CEREBROVASCULAR ACCIDENT

INTRODUCTION: An umbrella term that refers to a functional abnormality of the central nervous system (CNS) that occurs when the normal blood supply to the brain is disrupted. Stroke is the primary Cerebrovascular disorder in the world and is the 3rd leading cause of death behind heart disease and cancer. Approximately there are 700, 000 people experience a stroke each year in the United states. Strokes can be divided into two major categories: ischemic which is the most common cause of stroke which accounts for 85% in which vascular occlusion and significant hypoperfusion occur, and hemorrhagic (15%) in which there is extravasation of blood in the brain or subarachnoid space.

ISCHEMIC STROKE:
An ischemic stroke, Cerebrovascular (CVA) or brain attack, is a sudden loss of function resulting from disruption of the blood supply to a part of the brain. The term brain attack is being used to suggest to health care practitioner. Early treatment with thrombolytic therapy for ischemic stroke results in fewer stroke symptoms and less loss of function. Currently approved thrombolytic therapy has a treatment window of only 3 hours after the onset of stroke. Ishemic strokes is subdivided into 4 different types: Causes: Atherosclerotic plaque causing infarction Embolic originate from the heart and circulates to the cerebral vasculature Illicit drug use, migraine

large artery thrombotic strokes small penetrating thrombotic stroke cardiogenic embolic stroke cryptogenic stroke

CLINICAL MANIFESTATION:

Common signs and symptoms associated with Ischemic Strokes are: *Numbness or weakness of the face,arm, or leg especially one side of the body * Confusion or change in mental status * Trouble speaking or understanding speech * Visual disturbances * Sudden severe headache Neurologic Deficit of Stroke Visual Field Deficit: Hemianopsia Loss of peripheral vision Diplopia Motor deficits: Hemiparesis Hemiplegia Ataxia Dysarthria Dysphagia Sensory deficits: Paresthesias Agnosia Verbal deficits: Expressive Aphasia Receptive Aphasia Global Aphasia Cognitive Deficits: Weakness of the face, arm, leg on the same side Paralysis of the face arm, and leg ( due to lesion in the opposite hemisphere.) Staggering, unsteady gait Difficulty in forming words Difficulty in swallowing Manifestation

Unaware of persons or objects on side of visual loss Difficulty seeing at night Double vision

Numbness and tingling of extremity Ability to recognize previously familiar objects Unable to form words Unable to comprehend the spoken word Combination of both aphasias. Short and long term memory loss Decreased attention span, Altered judgement Impaired ability to concentrate Loss of self control Depression Withdrawal Fear

Emotional deficits

Modifiable Risk Factors for Ischemic Stroke:

Hypertension Atrial Fibrillation Hyperlipidemia Diabetes Mellitus Smoking Asymptomatic carotid stenosis Obesity Excessive Alcohol consumption