CEREBRO VASCULAR ACCIDENT

Presented By,Mr.Ramprasad.SAsst.Professor

NEUROLOGICAL DISORDERS

DEFINITION

It is a sudden loss of function resulting from disruption of the blood supply to the part of the brain. The C.V.A is also termed as “Brain attack”. This event is usually result of long standing cerebro vascular disease.

THE NORMAL BRAIN

BLOOD SUPPLY TO BRAIN

CAUSES FOR C.V.A

ETIOLOGICAL FACTORS

TYPES OF C.V.A

1. ISCHEMIC STROKE

a).Large artery Thrombosis

b).Small Penetrating artery Thrombosis

c).Cardiogenic Embolic Stroke

d).Cryptogenic

e).Other(due to cocaine use, coagulopathies, migraine,)

2. HEMORRHAGIC STROKE

PATHOPHYSIOLOGY

ISCHEMIA

↓

ENERGY FAILURE

↓

ACIDOSIS↔ION IMBALANCE

↓

↑ GLUTAMATE ↔ DEPOLARIZATION

↓ ↓

INTRACELLULAR CALCIUM INCREASED

↓

CELL MEMBRANE AND PROTEINS BREAK DOWN FORMATION OF FREE RADICALS PROTEIN

PRODUCTION DECREASED

↓

CELL INJURY AND DEATH

CLINICAL MANIFESTATIONS

1. Weakness of the face, arm, leg, especially on one side of the body.

2. Confusion or Mental changes.

3. Trouble Speaking.

4. Visual disturbances.

5. Difficulty in walking, dizziness, or loss of balance or coordination.

6. Sudden severe headache.

1. MOTOR LOSS:-

A). Hemiplegia (paralysis of one side of the body)

B). Hemiparesis (weakness of one side of the body)

2. COMMUNICATION LOSS:-

A). Dysarthria (difficulty in speaking)

B). Aphasia (loss of speech)

C). Apraxia (inability to perform previously learned actions)

3. PERCEPTUAL DISTURBANCES:-

A).Hemianopsia (loss of half of the visual field)

4. SENSORY LOSS:-

A). Loss of proprioception( ability to perceive the position and motion of the body parts)

B). Difficulty in interpreting visual,tactile,and auditory stimuli.

5. COGNETIVE AND PSYCHOLOGICAL EFFECTS.

DIAGNOSTIC FINDINGS1. Neurological Examinations

2. Computed tomography

3. ECG

4. Carotid Ultrasound

5. Cerebral Angiography

6. Transcranial Doppler flow studies

7. Transthoracic Echocardiography

8. MRI

9. SPECT(single photon emission computed tomography)

TREATMENT

Pharmacological Therapy

Stroke with Cardiogenic cause should treat promptly with warfarin sodium, Platelet inhibiting drugs (aspirin, clopidogrel, ticlopidine) can decrease the incidence of cerebral infarction.

1.Thrombolytic therapy.

Other Treatment Measures Include the following,

1.Elevation of the head of the bed to promote venous drainage and to lower increased ICP.

2. ETT intubation to maintain patent airway.

3. Continuous Hemodynamic monitoring.

4. Continuous Neurological Examination.

COMPLICATIONS

1. Tissue Ischemia.

2. Pneumonia.

3. Cardiac Failure.

4. Decreased Cerebral blood flow due to ↑ ICP.

5. Inadequate oxygen delivery to the brain.

Nursing Management

1. Improving Mobility.

2. Preventing Joint deformity.

3. Changing Position.

4. Establishing Exercise Programme.

5. Improving Communication.

6. Improving Thought Process.

7. Improving Skin Integrity.

8. Improving Family coping.

A SINgLE STEP TO MAN,

A ThOuSANd MILES TO MAN kINd……