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Cerebrovascular

Accident(CVA)

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Cerebrovascular accidents include

Ischemic stroke,

Hemorrhagic stroke,

Embolic stroke

Cerebrovascular anomalies such as intracranial aneurysms

and arteriovenous malformations (AVMs).

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A stroke, or cerebrovascular accident, is defined as

Abrupt onset of a neurologic deficit that is attributable to a

focal vascular cause.

The clinical manifestations of stroke are highly

variable because of the complex anatomy of the

brain and its vasculature.

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Cerebral ischemia is caused by a reduction in blood flow thatlasts longer than several seconds.

Neurologic symptoms are manifest within seconds because

neurons lack glycogen, so energy failure is rapid.

When blood flow is quickly restored, brain tissue can recover

fully and the patient's symptoms are only transient: this is

called a transient ischemic attack (TIA).

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Typically the neurologic signs and symptoms of a TIA last for 5

to 15 min but, by definition, must last 24 h.

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A generalized reduction in cerebral blood flow -

syncope

If low cerebral blood flow persists for a longer duration, then

infarction in the border zones between the major cerebral artery

distributions may develop.

In more severe instances, global hypoxia-ischemia causes

widespread brain injury

Hypoxic-ischemic encephalopathy.

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Etiology of ischemic stroke

1.Cardioembolic

2.Atherosclerosis

3.Hypercoagulable states4.Moya Moya disease

5.Binswangers disease

6.CADASIL

7.Arteritis

8.Venous sinus thrombosis9.Drugs

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Risk Factors

Hypertension

Diabetes mellitus

Oral contraceptives

Pregnancy

Menopause

Cigarette smoking

Substance abuse

Atherosclerosis

Obesity

Sedentary life-styleHyperlipidemia

Atrial fibrillation

Cardiac disease

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Embolic CVA

Blood clot or clump of

matter lodges in

cerebral blood vessel

Frequently in

bifurcation of vessels

Sources of emboli:

Atrial fibrillation

Carotid

atherosclerotic plaque

Bacterial endocarditis

MI

RHD

Ventricular aneurysm

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Hemorraghic stroke

Intracranial

hemorrhage

Cerebral blood vessel

rupture

Most fatal

Causes:

Hypertension

Intracranial aneurysm

Trauma

Tumors

AV malformation

Anticoagulants

Blood disorders

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Manifestations

HemiplegiaHemiparesis

Cranial nerve palsy

Hemianopia

Monoplegia/ paresisSeizures

Aphasia

Sensory deficit

Cognitive disturbancesDeath

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Complications

Aspiration

Recurrent infections

Disuse atrophy

Reduced quality of life

Dependent edema

Orthostatic hypotension

Thrombus formation

Osteoporosis

Renal calculi

ContracturesPressure ulcers

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Investigations

CT brain

MRI

Carotid doppler

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CT shows

Lft.MCA infarct

Massive

Midline shift present

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Rt. Capsular

hemorrhage

No midline shift

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Treatment

Acute stroke

1.Golden hour < 3 hrs

2.t- PA for thrombolysis

Anti platelets aspirin, clopidogrel

Heparin

venous infarct, embolic stroke

Statins

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Mass effect

Anti edema measures

mannitol, dexamethasone

Control of hypertension

Anti epileptics for seizure

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Physiotherapy

Occupational therapy

Speech therapy

Adequate nursing care

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