CEREBROVASCULAR ACCIDENT (CVA)

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CEREBROVASCULARACCIDENT (CVA)

• Tanja Cujic
• Iva Fercek
• Petra Crnac
• Mentor A. Žmegac Horvat

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WHO CVA - neurological deficit of
cerebrovascular cause that persists beyond 24
hours or is interrupted by death within 24 hours

• Classification
• ischemic (80) thrombotic, embolic
• hemorrhagic

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Embolic stroke

• blockage of an artery by an embolus
• An embolus is...
• thrombus
• fat
• air
• cancer cells
• clumps of bacteria
• amniotic fluid

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• embolus - arises from elsewhere, most
• commonly from the heart
• source must be identified
• symptoms - maximal at start
• symptoms may be transient

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Paradoxical embolism

• atrial septal defect

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Cardiac causes

• atrial fibrillation
• rheumatic disease
• artificial heart valves
• dilated cardiomyopathy
• Libman-Sacks endocarditis
• infective endocarditis
• marantic endocarditis
• left atrial myxoma

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Pathophysiology

• depletion of oxygen and glucose
• failure of energy-dependent processes
• major cause of neuronal injury GLUTAMATE
• influx of calcium
• failure of mitochondria

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Symptoms

• location and extension
• hemiplegia or muscle weakness
• numbness
• reduction of sensation

Prognosis disability
emotional problems Prevention better than cure!
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THROMBOTIC STROKE

• part of the brain supplied by the clotted
• blood vessel is deprived of blood and
• oxygen
• blockage of an artery in the brain by a
• clot (thrombosis) - most common cause
• of stroke
• cells of that part of the brain die

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RISK FACTORS

• high blood pressure (hypertension)
• high cholesterol
• diabetes
• smoking

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TIA

• mini-stroke
• short-lived episode (less than 24 hours) of
  neurological dysfunction caused by a loss of
  blood supply
• some develop slowly, others rapidly

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TIA vs stroke

• all TIAs resolve within 24 hours
• strokes take longer to resolve
• with strokes, complete function may never return
  ? more permanent and serious problem
• TIAs can occur once, multiple times, or precede a
  permanent stroke

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• although most TIAs last only a few minutes, all
  TIAs should be evaluated with the same urgency as
  a stroke in an effort to prevent recurrences
  and/or strokes
• a TIA should be considered an emergency because
  there is no guarantee that the situation will
  resolve and function will return

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TIA can cause

• temporary visual loss
• problems with movement or sensation on one side
  of the body
• paralysis of the arm, leg, and face, all on one
  side
• double vision, dizziness
• loss of speech, understanding and balance

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References

• www.medicinenet.com/stroke/article.htm
• www.post-gazette.com
• doctor2008.wordpress.com

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HEMORRHAGIC STROKE
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What is it?
Subarachnoid hemorrhage

• A disruption in the normal blood supply to the
  brain due to the rupture of blood vessels with
  intracerebral or subarachnoid hemorrhage
• 15 to 20 of strokes

Lobar hemorrhage
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Pathophysiology

• A small blood vessel inside the brain becomes
  weak and bursts
• Blood seeps into the brain tissue
• The flow of blood after the blood vessel ruptures
  directly damages brain cells
• An expanding hematoma causes compression of
  tissue which results in tissue injury

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Hypertensive basal ganglionic hemorrhage
Berry aneurysm

• The three major causes of hemorrhagic stroke
• High blood pressure (hypertension) ? HYPERTENSIVE
  INTRACEREBRAL HEMORRHAGE
• Ruptured arterial aneurysms
• ARTERIOVENOUS MALFORMATIONS (AVMs)
• Also very common in head trauma

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Risk factors

• Advanced age
• Cigarette smoking (active and passive)
• Heavy alcohol consumption and drug use
• Diabetes mellitus
• Lack of physical activity, obesity and unhealthy
  diet
• Some apply only to women (pregnancy, childbirth,
  menopause)

Arteriovenous malformation
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Symptoms

• Sudden start (seconds or minutes)
• Depend on the area of the brain affected
• The most common signs of a stroke are
• weakness down one side of the body, ranging from
  numbness to paralysis that can affect the arm and
  leg
• weakness down one side of the face, causing the
  mouth to droop
• speech may be difficult or become difficult to
  understand
• swallowing may be affected
• loss of muscle coordination or balance
• brief loss of vision
• severe headache
• confusion

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Diagnosis

• Medical history
• Physical examination
• Face-arm-speech test (FAST) for early
  recognition
• Facial weakness can the person smile? Has the
  mouth or eye drooped?
• Arm weakness can the person raise both arms?
• Speech problems can the person speak clearly and
  understand you?
• Test these symptoms

CT scan of a patient who has had a left middle
cerebral artery stroke. The arrow indicates the
location of the stroke.
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CT and MRI are both considered first-choice
options for identifying hematomas (arrowheads)
caused by hemorrhagic stroke

• CAT scan of the brain is often done to show
  bleeding into the brain
• Patients with intracerebral hemorrhage require
  neurosurgical evaluation to detect and treat the
  cause of the bleeding

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Treatment

• The first few days after a stroke
• Patients are monitored and their blood pressure,
  blood sugar, and oxygenation are kept at optimum
  levels
• The next phase of treatment
• Recovery through rehabilitation
• Part of the stroke patient's routine
• Daily rehabilitation exercises and a correct diet

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Important!

• Prevention (treat high blood pressure, diabetes,
  high cholesterol, and heart disease if present,
  follow a low-fat diet, quit smoking, exercise
  regularly...)
• Anticoagulants and antithrombotics, key in
  treating ischemic stroke, can make bleeding worse
  and cannot be used in intracerebral hemorrhage

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References

• www.wikipedia.org
• www.netdoctor.co.uk
• www.medterms.com
• http//jama.ama-assn.org