Stroke occurs when blood flow to the brain is interrupted, depriving brain cells of oxygen and nutrients. It is a leading cause of death and disability. The main types are ischemic (caused by clots) and hemorrhagic (caused by bleeding). Risk factors include age, gender, hypertension, heart disease, diabetes, and lifestyle factors like smoking and obesity. Symptoms depend on the affected area of the brain but may include weakness, trouble speaking, vision issues, and altered mental status. Diagnosis involves medical history, exam, and tests like CT/MRI. Treatment focuses on prevention for those at risk and management of acute issues like blood pressure as well as rehabilitation. Lifestyle changes and controlling underlying conditions can help

1. Stroke/ CVA
Mrs. Safoora Qureshi
Nursing Instructor
CON, PIMS

2. Define the terms
CVA: Stands for
“Cerebrovascular Accident” Or “Cerebral Vascular
Attack”
• is a sudden loss of brain functioning resulting from a disruption
of the blood supply to a part of the brain.
Stroke:
• Occurs when the flow of blood to a part of the brain is
interrupted due to block or rupture of a blood vessel, that results
death of the brain cells
Brain Attack:
• Is increasingly being used term to described the stroke
• Indicates; like Heart attack, stroke is a medical emergency that
required medical protocol to save the life

3. Epidemiology
• Estimated incidence of stroke in Pakistan is
• 250/100,000 population/year
• Prevalence is 1.2 %
• Common in men
• Common age group/ younger than 50--- 55
• Second leading cause of death
• Major cause of disability

4. Risk factors
Nonmodifiable Factors:
• Age, gender, race, heredity
Modifiable Factors
• Life style
• Hypertension
• is most common modifiable risk factor
• Heart diseases
• Obesity (abdominal)
• Sleep apnea
• Metabolic syndrome
• Lack of exercise
• Poor diet, drug abuses
Causes:
• Atherosclerosis
• Hypertension
• Diabetes mellites
• Hyperlipidemia
• Alcohol, smoking
• Contraceptive pills
• Sedentary life, lack of exercise
• Sickle cells disease

5. Blood Supply to the brain
By two major pairs of the Arteries
• Internal Carotid Artery (ICA)
• Branches / Middle cerebral, Anterior cerebral artery
• Anterior circulation/frontal, parietal and temporal lobes
• middle circulation/Basal ganglia, diencephalon (thalamus,& hypothalamus)
• Vertebral Arteries (Vertebrobasilar system)
• Branches/Basilary artery, posterior cerebral artery
• Posterior circulation
• Temporal lobe, occipital, cerebellum, brainstem
Regulation of CBF
• For optimal brain functioning CBF maintained at
• 750---1000 ml/ min
• 20 % of cardiac out put
• Total blood flow interruption (Cardiac arrest)/total perfusion failure
• alter neurologic metabolism in 30/sec
• brain death in 2minutes

7.  Cerebral Autoregulation:
• A compensatory mechanism resist change in CBF
• Maintain MAP at 50---150mmgH by
• Vasoconstriction
• Vasodilation
• Co2 , O2, & pH levels
Factors Affecting CBF:
• Atherosclerosis
• Increase ICP
• Transient Ischemic Attacks;
• A temporary focal loss of neurologic function caused by ischemia
last < 24hrs , often < 3 hrs. or 15min
• A Warning sign of stroke

8. Pathophysiology
• Decreased cerebral blood flow. The ischemic cascade begins
when cerebral blood flow decreases to less than 25 mL or 100g
of blood/min
• Aerobic respiration. At this point, neurons are unable to
maintain aerobic respiration.
• Anaerobic respiration. The mitochondria would need to switch
to anaerobic respiration, which generates large amounts
of lactic acid, causing a change in pH and rendering the
neurons incapable of producing sufficient quantities of ATP.
• Loss of function. The membrane pumps that maintain
electrolyte balances fail and the cells cease to function.

9. Types Of Stroke
1. Ischemic Stroke
• Results from inadequate blood
flow to the brain from partial or
complete occlusion of an artery
• Accounts 80% of all stroke
a) Thrombotic stroke
• Occurs from injury to a blood vessel
wall and formation of a clot
• Cerebral thrombosis is a narrowing
of the artery by fatty deposits
called plaque
b) Embolic stroke
An embolus lodges in and occludes a
cerebral artery
2. Hemorrhagic Stroke
• is due to bleeding into the brain by
the rupture of a blood vessel
• Accounts 15% of all stroke
• Have high morbidity and mortality
a) Intracerebral hemorrhage (ICH
• Bleeding within the brain by a
rupture blood vessel
• 40—80% death rate
• Cause; Hypertension, DIC
b) Subarachnoid Hemorrhage (SAH)
• Intracranial bleeding into the CSF
• Causes; a rupture aneurysm

10. Ischemic Stroke Hemorrhagic stroke

11. Clinical manifestation
• Numbness/weakness in face, leg &
arm
• Face drooping
• Change in mental status/ alter LOC
• Trouble speaking
• Slurred speech
• Visual disturbances
• Homonymous hemianopsia.
• Loss of One side vision
• Loss of peripheral vision.
• The patient experiences difficulty
seeing at night and is unaware of
objects
• Hemiparesis.
• weakness of the face, arm,
• and leg on the same side
• Hemiplegia.
• Paralysis of the face, arm,
and leg on the same side
due
• Ataxia.
• Staggering, unsteady gait
• Alter affect
• Depression, frustration,
uncontrol emotions
• Self neglect

12. Conti---
• Dysphagia
• There is difficulty is
wallowing.
• Paresthesia.
• There is numbness and
tingling
• Apraxia
• Inability to perform learned
skills
• Alter Intellect
• Loss of memory & learning capacity
• Dysarthria.
• This is the difficulty in forming
words.
• Dysphasia
• partial loss of language
• Aphasia
• full loss of producing
language/speech
• Expressive aphasia.
• The patient is unable to
form words
• Receptive aphasia.
• The patient is unable to
comprehend the spoken
word .

13. Ataxic Gait

15. Diagnosis
• History
• Physical Examination
• Clinical Background/ “FAST” test
• CT, MRI,
• CT angiography
• Angiography Ultrasound
• TCD --- Transcranial Doppler ultrasound
• X-rays
• LP– lumber puncture
• Blood Serum; Electrolytes,
BUN, BSR, BSF, LFTs, RFTs
ESR, CP

16. Collaborative therapy
Preventive Therapy
• Control of hypertension, diabetes mellitus & treat underline cardiac
problems
• Anticoagulant therapy for pt with atrial fibrillation
• Healthy food choices
• No smoking
• Limit alcohol
• Platelets inhibitors /aspirin
• Stenting of carotid artery
• Translaminar angiography

17. Collaborative Care
Acute Care :
• Maintenance of airway
• Treat hypotension/ hypovolemia
• Colloidal IV solution
• Fluid electrolyte replacement
• 1500ml to 2000 ml/day
• Avoid hypotonic solutions
• Record intake & output
• Reduce Cerebral edema
• Elevate head of the bed at 30 0
Drug therapy
• Ischemic Stroke
• Diuretics/mannitol to ICP
• Thrombolysis (fibrinolytic) Agents
• Antiplatelets/aspirin
• Anticoagulant/ heparin
• Antihypertensive
• Statins/ lipid lowering agents

18. Hemorrhagic Stroke
• Bed rest with sedation
• to prevent agitation and stress
• Manage hypertension
• antihypertensive
• Management of vasospasm
• vasodilators
• Surgical or medical treatment to
prevent rebleeding.
• Analgesics
• Codeine, acetaminophen)
• Elastic compression stockings
• to prevent DVT
Surgical Therapy
 Ischemic Stroke
• Thrombectomy
 Hemorrhagic stroke
• Aneurysm-induce hematoma
Clipping, wrapping, &
coiling
• Cerebral hematoma
Surgical decompression
 Embolic Stroke;
• treat the underline cause

19. Surgical Treatment of aneurysm

20. Prevention of Stroke
The risk of stroke can be
reduced by promoting
• Healthy lifestyle.
• No smoking,
• limit alcohol
• Maintaining a healthy weight
• Encourage healthy diet
• Regular exercise
• DASH diet. (Dietary
Approaches to Stop
Hypertension)
• High in fruits and vegetables
• Moderate in low-fat dairy
products, low in animal protein
& low in sodium
Stroke risk screenings.
• Identifying high risk
population/groups for stroke
• Education.
• Educate the community for
Recognition and prevention of
stroke.
• Low-dose aspirin.
• Lower the risk of stroke in
women who are at risk.
• Periodical Health Checkup
• Control of hypertension,
DM, Cholesterol level