by: Donnabell V.

Incognito, RN
Cerebrovascular accident is the term that refers to any functional abnormality of the Central
Nervous System that occurs when the normal blood supply to the brain is disrupted, as by a
blood clot or a ruptured blood vessel, and vital brain tissue dies. Cerebrovascular accident is
commonly called Strokes.
Cerebrovascular accident may be caused by any of three mechanisms.
• Cerebral Thrombosis – blockage in the thrombus (clot) that has built up on the wall of
the brain artery.
• Cerebral Embolism – blockage by an embolus (usually a clot) swept into the artery in the
brain.
• Hemorrhage – Rupture of a blood vessel and bleeding within or over the surface of the
brain.

Thrombosis and embolism both lead to cessation of blood supply to part of the brain thus to
infarction (tissue death). Rupture of a blood vessel in or near the brain may cause an
intracerebral hemorrhage or subarachnoid hemorrhage.
The symptoms of a stroke usually develop over minutes or hours occasionally over several days.
Depending on the site, cause and extent of damage, any or all of the symptoms at right may be
present, in any degree of severity. The more serious cases lead to rapid loss of consciousness,
coma, and death or to severe physical or mental handicap.
Hemiplegia – weakness or paralysis on one side of the body is one of the more common effects
of a serious stroke.
The following are the symptoms of Cerebrovascular accident:
• Headache
• Dizziness and confusion
• Visual disturbance
• Slurred speech or loss of speech
• Difficulty of swallowing
Risk factors:
• Age
 • High blood pressure – weakens the walls of arteries
• Atherosclerosis – narrowed artery channels
• Heart disease – cause blot clot in the heart that may break off and migrate to the brain.
• Diabetes mellitus – accelerated degeneration of small blood vessel
• Smoking – increase the risk ofhypertension
• Polycythemia – a raised level of red cells in the blood.
• Hyperlipidemia – high level of fatty substances in the blood

Definition of Cerebrovascular accident

Cerebrovascular accident: The sudden death of some brain cells due to lack of oxygen when
the blood flow to the brain is impaired by blockage or rupture of an artery to the brain. A CVA is
also referred to as a stroke.
Symptoms of a stroke depend on the area of the brain affected. The most common symptom is
weakness or paralysis of one side of the body with partial or complete loss of voluntary
movement or sensation in a leg or arm. There can be speech problems and weak face muscles,
causing drooling. Numbness or tingling is very common. A stroke involving the base of the brain
can affect balance, vision, swallowing, breathing and even unconsciousness.
A stroke is a medical emergency. Anyone suspected of having a stroke should be taken
immediately to a medical facility for diagnosis and treatment.
The causes of stroke: An artery to the brain may be blocked by a clot (thrombosis) which
typically occurs in a blood vessel that has previously been narrowed due to atherosclerosis
("hardening of the artery"). When a blood clot or a piece of an atherosclerotic plaque (a
cholesterol and calcium deposit on the wall of the artery) breaks loose, it can travel through the
circulation and lodge in an artery of the brain, plugging it up and stopping the flow of blood; this
is referred to as an embolic stroke. A blood clot can form in a chamber of the heart when the
heart beats irregularly, as in atrial fibrillation; such clots usually stay attached to the inner lining
of the heart but they may break off, travel through the blood stream, form a plug (embolus) in a
brain artery and cause a stroke. A cerebral hemorrhage (bleeding in the brain), as from an
aneurysm (a widening and weakening) of a blood vessel in the brain, also causes stroke.
The diagnosis of stroke involves a medical history and a physical examination. Tests are done to
search for treatable causes of a stroke and help prevent further brain damage. A CAT scan (a
special X-ray study) of the brain is often done to show bleeding into the brain; this is treated
differently than a stroke caused by lack of blood supply. A CAT scan also can rule out some
other conditions that may mimic a stroke. A soundwave of the heart (echocardiogram) may be
done to look for a source of blood clots in the heart. Narrowing of the carotid artery (the main
artery that supplies blood to each side of the brain) in the neck can be seen with a soundwave test
called a carotid ultrasound. Blood tests are done to look for signs of inflammation which can
suggest inflamed arteries. Certain blood proteins are tested that can increase the chance of stroke
by thickening the blood.
Stroke look-alikes: Just because a person has slurred speech or weakness on one side of the body
does not necessarily mean that person has had a stroke. There are many other nervous system
disorders that can mimic a stroke including a brain tumor, a subdural hematoma (a collection of
blood between the brain and the skull) or a brain abscess (a pool of pus in the brain caused by
bacteria or a fungus). Virus infection of the brain (viral encephalitis) can cause symptoms similar
to those of a stroke, as can an overdose of certain medications. Dehydration or an imbalance of
sodium, calcium, or glucose can cause neurologic abnormalities similar to a stroke.
Treatment of a stroke: Early use of anticoagulants to minimize blood clotting has value in some
patients. Treatment of blood pressure that is too high or too low may be necessary. (Lowering
elevated blood pressure into the normal range is no longer recommended during the first few
days following a stroke since this may further reduce blood flow through narrowed arteries and
make the stroke worse.) The blood sugar glucose in diabetics is often quite high after a stroke;
controlling the glucose level may minimize the size of a stroke. Drugs that can dissolve blood
clots may be useful in stroke treatment. Oxygen is given as needed. New medications that can
help oxygen-starved brain cells survive while circulation is reestablished are being developed.
Rehabilitation: When a patient is no longer acutely ill after a stroke, the aim turns to maximizing
the patient's functional abilities. This can be done in an inpatient rehabilitation hospital or in a
special area of a general hospital and in a nursing facility. The rehabilitation process can involve
speech therapy to relearn talking and swallowing, occupational therapy for regaining dexterity of
the arms and hands, physical therapy for improving strength and walking, etc. The goal is for the
patient to resume as many of their pre-stroke activities as possible.
Footnote: The term "stroke" reflects the belief among the ancient Greeks and Romans that
someone suffering a stroke (or any sudden incapacity) had been struck down by the gods.

Objectives:
Explain the pathophysiology of a stroke at the cellular level.
 Describe the cause and effects of a cerebrovascular accident.
 Correlate neurological deficits with the areas of the brain involved in a cerebrovascular
accident.
 Explain the effects of a cerebrovascular accident on sensory integration.
 Understand the visual pathway to the optic cortex and how stroke may affect vision.