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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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