Cerebrovascular Accident (CVA) in 5 minutes.

A cerebrovascular Accident (CVA) – otherwise known as a stroke, or apoplexy – is an ischemic or hemorrahagic event that occurs within the intracranial vasculature resulting in either injury, or death of surrounding brain tissues and loss of their related body functions.

Pathophysiology

Intraparenchymal bleed (bottom arrow) with surrounding edema (top arrow) – Courtesy: James Heilman, MD

In ischemic CVA’s, typically a blood vessel is occluded due to an atherosclerotic plaque, a blood clot, or some other sufficiently occlusive object (such as an air or gas bubble in the case of an air embolus). Bloodflow downstream of the occlusion ceases resulting in ischeamia brain tissues in this area. Neurologic dysfunction occurs, generally proportional to the degree of cell death.

In the case of hemorrahagic CVA, a blood vessel (typically an artery) is ruptured and hemorrahages freely into the cerebral space. This may result in partial or complete loss of blood supply to the brain tissues downstream of the rupture, and would follow the same pathology as an ischemic stroke in this case.

In addition to ischemic damage, a hemorrhagic CVA results in the formation of a hematoma which can put pressure on remaining healthy brain tissues, and my cause pressure ligature of the blood vessels supplying those areas, again leading to further ischemic damage to brain tissues well beyond the effective area of the occluded blood vessel. In severe cases, the hematoma can exert enough pressure to force the brain through the foramen magnum, resulting in severe traumatic brain injury, and likely death.

Etiology

Thrombus, embolism or , or bleeding into an intracranial vessel. Predisposing or causative factors include hypertension, atherosclerosis, poor dieat, smoking and cardiac complications (such as AV malformation).

Manifestations

S&S of intracranial pressure (ICP), headache, altered level of conciousness (LOC), pupillary changes, seizures, sensorimotor dysfunction, alterations in speech, altered cognition, or cranial nerve dusfuntions.

Nursing Diagnosis

Alteration in cerbral tissue perfusion; impaired physical mobility, speech and swallowing; alterations in thought and cognition; Numerous psychosocial diagnoses.

Nursing Care

Maintain airway patency. Frequently asses and monitor vital signs including neurologic status. Monitor nutritional status and fluid balance. Aim to turn every 1 to 2 hours. Coordinate and support rehabilitative regimes. Provide emotional support to patient and family. Provide education and resources to patient and family. Evaluate the efficacy of medication regimens and medical interventions.

Prognosis

Prognosis varies throughout the full span; from complete/full recovery, to persistive vegetative state or death. Prognosis will largely depend on the type, location and severity of the event as well as any pother comorbidities or other complicating factors.

 

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