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Pathophysiology of Cerebrovascular Accident

Article by Robyn Broyles (11,561 pts )


Edited & published by Leigh A. Zaykoski (60,578 pts ) on Nov 30, 2009

A cerebrovascular accident (CVA) or stroke is caused by an acute lack of blood supply to part of
the brain. There are two major types of stroke: ischemic, in which a blockage (usually a blood
clot) reduces or halts blood flow, and hemorrhagic, in which bleeding in the brain triggers a
response that restricts blood supply elsewhere. The pathophysiology of cerebrovascular accident
is different for these two types of stroke.

Pathophysiology of Ischemic Stroke

An ischemic stroke may be caused by a blood clot that occurs in the affected artery (thrombosis),
a blood clot that traveled from another part of the body (embolism), or a blockage due to damage
to the arterial wall (lacunar infarct). Blockage of a single artery can often be compensated for by
other arteries in the blood vessel network, call collaterals. Artherosclerosis (hardening of the
arteries), other damage to arteries, and natural variations in the collateral network can prevent the
collateral system from compensating fully. The result is a loss of perfusion, or blood supply, to
an area of the brain (ischemia).

Arteriovenous malformations (AVMs), abnormal tangles of blood vessels in which arteries flow
directly into veins, are another possible cause of ischemic stroke. AVMs can press directly on
brain tissue, blocking blood flow.

Pathophysiology of Hemorrhagic Stroke

The main type of hemorrhage that can lead to stroke is subarachnoid hemorrhage. In this type of
bleed, which usually results from head trauma or a ruptured aneurysm, there is uncontrolled
bleeding between the innermost two of the three meninges (membranes lining the brain), the pia
mater and the arachnoid mater.

The blood that pools or collects in a subarachnoid bleed is called a hematoma. Ischemia (lack of
blood flow) from the hematoma is a secondary problem. It is caused by constriction of the
arteries (vasospasm) as a protective response to reduce bleeding. About 25% of patients with
subarachnoid hemorrhages will experience stroke symptoms resulting from secondary ischemia.

Another common type of brain hemorrhage is an intracerebral hemorrhage, in which an artery


inside the brain tissue fails due to high blood pressure and begins to bleed. It usually results from
hypertension, but other causes of burst intracerebral arteries include various types of aneurysm,
brain tumors, and blood clotting disorders. Symptoms of intracerebral hemorrhages can mimic
symptoms of ischemic stroke, especially for smaller bleeds, but the two problems have different
etiologies and treatments.
References

The Merck Manual of Diagnosis and Therapy: Entries on Ischemic Stroke, Subarachnoid
Hemorrhage, and Intracerebral Hemorrhage

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PATHOPHYSIOLOGY of CVA (Stroke)

DiabeticNephropathyAcceleratedatherosclerosisRenalDiseaseProduction of glucose from


proteinand fat storesWasting of leanbody massWeight lossFatigueAcidosisAcetone breathInc.
KetonesSmall vesseldiseaseNeuropath Impaired immunefunction(decrease level
of morphonuclear leukocytes)Infection Delayed woundhealinDiabeticRetinopathyInc. serum
glucose levelGlycoprotein cellwall depositsInc. osmolaritydue to glucose

Destruction of alpha and betacells of the pancreasFailure to produce insulinProduction


of excess glucagonPolydipsiaPolyphagiaPolyuriaWeightLossM o d i f i a b l e
F a c t o r s N o n M o d i f i a b l e F a c t o r s Age, Family
History of CVA,Family History of DM, Sex(Men), RaceSmoking, Obesity, Hypertension, High
CholesterolLevel, Excessive Alcohol Consumption, DrugAddiction, High Dose of estrogen OC,
DiabetesMellitus, Atrial Fibrillation, Type A personality ,Sedentary Life Style
HypertensionIncrease LDL levelsSymmetrical loss of protectivesensationNumbnessand
tinglingin theextremitiesWasting of intrinsic Charcotchanges injointsAutonomicneuropathyDry
cracked skinGastro paresisImpotenceNeurogenicbladder Loss of visionBlindnessCerebral
ischemiaLong termEschemia(>10-15mins) Short termEschemia(<10-15mins)

TemporaryDeficitPermanentDeficitDecreased Tissueperfusion (brain)HemiparesisLoss of


speechHemisensory lossCerebral HypoxiaSyncope/
VertigoCEREBROVASCULARACCIDENTThrombusEmboliNopermanentdamageIrreversibledamageMID
CEREBRALARTERYANTERIORCEREBRAL A.POSTERIORCEREBRAL A.VERTEBROBASILARARTERY
Hemiparesis/ HemiplegiaAphasiaDysarthiaDysphagiaApraxiaVisual
ChangesAtaxiaA g n o s i a H e m i s e n s o r y l o s s Horner’sS
ndromeUnilarteral NeglectIncontinence
DEFINITION OF DISEASE]

Cerebrovascular accident (CVA) is the medical term for what is commonly termed as stroke. It
refers to the injury to thebrai n that occurs when flow of blood to brain tissue is interruptedby a
clogged or ruptured artery, causing brain tissue to die becauseof lack of nutrients and oxygen.A
stroke (sometimes called a cerebrovascular accident(CVA)) is the rapidly developing loss of
brain function(s) due todisturbance in the blood supply to the brain, caused by a blockedor burst
blood vessel. This can be due to ischemia (lack of glucoseand oxygen supply) caused by
thrombosis or embolism or due to ahemorrhage. As a result, the affected area of the brain is
unable tofunction, leading to inability to move one or more limbs on oneside of the body,
inability to understand or formulate speech, or inability to see one side of the visual field. A
stroke is a medicalemergency and can cause permanent neurological damage,complications, and
death.

S t r o k e i s a t e r m u s e d t o d e s c r i b e n e u r o l o g i c changes caused by an interruption


in the blood supply topart of the brain. Two major types of stroke are ischemic
andhemorrhagic. Ischemic stroke is caus ed by thrombotic or embolic blockage of blood
flow to the brain. Bleeding into thebrain tissue or the subarachnoid space causes
ahemorrhagic stroke. Ischemic strokes account for about 83%of all strokes. The remaining
17% of strokes arehemorrhagic.Cerebrovascular disorders are the third leadingcause of
death in United States and account for about 164,000 mortalities annually. An estimated
550,000 strokespeople experience a stroke each year. When second strokesare considered in
the estimates, the incidence increases to700, 000 per year in the united States alone.
Stroke is aleading cause of adult disability and leading primarydiagnosis for long term
care. More than four million strokesurvivors are living with varying degrees of disability in
theU n i t e d S t a t e s . A l o n g w i t h a h i g h m o r t a l i t y r a t e , s t r o k e s produce
significant morbidity in people who survive them.(Joyce M. Black et al Medical
Surgical Nursing 7

th

editionElsevier Suanders 2005)Vascular Disease which includes C.V.A. is thesecond


leading cause of death in the Philippines with a totalof 51,680 according to DOH 2004. Along
with this are 37,092w h o s u r v i v e d w i t h i t . (

http

://www.doh.gov.ph/kp/statistics/morbidity)New therapies can now prevent or limit the extentcan


now prevent or limit the extent of damage to brain tissuecaused by acute ischemic stroke.
Thrombolytic therapy mustb e a d m i n i s t e r e d a s s o o n a s p o s s i b l e a f t e r o n s e t o f
t h e s t r o k e ; a t r e a t m e n t w i n d o w 3 h o u r s f r o m t h e o n s e t o f manifestations has
been established. To convey this senseof urgency regarding the evaluation and treatment of
stroke,health care professionals now refer to stroke as brain attack.Public education is
focused on prevention, recognition of manifestation, and early treatment of brain attack.
(Joyce M.B l a c k e t a l M e d i c a l S u r g i c a l N u r s i n g 7

th

edition Elsevier Suanders 2005)Diabetes Mellitus is a chronic systemic


diseasecharacterized by either a deficiency of insulin or a decreasedability of the body to use
insulin Diabetes mellitus issometimes referred to as “high sugars” by both clients andhealth
care providers. The notion of associating sugar withdiabetes is appropriate because the
passage of largeamounts of sugar-laden urine is characteristic of poorlycontrolled
diabetes. However high levels of blood glucosea r e o n l y o n e c o m p o n e n t o f t h e
p a t h o l o g i c p r o c e s s a n d clinical manifestation associated with DM. DM can
beassociated serious complications, but people with diabetescan take preventive measures
to reduce the likelihood of such occurrences. (Joyce M. Black et al Medical
SurgicalNursing 7

th

edition Elsevier Suanders 2005)

Modifiable and Non Modifiable Factors1. Modifiable

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personality

DEFINITION OF DISEASE]

Cerebrovascular accident (CVA) is the medical term for what is commonly termed as stroke. It
refers to the injury to thebrai n that occurs when flow of blood to brain tissue is interruptedby a
clogged or ruptured artery, causing brain tissue to die becauseof lack of nutrients and oxygen.A
stroke (sometimes called a cerebrovascular accident(CVA)) is the rapidly developing loss of
brain function(s) due todisturbance in the blood supply to the brain, caused by a blockedor burst
blood vessel. This can be due to ischemia (lack of glucoseand oxygen supply) caused by
thrombosis or embolism or due to ahemorrhage. As a result, the affected area of the brain is
unable tofunction, leading to inability to move one or more limbs on oneside of the body,
inability to understand or formulate speech, or inability to see one side of the visual field. A
stroke is a medicalemergency and can cause permanent neurological damage,complications, and
death.

S t r o k e i s a t e r m u s e d t o d e s c r i b e n e u r o l o g i c changes caused by an interruption


in the blood supply topart of the brain. Two major types of stroke are ischemic
andhemorrhagic. Ischemic stroke is caused by thrombotic or embolic blockage of blood
flow to the brain. Bleeding into thebrain tissue or the subarachnoid space causes
ahemorrhagic stroke. Ischemic strokes account for about 83%of all strokes. The remaining
17% of strokes arehemorrhagic.Cerebrovascular disorders are the third leadingcause of
death in United States and account for about 164,000 mortalities annually. An estimated
550,000 strokespeople experience a stroke each year. When second strokesare considered in
the estimates, the incidence increases to700, 000 per year in the united States alone.
Stroke is aleading cause of adult disability and leading primarydiagnosis for long term
care. More than four million strokesurvivors are living with varying degrees of disability in
theU n i t e d S t a t e s . A l o n g w i t h a h i g h m o r t a l i t y r a t e , s t r o k e s produce
significant morbidity in people who survive them.(Joyce M. Black et al Medical
Surgical Nursing 7
th

editionElsevier Suanders 2005)Vascular Disease which includes C.V.A. is thesecond


leading cause of death in the Philippines with a totalof 51,680 according to DOH 2004. Along
with this are 37,092w h o s u r v i v e d w i t h i t . (

http

://www.doh.gov.ph/kp/statistics/morbidity)New therapies can now prevent or limit the extentcan


now prevent or limit the extent of damage to brain tissuecaused by acute ischemic stroke.
Thrombolytic therapy mustb e a d m i n i s t e r e d a s s o o n a s p o s s i b l e a f t e r o n s e t o f
t h e s t r o k e ; a t r e a t m e n t w i n d o w 3 h o u r s f r o m t h e o n s e t o f manifestations has
been established. To convey this senseof urgency regarding the evaluation and treatment of
stroke,health care professionals now refer to stroke as brain attack.Public education is
focused on prevention, recognition of manifestation, and early treatment of brain attack.
(Joyce M.B l a c k e t a l M e d i c a l S u r g i c a l N u r s i n g 7

th

edition Elsevier Suanders 2005)Diabetes Mellitus is a chronic systemic


diseasecharacterized by either a deficiency of insulin or a decreasedability of the body to use
insulin Diabetes mellitus issometimes referred to as “high sugars” by both clients andhealth
care providers. The notion of associating sugar withdiabetes is appropriate because the
passage of largeamounts of sugar-laden urine is characteristic of poorlycontrolled
diabetes. However high levels of blood glucose a r e o n l y o n e c o m p o n e n t o f t h e
p a t h o l o g i c p r o c e s s a n d clinical manifestation associated with DM. DM can
beassociated serious complications, but people with diabetescan take preventive measures
to reduce the likelihood of such occurrences. (Joyce M. Black et al Medical
SurgicalNursing 7

th

edition Elsevier Suanders 2005)

Modifiable and Non Modifiable Factors1. Modifiable

Increased hunger and food intake. Because glucose cannotenter cells of the satiety center of
the brain without insulin,the satiety center in the hypothalamus is stimulated resultingin a
“hunger sensation” as if there were very little blood glucose, resulting in an exaggerated
appetite.BODY MALAISEThis is due to the decreased glucose uptake by the tissuesleading to
decreased energy production.GLYCOSURIAThe kidney filters the blood, making it to its
normal state.Glucose was filtered out and excreted in the urine. Due tothe excess
glucose ad compared to the kidney threshold,which results to the excretion of glucose in
the urine.BLURRED VISIONDiabetes can affect the lens, vitreous, and retina,
causingvisual symptoms. Visual blurring may develop acutely as thelens changes shape with
marked changes in blood glucoseconcentrations. This effect, which is caused by
osmoticfluxes of water into and out of the lens, usually occurs as hyperglycemia
increases.WEIGHT LOSSDespite eating more than usual to relieve constant hunger bythe
stimulation of satiety center, weight loss may still exist.Without the glucose supplies, muscle
tissues and fat storesmay deplete.SLOW-HEALING SORE AND FREQUENT
INFECTIONHigh levels of blood sugar impair your body's natural healingprocess and your
ability to fight infections. For wom en,bladder and vaginal infections are especially
common.TINGLING SENSATION/ NUMBNESS IN THE HAND ANDFEETExcess sugar in
your blood can lead to nerve damage. Youmay notice tingling and loss of sensation in your
hands andfeet, as well as burning pain in your arms, hands, legs andfeet.PROTEINURIATesting
the urine for microalbuminuria shows earlynephropathy, long before it would be on routine
urinalysis,ANEMIAIf there are renal affectations, this might bring to decreaseproduction of
erythropoietin which brings to decreaseproduction of RBC from the bone marrow that may
result toanemia.

CEREBROVASCULAR ACCIDENT

Clinical Manifestations1. headache and vomiting – due to an increase ICP whichcauses


cerebraledema, and compressing the medulla oblongata2. seizures – due to hyper-excitability of
neurons because of irritation.3. changes in mental status – affectation in the RAS4. fever –
affectation in the hypothalamus5. ECG changes – problem with the medulla oblongataWarning
Signs1. transient hemiparesis2. loss of speech3. hemisensory loss4. vertigo/syncope

Specific Deficits

1. Hemiparesis/Hemiplegia – the former means weakness of one sideof the body while the latter
means paralysis of one side of the body.2. Aphasia – defects on using and interpreting symbols
of language3. Apraxia - a condition in which a client can move the affected partbut cannot use it
for purposeful actions.4. Homonymous Hemianopsia – a defective vision or vision loss inthe
same half of the visual field.5. Agnosia – a problem in interpreting visual, tactile or other
sensoryinformation.

6. Dysarthia – imperfect articulation condition.7. Kinesthesia – alteration in sensation.8.


Incontinence – due to inattention, memory lapses, emotionalfactors, and inability to
communicate.9. Shoulder pain – severe pain in the affected shoulder after CVA10. Horner’s
syndrome – paralysis of sympathetic nerves to the eyecausing sinking of the eyeball, ptosis of the
upper eyelid, constrictionof pupil, and lack of tearing in the eye.1 1 . U n i l a t e r a l n e g l e c t –
i n a b i l i t y t o r e s p o n d t o s t i m u l u s o n t h e contralateral side.12. Dysphagia (01/29/09 -
01/31/09) – difficulty of swallowing13. Ataxia (01/29/09 -01/31/09) –Problem with motor
coordination

35770699-Pathophysiology-of-CVA

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Proved 100% sugar down to NORMAL
www.greenlife-herbal.com

IATA Infectious Substance


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for shipping infectious substances
www.eduwhere.com

Glucobetic > All Natural


Most Advanced Formula > It Works
Maintain Healthy Blood Sugar
www.flourishbloodsugar.com

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