CEREBROVASCULAR ACCIDENT (STROKE)

STROKE
Sudden impairment of blood circulation to the brain Recurrences possible within weeks, months, or years Also known as cerebrovascular accident (CVA) or brain attack

PATHOPHYSIOLOGY
Oxygen supply to the brain is interrupted or diminished In thrombotic or embolic stroke, neurons die from lack of oxygen; in hemorrhagic stroke, impaired cerebral perfusion causes infarction

CAUSES
Cerebral embolism
Cardiac arrhythmias Post traumatic valvular disease

Cerebral Hemorrhage
Arteriovenous malforation Cerebral Aneurysm Chronic hypertension

CAUSES
Cerebral thrombosis
Most common cause of stroke results from obstruction of blood vessel in the extracerebral vessels Site may be intracerebral

RISK FACTORS:
History of Transient Ischemic Attack Heart Disease Smoking Familial History of CVA Obesity Alcohol use High Red Blood Count Diabetes Mellitus

RISK FACTORS:
High Serum Triglycerides and cholesterol level Use of hormonal contraceptives hypertension

SIGNS AND SYMPTOMS

Change in level of consciousness With conscious patients, anxiety along with communication and mobility difficulties Urinary Incontinence Loss of voluntary muscle control

SIGNS AND SYMPTOMS

Hemipharesis or hemiplegia on one side of the body Decreased deep tendon reflex Hemianopsia on the affected side of the body With left sided hemiplegia, problem with visuospatial relations Sensory losses

DIAGNOSTIC TEST RESULT

Magnetic Resonance Imaging (MRI) and Magnetic Resonance Angiography : Allow for the evaluation of the location and the size of the lesion Cerebral Angiography : details the disruption of the cerebral circulation and is the test of choice for examining the entire cerebral blood flow

DIAGNOSTIC TEST RESULT

Computed Tomography (CT Scan) : Detects structural abnormalities Positron Emission Tomography : provides data on cerebral metabolism and on cerebral blood flow changes Laboratory Test

TREATMENT
Secure patent airway Careful blood pressure management : tiration of fluids and vasoactive drugs to maintain normotension Medication: Analgesics, anticoagulants, anticonvulsants, antidepressants, antihypertensive, anti platelet, lipid lowering agents and stool softener

TREATMENT
Surgery: Craniotomy, endarterectomy, extracranial bypass, ventricular shunts Pureed dysphagia diet or tube feedings if indicated Physical, speech and occupational rehabilitation

NURSING INTERVENTION
Maintain a patent airway and oxygenation Insert an indwelling urinary catheter, if necessary Ensure adequate nutrition Follow the physical therapy program and assist the patient with exercise Establish and maintain patient communication

NURSING INTERVENTION
Protect the patient from injury and complications Provide careful positioning to prevent aspiration and contractures Monitor patients
neurologic, Gi and respiratory status Vital signs Fluid and electrolytes Nutritional intake Development of deep vein thrombosis Pulmonary Embolus