Cerebrovascular

Accident(CVA)
Cerebrovascular accidents include

Ischemic stroke,

Hemorrhagic stroke,

Embolic stroke

Cerebrovascular anomalies such as intracranial aneurysms

and arteriovenous malformations (AVMs).
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.
Cerebral ischemia is caused by a reduction in blood flow that
lasts 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).
Typically the neurologic signs and symptoms of a TIA last for 5
to 15 min but, by definition, must last <24 h.

If the cessation of flow lasts for more than a few minutes,

infarction or death of brain tissue results.

Stroke has occurred if the neurologic signs and symptoms last

for >24 h.
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.
Etiology of ischemic stroke

1.Cardioembolic
2.Atherosclerosis
3.Hypercoagulable states
4.Moya Moya disease
5.Binswangers disease
6.CADASIL
7.Arteritis
8.Venous sinus thrombosis
9.Drugs
Risk Factors Cigarette smoking
Hypertension Substance abuse
Diabetes mellitus Atherosclerosis
Obesity
Oral contraceptives Sedentary life-style
Pregnancy Hyperlipidemia
Menopause Atrial fibrillation
Cardiac disease
 Sources of emboli:
Embolic CVA
• Atrial fibrillation
• Blood clot or clump of • Carotid
matter lodges in atherosclerotic plaque
cerebral blood vessel
• Bacterial endocarditis
• MI
• Frequently in
bifurcation of vessels
• RHD
• Ventricular aneurysm
Hemorraghic stroke Causes:
• Intracranial • Hypertension
hemorrhage • Intracranial aneurysm
• Cerebral blood vessel • Trauma
rupture • Tumors
• Most fatal • AV malformation
• Anticoagulants
• Blood disorders
Manifestations
Hemiplegia
Hemiparesis
Cranial nerve palsy
Hemianopia
Monoplegia/ paresis
Seizures
Aphasia
Sensory deficit
Cognitive disturbances
Death
Complications
Aspiration
Recurrent infections
Disuse atrophy
Reduced quality of life
Dependent edema

Orthostatic hypotension
Thrombus formation
Osteoporosis
Renal calculi
Contractures
Pressure ulcers
Investigations
CT brain
MRI
Carotid doppler
CT shows

Lft.MCA infarct
Massive
Midline shift present
Rt. Capsular
hemorrhage
No midline shift
Treatment
Acute stroke
1.Golden hour < 3 hrs
2.t- PA for thrombolysis
Anti platelets – aspirin, clopidogrel
Heparin
venous infarct, embolic stroke
Statins
Mass effect
Anti edema measures
mannitol, dexamethasone
Control of hypertension
Anti epileptics for seizure
Physiotherapy
Occupational therapy
Speech therapy
Adequate nursing care