define term, patho, treatment

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