CEREBROVASCULARACCIDENT

PRESENTED BY-

GEETA JOSHI

STATE COLLEGE OF NURSING

DEFINITION

Cerebrovascular accident or Brain attack is sudden loss of

function resulting from disruption of blood supply to a

part of the brain.

ETIOLOGYMODIFIABLE RISK FACTORS-

• Hypertension• Smoking & alcoholism• Diabetes mellitus• Cardiovascular disease• Asymptomatic carotid stenosis• Transient ischemic attacks• Sickle cell anemia• Dyslipidemia• Obesity• Poor diet ( increased fat & sodium,

decreased Potassium)• Physical inactivity• Postmenopausal hormone therapy

NON- MODIFIABLE RISK FACTORS

• Older age• Gender (males)• Heredity• Prior stroke or heart attack

S. NO

COMPARISION ISCHEMIC STROKE HEMORRHAGIC STROKE

1. CAUSE •Large artery thrombosis• small penetrating artery thrombosis• Cardiogenic embolic • cryptogenic•others

•Intracerebral hemorrhage•Subarachnoid hemorrhage•Cerebral aneurysm•Arteriovenous malformation

2. SYMPTOMS Numbness or weakness on one side of face especially arm & legs.

Exploding headache. Decreased LOC

3. FUNCTIONAL RECOVERY

Plateau at 6 months Plateau at 18 months

ISCHEMIC STROKE- TYPES

1.Large artery thrombotic strokes- caused by atherosclerotic plaques in large arteries of brain , resulting in thrombus formation & occlusion.

2.Small penetrating artery thrombotic strokes- also called Lacunar stroke, most common.

3.Cardiogenic embolic stroke- due to cardiac dysrhythmias, usually atrial fibrillation.

1.Embolic strokes- caused by valvular heart disease & thrombi in left ventricle, can be prevented by use of anticoagulants.

2.Cryptogenic strokes- no known cause.

3.Others- illicit drug use, coagulopathy, migraine & spontaneous dissection of carotid or vertebral arteries.

PATHOPHYSIOLOGY- ischemic stroke• Due to obstruction of a blood vessel• Disruption in cerebral blood flow

• Cellular metabolic events• Failure of neurons to maintain aerobic

respiration•Mitochondria switch to anaerobic respiration• Production of lactic acid in large amounts

• Change in ph (ACIDOSIS)• Inability of neuron to produce adequate

energy• Insufficient fuel for depolarisation• Cessation of membrane pumps

• Accumulation of calcium & release of glutamate

• Activation of damaging pathways.

CLINICAL MANIFESTATIONS- ischemic stroke

•Numbness or weakness of face, arm or leg, especially on one side of body.•Confusion•Change in mental status•Trouble speaking or understanding speech•Visual disturbances•Difficulty in walking, dizziness or loss of balance•Sudden severe headache

CLINICAL MANIFESTATIONS- ischemic stroke

•Hemiplegia, hemiparesis, flaccid paralysis•Dysarthria, dysphasia, aphasia (expressive, •receptive or global)•Apraxia•Hemianopsia•Disturbed visual spatial relationships•agnosia

CLINICAL MANIFESTATIONS

SENSORY

DEFICITS

VERBAL DEFICIT

S

MOTOR DEFICIT

SEMOTIO

NAL DEFICIT

SCOGNITIVE

DEFICITS

VISUAL FIELD

DEFECTS

DIAGNOSIS•Careful history•Complete physical & neurologic examination•NCCT (non contrast computed tomography)- whether ischemic or hemorrhagic•ECG•Carotid ultrasound•CT angiography•MRI or MRA•Transcranial Doppler flow studies•Echocardiography•SPECT

MEDICAL MANAGEMENT•Platelet inhibiting medications- aspirin, clopidogrel•Statins- 3- hydroxy 2-methyl glutaryl- coenzyme A , e.g. simvastatin• Anti- hypertensive drugs- ACE inhibitors, thiazides• Thrombolytic therapy- t-PA – Tissue plasminogen activator•Anticoagulant therapy- INR above 1.7

•DOSAGE- 0.9mg/kg with max. dose 90mg.•10% of the dose is

administered IV bolus over 1 minute.

•Remaining 90%is administered over 1

hour.•Obtain vital signs every 15 min for first 2 hours.

t-PA THERAPY

OTHER TREATMENTS-Anticoagulant

administration- heparinOsmotic diuretics-

mannitolElevation of the head

Endotracheal intubation

Neurologic assessmentHemodynamic

monitoring

SURGICAL MANAGEMENT

•Endarterectomy- removal of atherosclerotic plaque from carotid artery.

•Carotid stenting •with angioplasty.

•Carotid stenting •without angioplasty.

NURSING MANAGEMENTAcute pain R/t Hemiplegia & disuse

Impaired physical motility R/t loss of balance & coordination

Self care deficit R/t stroke sequalae

Disturbed sensory perception R/t altered sensory reception

Impaired urinary elimination R/t flaccid bladder

Disturbed thought process R/t brain damage

BEHAVIOURAL AND DIETARY MANAGEMENT PREVENTIVE MEASURES-

• Leading a healthy lifestyle.•Quitting smoking.

•Maintaining a healthy weight.•Daily exercise

• Following a healthy diet.•DASH (dietary approaches to stop

hypertension)- high in fruits & vegetables, low fat dairy products, low in

animal proteins.