Crebrovascular Accident Case Study

1301 Words 6 Pages
Clinical Decision Making
Pathophysiology: Cerebrovascular Accident (CVA) A cerebral vascular accident (CVA) is defined as “a sudden loss of brain functioning from a disruption of blood supply to a part of the brain causing temporary or permanent loss of movement, thought, memory, speech, or sensation”(Belleza, 2016, p. 1). CVA is categorized as ischemic or hemorrhagic. Hypertension accounts for the majority of ischemic CVAs or strokes. According to the American Heart Association, ischemic strokes are “caused by narrowed or clogged blood vessels in the brain that cut off the blood flow to the brain cells”("Stroke and High Blood Pressure," 2016, p. 1). The following are the main causes of ischemic stroke:
• Thrombosis: An obstruction of a blood
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This occurs more commonly in the heart and lungs and can lead to hemorrhagic transformation.
• Lacunar infarction: Occurs as a result of small vessel disease, specifically in the brain, and are commonly affected by chronic hypertension. This process leads to “hyperplasia of the tunic media of these vessels and deposition of fibrinoid material leading to lumen narrowing and occlusion”(Majid, 2016, p.
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Patients who are outside of the “treatment window” can benefit from other treatment methods, reducing the risk for another CVA. A study completed by the TIAregistry.org project revealed that the rates of recurrent stroke have decreased and can be attributed to “better and faster implementation of secondary stroke prevention strategies. These include immediate initiation of antiplatelet drugs, oral anticoagulation in the event of atrial fibrillation, urgent revascularization in patients with critical carotid stenosis, and other secondary prevention measures such as treatment with statins and blood-pressure-lowering drugs”(Amarenco et al., 2016, p. 1539). The importance of anticoagulant therapy after a stroke has also proven to be vastly promising. These medications inhibit platelet aggregation and work favorably when combined with blood pressure lowering medication. The Clopidogrel in High-Risk Patients with Acute Non-Disabling Cerebrovascular Events (CHANCE) trial “found that the combination of aspirin and clopidogrel given for 21 days with clopidogrel alone continued up to day 90 was more effective than aspirin alone in preventing recurrent strokes in patients who had had a minor stroke or TIA”(Hughes, 2013, p. 1). Fortunately, these interventions offer a better outcome for these particular

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