ALTERATIONS IN THE ALTERATIONS IN THE CENTRAL NERVOUS CENTRAL NERVOUS SYSTEMSYSTEM

ExemplarCerebrovascular Accident(CVA)Introduction to CVA / StrokePrevention

Stroke (Brain Attack)Stroke (Brain Attack)Definition

-Blood flow interrupted to an area of the brain

-Ischemia to the part of the brain

-Bleeding into brain tissue-The brain doesn’t store

oxygen/ glucose and needs a constant flow of blood

Cerebrovascular AccidentCerebrovascular Accident Approximately 800,000 in USA annually (425,000=F; 370,000=M) *

Third most common cause of death #1 leading cause of disability

Physical, cognitive, emotional, & financial impact

*http://www.stroke.org/site/News2?page=NewsArticle&id=9015&news_iv_ctrl=1222

Transient Ischemic Attack (TIA)Transient Ischemic Attack (TIA)

Temporary focal loss of neurologic function

Caused by ischemia of one of the vascular areas of the brain

Most resolve within 3 hours

Difference of TIA vs. CVA is infarction*

*Easton,JD, Saver,JL, Albers, GW, et al. Definition and evaluation of transient ischemic attack.Stroke. 2009; 40(6)2276-2293.

Faculty animations from chtr 47 TIA

Types of StrokesTypes of StrokesIschemic stroke (87%)

-Thrombotic stroke: atherosclerosis of blood vessel wall -Embolic stroke: dislodged clot from other area of body

Hemorrhagic stroke (13%)Bleeding into brain tissue r/t

ruptured aneurysm, arteriovenous malformation

Faculty animation a fib cht 47

Cerebrovascular Accident: Cerebrovascular Accident: IschemicIschemic

Thrombotic Thrombotic Lumen of the blood vessels narrows

(atherosclerosis) - becomes occluded -infarction occurs

Associated with HTN and Diabetes Mellitus

Cerebrovascular Accident: Cerebrovascular Accident: IschemicIschemic

Embolic Stroke Embolic StrokeEmbolus lodges in/ occludes a cerebral artery

Infarction & cerebral edema developEmboli R/T : atrial fibrillation

-MI -valvular prostheses

Severe symptoms occur rapidly– no collateral circulation

Any age groupRecurrence common if underlying cause

not treated

Cerebrovascular AccidentCerebrovascular AccidentEmbolic StrokeEmbolic Stroke

Cerebrovascular Accident Cerebrovascular Accident Hemorrhagic Hemorrhagic

Subarachnoid Hemorrhage-Intracranial bleeding-Increases with age and

more common in women

Intracerebral Hemorrhage - rupture within the brain

tissueAneurysm

-abnormal blood vessel wall which ruptures

Cerebrovascular AccidentCerebrovascular AccidentHemorrhage Stroke Hemorrhage Stroke Intracerebral HemorrhageIntracerebral Hemorrhage

Cerebrovascular AccidentCerebrovascular AccidentPopulations at RiskPopulations at Risk

Age – Occurrence doubles each decade >55 years

Gender – Almost equal for men & women

Race – African Americans, Hispanics, Native Americans, Asian Americans -- higher incidence

Heredity – family history, prior transient ischemic attack, or prior stroke increases risk

http://www.stroke.org/site/PageServer?pagename=RISK

Pediatric StrokesPediatric StrokesPopulations at Risk

M>F; African American>White, Asian

Medical Hx -sickle cell disease -heart disease (congenital or acquired)

Signs & Symptoms -infant may have one sided seizure -older child has weakness/numbness

Video on Pediatric StrokeVideo on Pediatric Strokehttp://abcnews.go.com/Health/

video/year-stroke-survivor-10139867

Cerebrovascular AccidentCerebrovascular AccidentRisk FactorsRisk Factors

Controllable Risks with Medical Treatment & Lifestyle Changes:

High blood pressure DiabetesCigarette smoking TIA (Aspirin)High blood cholesterol ObesityHeart Disease Atrial fibrillation

Oral contraceptive use Physical inactivity

Sickle cell disease Asymptomatic carotid Hypercoagulability stenosis

PreventionPreventionMaintain healthy lifestyle

-exercise -don’t smoke/alcohol in moderation

Diet -low sodium, low cholesterol

Control underlying medical problems -hypertension -diabetes mellitus -atrial fibrillation