Introduction

Cerebrovascular Accident
A stroke (apoplexy) is the sudden onset of weakness, numbness, paralysis, slurred
speech, aphasia, problems with vision and other manifestations of a sudden
interruption of blood flow to a particular area of the brain. The ischemic area
involved determines the type of focal deficit that is seen in the patient.

Signs and Symptoms

The quicker you can get a diagnosis and treatment for a stroke, the better your
prognosis will be. For this reason, it is important to understand and recognize the
symptoms of a stroke.

difficulty walking
dizziness
loss of balance and coordination
difficulty speaking or understanding others who are speaking
numbness or paralysis in the face, leg, or arm, most likely on just one side of
the body
blurred or darkened vision
a sudden headache, especially when accompanied by nausea, vomiting, or
dizziness

The symptoms of a stroke can vary depending on the individual and where in the
brain it has happened. Symptoms usually appear suddenly, even if they are not very
severe. They may become worse over time.
Risk Factors

Non-reducable Risk Factors

1.

The possibilities of a stroke occurring increases with age. For every decade
(10 years) over the age of 55, the possibility of a stroke occurring doubles. A
patient that is 75 years of age has four times the risk of having a stroke
compared to someone who is 55 years old. Of all strokes that occur in people,
approximately 65% occur in those who are over the age of 65.

2.

3.
4.
5.

6.

Those who have had a stroke or TIA are more likely to have another stroke or
transient ischemic attack. Approximately 60% of strokes occur in patients who
have had a previous TIA.
Strokes generally occur more often in males than females, until the age of 55;
after age 55 the risk is the same for both men and women.
The occurrence of stroke is higher in the African-American, Hispanic, and
Asian-Pacific Islander population than in other ethnical backgrounds.
Patients who have immediate family members (mother, father, or sibling)
that have had a stroke or TIA are at greater risk for having a stroke or TIA than
those who do not have a family history with these events.
People who have diabetes are also at greater risk of stroke that those without
diabetes.

Reducable Risk Factors

1.

Lower your high blood pressure. Hypertension (high blood pressure) is the
number one most treatable risk factor for stroke. You can help prevent a TIA or
stroke considerably by working to lower your blood pressure.
2. Lowering cholesterol levels may decrease the risk of stroke. By working to
lower your cholesterol, you can help prevent a TIA or stroke.
3. Stop smoking. If you stop smoking, you can decrease your risk for stroke to
that of a non-smoker within two to five years.
4. Management of heart disease and diabetes may also help to decrease your
risk of stroke.
Statistics
According to the latest WHO data published in may 2014 Stroke Deaths in
Philippines reached 63,261 or 12.14% of total deaths. The age adjusted Death Rate
is 119.21 per 100,000 of population ranks Philippines #54 in the world.
Men
Men are at greater risk of stroke than women up until the age of 55 years, after
which both sexes have similar risks. Stroke is a major cause of morbidity and
mortality in the elderly.
Women
Whilst stroke is considered a disease more commonly affecting men, women are
actually twice as likely to die from stroke than men. In addition, females have

additional risk factors for stroke such as oral contraceptives, that are not present in
men.
Children
Stroke is uncommon in children accounting for only a small percentage of stroke
cases each year. Stroke in children is often secondary to congenital heart disease
(embolic stroke), genetic disorders, abnormalities of intracranial vessels or blood
disorders such as Thrombophilia. Half of strokes in children are hemorrhagic and
these may be associated with long term disabilities.Anatomy and Physiology
Brain

The brain is well protected by:

The scalp
The skull
The dura
o A tough 3-layer sheath that surrounds the brain and spinal cord
o Layers include the dura mater (strongest layer), arachnoid mater
(middle layer), and pia mater (closest to the brain)
The brain is a complicated structure containing many parts. These include:
The cerebrum:
o Made up of two cerebral hemispheres that are connected in the middle

o
o
o
o
o

It is the largest part of the brain

Each area of the cerebrum performs an important function, such as
language or movement
Higher thought (cognition) comes from the frontal cortex (front portion
of the cerebrum)
Outside of the cerebrum are blood vessels
There are fluid-filled cavities and channels inside the brain

The cerebellum:
o Located in the lower, back part of the skull
o Controls movement and coordination
The brainstem and pituitary gland:
o Responsible for involuntary functions such as breathing, body
temperature, and blood pressure regulation
o Pituitary gland is the "master gland" that controls other endocrine
glands in the body, such as the thyroid and adrenal glands
o Pineal gland
The cranial nerves:
o Twelve large nerves exit the bottom of the brain to supply function to
the senses such as hearing, vision, and taste
The cerebral blood vessels:
o A complicated system that supplies oxygenated blood and nutrients to
the brain

The blood supply to the brain is divided into two main parts:
Anterior cerebral circulation:
o The front of the brain is supplied by the paired carotid arteries in the
neck.
Posterior cerebral circulation:
o The back portion of the brain is supplied by the paired vertebral
arteries in the spine.
Cerebrovascular accident results from sudden interruption of blood supply to the
brain, which precipitates neurologic dysfunction lasting longer than 24 hours. Stroke
are either ischemic, caused by partial or complete occlusions of a cerebral blood
vessel by cerebral thrombosis or embolism or hemorrhage (leakage of blood from a
vessel causes compression of brain tissue and spasm ofadjacent vessels).
Hemorrhage may occur outside the dura (extradural), beneath the dura mater
(subdural), in the subarachnoid space (subarachnoid), or within the brain substance
itself (intracerebral).
Blood Vessels
The blood vessels are the part of the circulatory system that
transports blood throughout the human body. There are three major types of blood
vessels: the arteries, which carry the blood away from the heart; the capillaries,
which enable the actual exchange of water and chemicals between the blood and
the tissues; and the veins, which carry blood from the capillaries back toward the

heart. The word vascular, meaning relating to the blood vessels, is derived from the
Latin vas, meaning vessel.
The arteries and veins have three layers, but the middle layer is thicker in the
arteries than it is in the veins:

Tunica intima (the thinnest layer): a single layer of simple

squamous endothelial cells glued by a polysaccharide intercellular matrix,
surrounded by a thin layer of subendothelial connective tissue interlaced with a
number of circularly arranged elastic bands called the internal elastic lamina.

Tunica media (the thickest layer in arteries): circularly arranged elastic fiber,
connective tissue, polysaccharide substances, the second and third layer are
separated by another thick elastic band called external elastic lamina. The
tunica media may (especially in arteries) be
rich in vascular smooth muscle, which
controls the caliber of the vessel.

Tunica adventitia: (the thickest layer in veins)

entirely made of connective tissue. It also
contains nerves that supply the vessel as
well as nutrient capillaries (vasa vasorum) in
the larger blood vessels.

Pancreas
The pancreas, named for the Greek
words pan (all) and kreas (flesh), is a 12-15cm
long J-shaped (like a hockey stick), soft,
lobulated, retroperitoneal organ. It lies
transversely, although a bit obliquely, on the
posterior abdominal wall behind the stomach,
across the lumbar (L1-2) spine.
The pancreas develops as 2 buds (outpouchings) of endoderm from the primitive
duodenum at the junction of the foregut and the midgut. A small ventral bud
(pouch) forms the lower (inferior) part of the head and the uncinate process of
pancreas, whereas a large dorsal bud (pouch) forms the upper (superior) part of the
head as well as the body and tail of the pancreas. The ventral bud rotates dorsally
and fuses with the dorsal bud, and the duct of the distal part (body and tail) of the
dorsal bud unites with the duct of the ventral bud to form the main pancreatic duct

(of Wirsung). Because the common bile duct (CBD) also arises from the ventral bud,
it forms a common channel with the main pancreatic duct. The remaining proximal
part (head) of the duct of the dorsal bud remains as the accessory pancreatic duct
(of Santorini).

Liver

The liver is the second largest (after the skin) organ in the human body and the
largest gland (weighing an average of 1500 g). It lies under the diaphragm in the
right upper abdomen and mid-abdomen and extends to the left upper abdomen.
The liver has the general shape of a prism or wedge, with its base to the right and
its apex to the left (see the image below). It is pinkish brown in color, with a soft
consistency, and is highly vascular and easily friable.
There is an H-shaped fissure on the inferior surface of the liver. The right vertical
arm of the H is formed by the gallbladder anteriorly and the inferior vena cava (IVC)
posteriorly; it is incomplete, with the caudate process between the two. The left
vertical arm of the H is formed by the ligamentum teres hepatis in front and the
ligamentum venosum behind.
The transverse limb of the H is the porta hepatis (hilum), a 5-cm transverse fissure
(slit) on the undersurface of the liver with the quadrate lobe in front and the
caudate lobe behind. It contains the common hepatic duct (CHD) in front and to the
right, the proper hepatic artery in front and to the left, and the portal vein behind,
enclosed in the hepatoduodenal ligament (HDL), composed of 2 layers of lesser
omentum.

Kidney

The kidneys are a pair of organs located in the back of the abdomen. Each kidney is
about 4 or 5 inches long -- about the size of a fist.
The kidneys' function are to filter the blood. All the blood in our bodies passes
through the kidneys several times a day. The kidneys remove wastes, control the
body's fluid balance, and regulate the balance of electrolytes. As the kidneys filter
blood, they create urine, which collects in the kidneys' pelvis -- funnel-shaped
structures that drain down tubes called ureters to the bladder.
Each kidney contains around a million units called nephrons, each of which is a
microscopic filter for blood. It's possible to lose as much as 90% of kidney function
without experiencing any symptoms or problems.