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Occurs when impaired circulation in the brain disrupts the supply of oxygen.
A cerebrovascular accident results from impaired circulation in one or more of the brain’s
blood vessels. Impairments are usually caused by:
A. THROMBUS
The most common cause of CVA, which is usually related to atherosclerosis.
Plaque and atheromatous deposits gradually occlude the artery. Occlusion leads to
ischemia and infarction of brain tissue, followed by edema and necrosis. It usually
occurs in the extracerebral vessels but sometimes occurs in the intracerebral
vessels.
B. HEMORRHAGE
The most devastating cause of CVA, hemorrhage occurs when a cerebral vessel
ruptures and bleeds into brain tissue or subarachnoid space. Usually results from a
rupturing arteriosclerotic vessel caused by exposure to prolonged hypertension, a
cerebral aneurysm. Effects may be severe. More than 50% of patients die within
the first 3days from brain herniation.
Photographs show acute, massive hypertensive hemorrhages. Note that the blood here
is under enough driving pressure to destroy the tissue, rupture through the ependymal
lining and fill the ventricle with blood. When massive, these tend to be fatal events.
C. EMBOLISM
Usually, fragments break off from a mural thrombus in the left atrium or ventricles or
from bacterial vegetations affecting heart valves. These emboli travel through the carotid
artery and typically lodge in the smaller cerebral vessels. It may occur quite suddenly,
often followed by necrosis and edema.
B. Risk factors.
1. Atherosclerosis
2. Hypertension
3. Anticoagulation therapy
4. Cardiac vascular disease
5. Synthetic valve and organ displacement
6. Atrial arrhythmias
7. Diabetes
E. Cerebral anoxia longer than ten minutes to a localized area of brain—causes cerebral
infarction (irreversible changes).
H. Permanent disability unknown until edema subsides. Order in which function may
return: facial, swallowing, lower limbs, speech, arms.
Assessment:
3. General
a. Memory deficits; reduced memory span; emotional liability.
b. Visual deficits such as homonomous hemianopia (loss of half of
each visual field).
c. Apraxia (can move but unable to use body part for specific
purpose).
NURSING MANAGEMENTS:
B. Maintain patient airway and ventilation--- elevate head of bed 20 degrees unless
shock is present.
I. Promote elimination.
1. Bladder control may be regained within three to five days.
2. Retention catheter may not be part of treatment regimen.
3. Offer urinal or bedpan every two hours day and night.
Causes:
• vascular disorders
• blood disorders
• cerebrovascular insufficiency
• High blood pressure. You can lower your risk of TIA by lowering your blood
pressure.
• High cholesterol. High cholesterol increases your risk of atherosclerosis, which
can lead to blood clots. By lowering your cholesterol, you can lower your chance
of having a TIA.
• Smoking. If you stop smoking, you can lower your risk of having a TIA.
• Heart disease. The higher your risk of heart attack, the higher your chance of
having a TIA. By lowering your risk of heart attack, you also reduce your chance
of having a TIA.
• Age. Most TIAs occur after the age of 60.
• Family and medical history. If one of your family members has had a stroke or
TIA or you have had a previous TIA, you are more likely to have a stroke or TIA.
Common Clinical Presentations of TIA
Affected
area Signs and symptoms Implications
Cranial Visual loss in one or both eyes Bilateral loss may indicate more
nerves ominous onset of brainstem ischemia.
Speech and Slurring of words or reduced verbal If speech is severely slurred or facial
language output; language difficulty drooling is excessive, there is an
pronouncing, comprehending, or increased risk of aspiration.
"finding" words Writing and reading also may be
impaired.
Excessive somnolence This symptom may indicate bilateral
hemispheric or brainstem involvement.
The doctor will ask about your symptoms and medial history, and perform a physical
exam. A primary goal is to determine your stroke risk.
Blood Tests - including a complete blood count, blood sugar, cholesterol, fat levels,
clotting levels, and a check of other elements in the blood
Electrocardiogram (EKG) – to measure heart rhythm and check for an irregular heart
beat
Ultrasound– a test that uses sound waves to help determine if there are blockages in the
arteries supplying the brain
MRI Scan – a test that uses magnetic waves to make pictures of structures inside the
head
CT Scan – a type of x-ray that uses a computer to make pictures of structures inside the
head
Echocardiogram - an ultrasound test that looks for blood clots and valve abnormalities
within the heart
Electroencephalogram (EEG) - a test that can detect seizures by measuring brain waves
(used only if a seizure is suspected)
Occupational Therapist Rehabilitation after an injury may help some patients regain lost
functions or learn new ways of accomplishing everyday tasks.
The Human Brain