Cerebral Vascular Accident

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Clinical Manifestations o f stroke

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- vary depending on the vessel and cerebral territory
- headache may be sign of SAH ("bleeding stroke")
- Parasthesias (numbness), paresis (weakness)
- plegia (loss of motor ability
- dysphagia, increased risk for aspiration and pneumonia
- aphasia (expressive, receptive, or global)
- visual difficulties - neglect, diplopia, homonymous hemianopsia
- alteration in cognative abilities, can't read or do math
- self care deficits (ADL's)

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Stroke Types

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Ischemic & Hemorrhagic

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Ischemic Stroke

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Ischemic stroke (occlusion of cerebral artery with thrombus or embolus
- thrombotic (associated with dvlpmnt of atherosclerosis of the blodd vessel wall)
- causes: atherosclerosis, hypertension
- embolic
- cause: cardiac disease, can occur in clients with nonvalvular atrial fibrillation (on life long coumadin), ischemic heart disease, rheumatic heart disease, mural thrombi following a MI or insertion of a prosthetic heart valve
- risk factors:

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Hemorrhagic Stroke

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Hemorrhagic (bleeding occurs into the braon tissue or into the spaces surrounding the brain - ventricular, subdural, subarachnoid - Results from a ruptured of a arteriovenous malformation, or most commonly severe hypotension. LOC in pt: deepening stupor or coma. Might have seizures
- intercerebral hemorrhage (the accumulation of blood within the brain tissure caused by the tearing of small arteries and veins in the subcortical white matter. may act as a space occupying lesion and may be potentially devastating, depending on location. May produce significant brain edema and ICP elevation
- result of direct trauma, fractures, or torsion injuries to the brainstem
- SAH (Subarachnoid hemorrhage): bleeding b/t the middle membrane covering the brain and the brain itself, within the cerebospinal fluid filled spaces
- causes: Most common cause is trauma - 95% of all cases are as aresult of ruptured aneurysm. 20 - 60 years old, more common in women then men
- Manifestations: sudden onset of headaches - popping or snapping in head "worst headache of my life" worse near back of the head, Decreased LOC, changes in vision, seizures, behavior changes
- Dx: CT scan, MRI, MRA, spinal tap - which may show blood, angigraphy of brain
- Tx: life saving measures, relief od symptoms, repair of bleeding, prevention of complications
- positioning; airway protection, ventilation, drains
- bedrest, avoid measures that increase ICP
- stool softeners, bending changing positions
- pain management - reduce ICP
- antihypertensives
- carniotomy - opening of skull and clipping of the aneurysm
- coiling --> neurointerventional procedure

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TIA

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Transient Ischemic Attack:

Ischemic strokes are often preceded by warning signs; also called silent stroke and as RIND (last > 24hrs < 1week), reversible ishemic neurologic deficit, brief interuption of cerebral blood flow causing possible deficits that resolve within 24hours. Damage the brain tissue with repeated insults. TIA lasts: a few minutes to < 24hours

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Deficits of stroke based on part of the brain damaged

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- Damage to the motor area of the right cerebral hemisphere --> weakness of the left arm, leg, and face

- Broca's Area --> speech problems

- even a small stroke in the brain stem --> severe problems as many nerves pass through here from the brain to the spinal cord

- Laft parietal lobe ---> loss of co-ordination in the right arm and leg

- Wernicke's area --> difficulty in understanding speech, reading, naming objects

- cerebellum --> unsteadiness and poor co-ordination

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Right brain injury

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- Paralyzed left side
- Special preceptual deficits
- Quick impulsive behavior style
- Memory deficits

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Left brain injury

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- Paralyzed right side
- Speech-language deficits
- Slow cautions behavioral style
- Memory deficits