cerebrovascular accident cva (stroke), angin ahmar (malay)

Cerebrovascular AccidentCerebrovascular Accident

CVACVA

Cerebrovascular AccidentCerebrovascular Accident Results from ischemia to a part of the brain or Results from ischemia to a part of the brain or

hemorrhage into the brain that results in death of brain hemorrhage into the brain that results in death of brain cellscells. .

#1 leading cause of disability #1 leading cause of disability 25% with initial stroke die within 1 year25% with initial stroke die within 1 year 50-75% will be functionally independent50-75% will be functionally independent 25% will live with permanent disability25% will live with permanent disability

Physical, cognitive, emotional, & financial impactPhysical, cognitive, emotional, & financial impact

Cerebrovascular AccidentCerebrovascular AccidentRisk FactorsRisk Factors

Age Age – Occurrence doubles each decade >55 years– Occurrence doubles each decade >55 years

GenderGender – Equal for men & women; – Equal for men & women; Heredity Heredity – family history, prior transient – family history, prior transient

ischemic attack, or prior stroke increases riskischemic attack, or prior stroke increases risk

Cerebrovascular AccidentCerebrovascular AccidentRisk FactorsRisk Factors

High blood pressure DiabetesCigarette smoking ObesityHigh blood cholesterol Physical InactivityHeart Disease

CVA – Risk FactorsCVA – Risk Factors

Cerebrovascular AccidentCerebrovascular AccidentPathophysiologyPathophysiology

AtherosclerosisAtherosclerosis: major cause of CVA: major cause of CVA Thrombus formation & emboli developmentThrombus formation & emboli development

Abnormal filtration of lipids in the intimal layer of the arterial Abnormal filtration of lipids in the intimal layer of the arterial wallwall

Plaque develops & locations of increased turbulence of blood - Plaque develops & locations of increased turbulence of blood - bifurcationsbifurcations

Increased turbulence of blood or a tortuous areaIncreased turbulence of blood or a tortuous area Calcified plaques rupture or fissureCalcified plaques rupture or fissure Platelets & fibrin adhere to the plaquePlatelets & fibrin adhere to the plaque Narrowing or blockage of an artery by thrombus or emboliNarrowing or blockage of an artery by thrombus or emboli Cerebral Infarction: blocked artery with blood supply cut Cerebral Infarction: blocked artery with blood supply cut

off beyond the blockageoff beyond the blockage

CVA SIGN & SYMPTOMS? CVA SIGN & SYMPTOMS? Sudden numbness or weakness of face, arm, or leg, Sudden numbness or weakness of face, arm, or leg,

especially on one side of the body. especially on one side of the body. Sudden confusion or trouble speaking or understanding Sudden confusion or trouble speaking or understanding

speech. speech. Sudden trouble seeing in one or both eyes. Sudden trouble seeing in one or both eyes. Sudden trouble walking, dizziness, or loss of balance or Sudden trouble walking, dizziness, or loss of balance or

coordination coordination Sudden severe headache with no known cause. Sudden severe headache with no known cause.

Cerebrovascular AccidentCerebrovascular AccidentTransient Ischemic AttackTransient Ischemic Attack

Temporary focal loss of neurologic function Temporary focal loss of neurologic function

Caused by ischemia of one of the vascular territories of Caused by ischemia of one of the vascular territories of the brainthe brain Microemboli with temporary blockage of blood flowMicroemboli with temporary blockage of blood flow

Lasts less than 24 hrs – often less than 15 minsLasts less than 24 hrs – often less than 15 mins Most resolve within 3 hoursMost resolve within 3 hours Warning sign of progressive cerebrovascular diseaseWarning sign of progressive cerebrovascular disease

Cerebrovascular AccidentCerebrovascular Accident Transient Ischemic AttackTransient Ischemic Attack

Diagnosis: Diagnosis: CT without contrast CT without contrast

Confirm that TIA is not related to brain lesions Confirm that TIA is not related to brain lesions Cardiac EvaluationCardiac Evaluation

Treatment:Treatment: Medications that prevent platelet aggregationMedications that prevent platelet aggregation

ASA, PlavixASA, Plavix Oral anticoagulantsOral anticoagulants

Cerebrovascular AccidentCerebrovascular AccidentClassificationsClassifications

Ischemic StrokeIschemic Stroke ThromboticThrombotic EmbolicEmbolic

Hemorrhagic StrokeHemorrhagic Stroke Intracerebral HemorrhageIntracerebral Hemorrhage Subarachnoid HemorrhageSubarachnoid Hemorrhage

AneurysmAneurysm

Cerebrovascular AccidentCerebrovascular AccidentThrombotic StrokeThrombotic Stroke

Cerebrovascular AccidentCerebrovascular AccidentEmbolic StrokeEmbolic Stroke

Cerebrovascular AccidentCerebrovascular AccidentHemorrhage Stroke Hemorrhage Stroke

Intracerebral HemorrhageIntracerebral Hemorrhage

Rupture of a vesselRupture of a vessel Hypertension – most important causeHypertension – most important cause Others: vascular malformations, coagulation Others: vascular malformations, coagulation

disorders, anticoagulation, trauma, brain tumor, disorders, anticoagulation, trauma, brain tumor, ruptured aneurysmsruptured aneurysms

Sudden onset of symptoms with progressionSudden onset of symptoms with progression Neurological deficits, headache, nausea, vomiting, Neurological deficits, headache, nausea, vomiting,

decreased LOC, and hypertensiondecreased LOC, and hypertension Prognosis: poor – 50% die within weeksPrognosis: poor – 50% die within weeks 20% functionally independent at 6 months20% functionally independent at 6 months

Cerebrovascular AccidentCerebrovascular AccidentHemorrhage Stroke Hemorrhage Stroke

Intracerebral HemorrhageIntracerebral Hemorrhage

Cerebrovascular AccidentCerebrovascular AccidentHemorrhagic-SubarachnoidHemorrhagic-Subarachnoid

Hemorrhagic Stroke–Subarachnoid HemorrhageHemorrhagic Stroke–Subarachnoid Hemorrhage

Intracranial bleeding into the cerebrospinal fluid-Intracranial bleeding into the cerebrospinal fluid-filled space between the arachnoid and pia mater filled space between the arachnoid and pia mater membranes on the surface of the brain membranes on the surface of the brain

Cerebrovascular AccidentCerebrovascular AccidentClinical ManifestationsClinical Manifestations

Motor Function ImpairmentMotor Function Impairment Caused by destruction of motor neurons in the Caused by destruction of motor neurons in the

pyramidal pathway (brain to spinal cord)pyramidal pathway (brain to spinal cord) MobilityMobility Respiratory functionRespiratory function Swallowing and speechSwallowing and speech Gag reflexGag reflex Self-care activitiesSelf-care activities

Cerebrovascular AccidentCerebrovascular AccidentClinical ManifestationsClinical Manifestations

Right Brain – Left Brain DamageRight Brain – Left Brain Damage

Cerebrovascular AccidentCerebrovascular AccidentClinical ManifestationsClinical Manifestations

AffectAffect Difficulty controlling emotionsDifficulty controlling emotions Exaggerated or unpredictable emotional responseExaggerated or unpredictable emotional response Depression / feelings regarding changed body Depression / feelings regarding changed body

image and loss of functionimage and loss of function

Cerebrovascular AccidentCerebrovascular AccidentClinical ManifestationsClinical Manifestations

Intellectual FunctionIntellectual Function Memory and judgment Memory and judgment

Left-brain stroke: cautious in making Left-brain stroke: cautious in making judgmentsjudgments

Right-brain stroke: impulsive & moves quickly Right-brain stroke: impulsive & moves quickly to decisionsto decisions

Difficulties in learning new skillsDifficulties in learning new skills

Cerebrovascular AccidentCerebrovascular AccidentTreatment GoalsTreatment Goals

Prevention – Health Maintenance Focus:Prevention – Health Maintenance Focus: Healthy dietHealthy diet Weight controlWeight control Regular exerciseRegular exercise No smokingNo smoking Limit alcohol consumptionLimit alcohol consumption Route health assessmentRoute health assessment Control of risk factorsControl of risk factors

Cerebrovascular AccidentCerebrovascular AccidentTreatment GoalsTreatment Goals

PreventionPrevention Drug TherapyDrug Therapy Surgical TherapySurgical Therapy RehabilitationRehabilitation

Cerebrovascular AccidentCerebrovascular AccidentTreatment GoalsTreatment Goals

Drug TherapyDrug Therapy Measures to prevent the development of a Measures to prevent the development of a

thrombus or embolus for “At Risk” patients:thrombus or embolus for “At Risk” patients:

Antiplatelet AgentsAntiplatelet Agents AspirinAspirin PlavixPlavix CombinationCombination

Cerebrovascular AccidentCerebrovascular AccidentWarning Signs of StrokeWarning Signs of Stroke

Sudden weakness, paralysis, or numbness of the Sudden weakness, paralysis, or numbness of the face, arm, or leg, especially on one side of the face, arm, or leg, especially on one side of the bodybody

Sudden dimness or loss of vision in one or both Sudden dimness or loss of vision in one or both eyeseyes

Sudden loss of speech, confusion, or difficulty Sudden loss of speech, confusion, or difficulty speaking or understanding speechspeaking or understanding speech

Unexplained sudden dizziness, unsteadiness, loss Unexplained sudden dizziness, unsteadiness, loss of balance, or coordinationof balance, or coordination

Sudden severe headacheSudden severe headache

Cerebrovascular AccidentCerebrovascular AccidentRehabilitationRehabilitation

Assess: Swallowing; Communication; Assess: Swallowing; Communication; Complications; motor and sensory functionComplications; motor and sensory function

Action: Coordinate resources:Action: Coordinate resources: Speech Therapy—assess swallowingSpeech Therapy—assess swallowing Physical Therapy—ambulation/strengtheningPhysical Therapy—ambulation/strengthening Bowel/BladderBowel/Bladder Appropriate self-help resourcesAppropriate self-help resources

Cerebrovascular AccidentCerebrovascular AccidentRehabilitationRehabilitation

Comprehensive plan – Comprehensive plan – Physical Medicine & Rehabilitation / Inpatient RehabPhysical Medicine & Rehabilitation / Inpatient Rehab

Learn techniques to self-monitor & maintain physical Learn techniques to self-monitor & maintain physical wellnesswellness

Demonstrate self-care skillsDemonstrate self-care skills Exhibit problem-solving skills with self-careExhibit problem-solving skills with self-care Avoid complications of strokeAvoid complications of stroke CommunicationCommunication Maintain nutrition & hydrationMaintain nutrition & hydration Use community resourcesUse community resources Family cohesivenessFamily cohesiveness

SEKIAN TERIMA KASIHSEKIAN TERIMA KASIH