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Case Study Cva
Case Study Cva
Causes
Ischemia
Occurs when the blood supply to a part of the brain is interrupted or totally occluded
Commonly due to thrombosis or embolism
Embolic stroke
>Occlusion of a cerebral artery by an embolus or blood clot
>Embolus forms outside the brain, detaches and travels through the cerebral circulation where it
lodges and causes an obstruction
>Chronic atrial fibrillation is associated with a high incidence
>Other sources of emboli include tumor, fat, bacteria and air
>Usually has a sudden onset with immediate maximum deficit
Hemorrhage
Results from rupture of a cerebral vessel causing bleeding into the brain tissues
Bleeding results with edema, compression of the brain contents or spasm of the adjacent
blood vessels
Often secondary to hypertension and most common after age 50
Other factors includes ruptured intracranial aneurysms, trauma, erosion of blood vessels by
tumors, arteriovenous malformations, anticoagulant therapy, blood disorders
Usually produce extensive residual functional loss and slowest recovery
Risk factors
Hypertension
Diabetes mellitus
Atherosclerosis
Substance abuse including alcohol, nicotine, heroin, amphetamines, cocaine
Obesity, sedentary life-style, hyperlipidemia, atrial fibrillation, cardiac disease, cigarette
smoking, previous transient ischemic attacks
Women: oral contraceptive use, pregnancy, menopause
Clinical manifestations
Stroke manifestations can be correlated with the cause and with the area of the brain in
which perfusion is affected
Manifestations of thrombotic stroke develop over minutes to hours to days (slow
onset is related to increasing size of the thrombus)
Embolic strokes occur suddenly and without warning
Hemorrhagic stroke occurs rapidly with manifestations developing over minutes
to hours
General findings unrelated to specific vessel sites includes headache, vomiting, seizures
and changes in mental status
Early warnings of impending ischemic stroke includes
Transient hemiparesis
Loss of speech
Hemisensory loss
Pathophysiology
Characterized by gradual, rapid onset of neurologic deficits due to compromised
cerebral blood flow
Blood flow and oxygenation of cerebral neurons decreased or interrupted; changes occur
in 4 – 5 minutes
Cells swell and cerebral blood vessels swell decreasing blood flow; vasospasm and
increased blood viscosity further impede blood flow
Penumbra is a central core of dead or dying cells surrounded by band of minimally
perfused cells
Cells of the penumbra receives marginal blood flow and their metabolic
activities are impaired
These cells may survive if adequate circulation is re-established
Neurologic deficits occur on opposite side where stroke occurred in brain: contralateral
deficit
Signs and Symptoms of CVA
Signs
>Sudden weakness, numbness, or paralysis of the face, arm or leg, on one or both sides of the body.
>Sudden blurred vision or blindness in one or both eyes.
>Sudden difficulty speaking, slurring of speech or difficulty understanding.
>Sudden severe headache with sudden onset that occurs without apparent reasons.
>Sudden loss of balance, dizziness, or falling without any apparent reason.
Symptoms
Diagnostic Procedures
>Blood Tests - including a complete blood count, blood sugar, cholesterol, fat levels, clotting levels, and
a check of other elements in the blood
>Electrocardiogram (EKG) – to measure heart rhythm and check for an irregular heart beat
>Ultrasound– a test that uses sound waves to help determine if there are blockages in the arteries
supplying the brain
>MRI Scan – a test that uses magnetic waves to make pictures of structures inside the head
>CT Scan – a type of x-ray that uses a computer to make pictures of structures inside the head
>Magnetic Resonance Angiography – performed prior to carotid artery surgery to determine how
much the artery has narrowed. Gadolinium, a type of dye, may be injected into your vein for this test.
>Arteriogram - during a conventional arteriogram, a contrast dye is injected and x-ray images are
produced to precisely locate the blockage and to determine how much of the artery is blocked. This test
is usually only done to confirm the need for surgery.
>Echocardiogram - an ultrasound test that looks for blood clots and valve abnormalities within the
heart
>Electroencephalogram (EEG) - a test that can detect seizures by measuring brain waves (used only if
a seizure is suspected)
Surgical Management
>Endarterectomy – purpose is to remove the atherosclerotic plaque from the inner lining of the carotid
artery.
>Extracranial-Incracranial Bypass – bypasses the blocked artery by making a graft or a bypass from
the first artery to the second artery.
>Management Of Anteriovenous Malformation - is an interventional therapy to occlude abnormal
arteries or veins and prevent bleeding from the vascular lesions. Whenever possible the affected vessels
are totally removed. The surgeon ligates the vessels and removes the defect.
>Management of Cerebral Aneurism – Aneurysm may be repaired via craniotomy. Less invasive
procedure is interventional Radiology
>Management of Intracranial Bleeding – Blood clots are removed via craniotomy.
Medical Management
a. Steroids/corticosteroids given in full stomach with antacid or H2 receptor antagonists
b. Vitamin B complex – promote restitution of function of neurons which have reversible damage.
c. Cerebral activator/stimulants – stimulate CNS function.
• nootrophil- PIRACETAM
• encephabol- PYRITINOL HCl
• hydergine- CODERGOCRIN
d. Drugs if it is due to thrombus, give ANTI-COAGULANT
Nursing Managements
A. Initial nursing objective is to support life and prevent complications.
B. Maintain patient airway and ventilation--- elevate head of bed 20 degrees unless shock is present.
I. Promote elimination.
1. Bladder control may be regained within three to five days.
2. Retention catheter may not be part of treatment regimen.
3. Offer urinal or bedpan every two hours day and night.