usually occurs without warning
• Client often with history of cardiovascular disease
In thrombosis
• Dizzy spells or sudden memory loss
• No pain, and client may ignore symptoms
In cerebral
hemorrhage
• May have warning like dizziness and ringing in the ears (tinnitus)
• Violent headache, with nausea and vomiting
Sudden Onset CVA
•
•
•
•
Usually most severe
Loss of consciousness
Face becomes red
Breathing is noisy and strained

10. Signs and Symptoms
Sudden Onset CVA
• Usually most severe
• Loss of consciousness
• Face becomes red
• Breathing is noisy and strained
• Pulse is slow but full and bounding
• Elevated BP
• May be in a deep coma

11. TIME IS CRTITICAL!
– The longer the time period that the person remains
unresponsive, the less likely it is that the person will
recover.
– The first few days after onset is critical.
– The responsive person may:
• Show signs of memory loss or inconsistent
behavior
• May be easily fatigued, lose bowel and bladder
control, or have poor balance

12. • RISK FACTORS:
•
•
•
•
Being over age 55
Being an African-American
Having diabetes
Having a family history of stroke
– MEDICAL STROKE RISK
• Previous stroke
• Previous episode of transient ischemic attack (TIA) or ministroke
• High cholesterol
• High blood pressure
• Heart disease

13. • RISK FACTORS:
– LIFESTYLE STROKE RISK
•
•
•
•
Smoking
Being overweight
Drinking too much alcohol
You can control lifestyle risks by quitting smoking,
exercising regularly, watching what and how much you eat
and limiting alcohol consumption.

14. Common STROKE symptoms…
Weakness or paralysis
Numbness, tingling, decreased sensation
Vision changes
Speech problems
Swallowing difficulties or drooling
Loss of memory
Vertigo (spinning sensation)
Loss of balance and coordination
Personality changes
Mood changes (depression, apathy)
Drowsiness, lethargy, or loss of consciousness
Uncontrollable eye movements or eyelid drooping

16. MAJOR EFFECT of STROKE
– HEMIPLEGIA – most common result of CVA
• Paralysis of one side of the body
• May affect other functions, such as hearing, general
sensation and circulation
• The degree of impairment depends on the part of the
brain affected
• Stages:
–Flaccid – numbness and weakness of affected side
–Spastic – muscles contracted and tense, movement hard
–Recovery – therapy and rehab methods successful

17. MAJOR EFFECT of STROKE
• Aphasia and Dysphasia
• Brain Damage – extent of brain damage determines chances of
recovery
• Hemianopsia – blindness in half of the visual field of one or
both eyes
• Pain – usually very little; injection of local anesthetic provides
temporary relief
• Autonomic Disturbances
– Such as perspiration or “goose flesh” above the level of
paralysis
– May have dilated pupils, high or low BP or headache
– Treated with atropine-like drugs

18. DIAGNOSIS
• Physical Examination (neurological
examination & medical history)
• Imaging (CT scan and MRI)

19. ISCHEMIC STROKE

20. HEMORRHAGIC STROKE

21. TRANSIENT ISCHEMIC ATTACK (TIA)

22. ACT F.A.S.T
F – FACE
• Ask the person to smile. Does one side of the face droop?
A – ARMS
• Ask the person to raise both arms. Does one arm drift
downward?
S – SPEECH
• Ask the person to repeat a simple sentence. Does the
speech sound slurred or strange?
T – TIME
• Call 911 Immediately

24. ASSESSMENT
– Monitor for signs and symptoms
– Symptoms will vary based on the area of the brain that is
not adequately supplied with oxygenated blood
– The left cerebral hemisphere is responsible for language,
mathematic skills and analytic thinking
– The right cerebral hemisphere is responsible for visual
and spatial awareness and proprioception
– Assess/Monitor Airway patency

25. ASSESSMENT
– Swallowing ability/aspiration risk
– Level of consciousness
– Neurological status
– Motor, sensory and cognitive functions
– Glasgow Coma Scale score

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

27. NURSING CONSIDERATIONS
Maintain patent airway
Monitor for changes in the client’s level of
consciousness
Institute seizure precautions.
Maintain a non-stimulating environment.
Assist with communication skills if the client’s speech is
impaired.
Assist with safe feeding.
• Assess swallowing reflexes.
• Thicken liquid to avoid aspiration.
• Eat in an upright position and swallow with the head and neck flexed
slightly forward.
• Place food in the back of the mouth on the unaffected side.
• Suction on standby.

28. NURSING CONSIDERATIONS
– Maintain skin integrity.
– 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.
– Scanning technique (turning head from side to side)
when eating and ambulating to compensate for
hemianopsia.
– Provide care to prevent deep-vein thrombosis (sequential
compression stockings, frequent position changes,
mobilization)

29. THROMBOLYTIC THERAPY
–Anticoagulants: Sodium heparin, warfarin
(Coumadin)
–Antiplatelets: Ticlopidine (Ticlid), clopidogrel
(Plavix)
–Antiepileptic medications: Phenytoin
(Dilantin), gabapentin (Neurontin)

30. STROKE PREVENTION
– Get screened for high BP.
– Have your cholesterol level checked. LDL
should be lower than 70 mg/dL.
– Follow a low-fat diet.
– Quit smoking!
– Exercise!
– Limit alcohol intake!

31. THAT’S it!
THANK YOU FOR
LISTENING! 