Regie Delariarte , Trexie Dipa .

Khrystle Dote, Clarice Estores BN3A October 3, 2017

Cerebrovascular accident, also known as stroke, cerebral infarction, brain attack, is any functional or structural
abnormality of the brain caused by pathological condition of the cerebral vessels of the entire cerebrovascular
system. It is the sudden impairment of cerebral circulation in one or more of the blood vessels supplying the
brain.
Causes:
A stroke may be caused by a blocked artery (ischemic stroke) or the leaking or bursting of a blood vessel
(hemorrhagic stroke). Some people may experience only a temporary disruption of blood flow to their brain
(transient ischemic attack, or TIA).
Types
Ischemic stroke
About 85 percent of strokes are ischemic strokes. Ischemic strokes occur when the arteries to your brain
become narrowed or blocked, causing severely reduced blood flow (ischemia). The most common ischemic
strokes include:
Thrombotic stroke. A thrombotic stroke occurs when a blood clot (thrombus) forms in one of the
arteries that supply blood to your brain. A clot may be caused by fatty deposits (plaque) that build up
in arteries and cause reduced blood flow (atherosclerosis) or other artery conditions.
Embolic stroke. An embolic stroke occurs when a blood clot or other debris forms away from your
brain commonly in your heart and is swept through your bloodstream to lodge in narrower brain
arteries. This type of blood clot is called an embolus.
Hemorrhagic stroke
Hemorrhagic stroke occurs when a blood vessel in your brain leaks or ruptures. Brain hemorrhages can result
from many conditions that affect your blood vessels, including uncontrolled high blood pressure
(hypertension), overtreatment with anticoagulants and weak spots in your blood vessel walls (aneurysms).
A less common cause of hemorrhage is the rupture of an abnormal tangle of thin-walled blood vessels
(arteriovenous malformation) present at birth.
Types of hemorrhagic stroke include:
Intracerebral hemorrhage. In an intracerebral hemorrhage, a blood vessel in the brain bursts and spills into
the surrounding brain tissue, damaging brain cells. Brain cells beyond the leak are deprived of blood and also
damaged.
High blood pressure, trauma, vascular malformations, use of blood-thinning medications and other conditions
may cause an intracerebral hemorrhage.
Subarachnoid hemorrhage. In a subarachnoid hemorrhage, an artery on or near the surface of your brain
bursts and spills into the space between the surface of your brain and your skull. This bleeding is often
signaled by a sudden, severe headache.
A subarachnoid hemorrhage is commonly caused by the bursting of a small sack-shaped or berry-shaped
outpouching on an artery known as an aneurysm. After the hemorrhage, the blood vessels in your brain may
widen and narrow erratically (vasospasm), causing brain cell damage by further limiting blood flo
Transient ischemic attack (TIA)
A transient ischemic attack (TIA) also known as a ministroke is a brief period of symptoms similar to
those you'd have in a stroke. A temporary decrease in blood supply to part of your brain causes TIAs, which
often last less than five minutes.
It's not possible to tell if you're having a stroke or a TIA based only on your symptoms. Up to half of people
whose symptoms appear to go away actually have had a stroke causing brain damage.
Regie Delariarte , Trexie Dipa . Khrystle Dote, Clarice Estores BN3A October 3, 2017

Pathophysiology
Causes: excessive eating of high cholesterol foods

Causing increase cholesterol levels

Accumulation of plaques and thrombus formation in the arteries are formed

Increased BP

Decreased blood flow to the brain

Decreased O2 and nutrition supply

Leading to stroke
Signs of Stroke in Men and Women
Sudden numbness or weakness in the face, arm, or leg, especially on one side of the body
Sudden confusion, trouble speaking, or difficulty understanding speech
Sudden trouble seeing in one or both eyes
Sudden trouble walking, dizziness, loss of balance, or lack of coordination
Sudden severe headache with no known cause

Diagnostic tests:

Tests that View the Brain, Skull, or Spinal Cord

CT scan
(CAT Scan, Computed axial tomography)
A CT scan uses X-rays to produce a 3-dimensional image of your head. A CT scan can be used to diagnose
ischemic stroke, hemorrhagic stroke, and other problems of the brain and brain stem.
MRI scan
(Magnetic resonance imaging, MR)
An MRI uses magnetic fields to produce a 3-dimensional image of your head. The MR scan shows the
brain and spinal cord in more detail than CT. MR can be used to diagnose ischemic stroke, hemorrhagic
stroke, and other problems involving the brain, brain stem, and spinal cord.

Tests that View the Blood Vessels that Supply the Brain
Carotid doppler
(Carotid duplex, Carotid ultrasound)
Painless ultrasound waves are used to take a picture of the carotid arteries in your neck, and to show
the blood flowing to your brain. This test can show if your carotid artery is narrowed by arteriosclerosis
(cholesterol deposition).
Transcranial doppler
(TCD)
Ultrasound waves are used to measure blood flow in some of the arteries in your brain.
MRA
(Magnetic resonance angiogram)
This is a special type of MRI scan (see above) which can be used to see the blood vessels in your neck or
brain.
Cerebral arteriogram
(Cerebral angiogram, Digital subtraction angiography, [DSA])
Regie Delariarte , Trexie Dipa . Khrystle Dote, Clarice Estores BN3A October 3, 2017

A catheter is inserted in an artery in your arm or leg, and a special dye is injected into the blood vessels
leading to your brain. X-ray images show any abnormalities of the blood vessels, including narrowing,
blockage, or malformations (such as aneurysms or arterio-venous malformations). Cerebral
arteriogram is a more difficult test than carotid doppler or MRA, but the results are the most accurate.
Routine Screening Tests
Chest x-ray
(CXR)
An x-ray of the heart and lungs is a standard test for patients with acute medical problems.
Abnormalities may alert your doctor to important problems such as pneumonia or heart failure.
Urinalysis
(UA)
A urine sample is often obtained to screen for bladder infection or kidney problems. If infection is
suggested, a urine culture test may be required.
Pulse oximetry
(Blood oxygen)
This painless test is sometimes done in the emergency room or hospital to determine if your blood is
receiving enough oxygen from the lungs. A small probe with a red light is usually attached to one finger.
Other Neurologic Tests
Electroencephalogram
(EEG)
The EEG measures your brain waves through several electrical leads painlessly attached to your head.
EEG is not routinely used for stroke diagnosis, but would be ordered if your doctor thinks that you may
have had a seizure.
Lumbar puncture
(LP, spinal tap)
A needle is inserted in your lower back to obtain a sample of the fluid (cerebrospinal fluid, CSF) which
surrounds your brain and spinal cord. LP is not routinely used for diagnosis of ischemic stroke. However,
LP is often required if subarachnoid hemorrhage (bleeding from a cerebral aneurysm) is suspected. LP
may also be needed if your doctor suspects a nervous system infection (such as meningitis) or
inflammation.
Electromyogram / Nerve conduction test
(EMG / NCV)
This test records the electrical activity of the nerves and muscles. EMG is not used for stroke diagnosis,
but might be needed if your doctor suspects a problem with the nerves in your arms or legs.
Brain biopsy
This is a surgical procedure in which a small piece of the brain is removed for microscopic examination.
Biopsy is used to diagnose lesions (such as tumors) which cannot be identified by CT or MRI scan. It is
very rarely used for stroke diagnosis, often only when cerebral vasculitis is suspected

Treatment and procedure:

Hemorrhagic stroke

Emergency treatment of hemorrhagic stroke focuses on controlling your bleeding and reducing pressure in
your brain. Surgery also may be performed to help reduce future risk.

Surgical blood vessel repair. Surgery may be used to repair blood vessel abnormalities associated with
hemorrhagic strokes. Your doctor may recommend one of these procedures after a stroke or if an
aneurysm or arteriovenous malformation (AVM) or other type of vascular malformation caused your
hemorrhagic stroke:
Surgical clipping. A surgeon places a tiny clamp at the base of the aneurysm, to stop blood flow to it. This
clamp can keep the aneurysm from bursting, or it can prevent re-bleeding of an aneurysm that has
recently hemorrhaged.

Coiling (endovascular embolization). In this procedure, a surgeon inserts a catheter into an artery in
your groin and guides it to your brain using X-ray imaging. Your surgeon then guides tiny detachable coils
Regie Delariarte , Trexie Dipa . Khrystle Dote, Clarice Estores BN3A October 3, 2017

into the aneurysm (aneurysm coiling). The coils fill the aneurysm, which blocks blood flow into the
aneurysm and causes the blood to clot.

Surgical AVM removal. Surgeons may remove a smaller AVM if it's located in an accessible area of your
brain, to eliminate the risk of rupture and lower the risk of hemorrhagic stroke. However, it's not
always possible to remove an AVM if its removal would cause too large a reduction in brain function, or
if it's large or located deep within your brain.

Intracranial bypass. In some unique circumstances, surgical bypass of intracranial blood vessels may be
an option to treat poor blood flow to a region of the brain or complex vascular lesions, such as
aneurysm repair.

Stereotactic radiosurgery. Using multiple beams of highly focused radiation, stereotactic radiosurgery
is an advanced minimally invasive treatment used to repair vascular malformations.

Nursing Diagnosis

Ineffective Cerebral Tissue Perfusion r/t interruption of blood flow: occlusive disorder, hemorrhage;
cerebral vasospasm, cerebral edema

Impaired Physical Mobility r/t neuromuscular involvement: weakness, paresthesia; flaccid/hypotonic

paralysis (initially); spastic paralysis
Communication, impaired verbal [and/or written] r/t impaired cerebral circulation; neuromuscular
impairment, loss of facial/oral muscle tone/control; generalized weakness/fatigue