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CEREBROVASCULAR ACCIDENT (CVA)

CEREBROVASCULAR ACCIDENT (CVA). Tanja Čujić Iva Ferček Petra Črnac Mentor: A. Žmegač Horvat. WHO: CVA - neurological deficit of cerebrovascular cause that persists beyond 24 hours or is interrupted by death within 24 hours. Classification ischemic (80%): thrombotic, embolic hemorrhagic.

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CEREBROVASCULAR ACCIDENT (CVA)

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  1. CEREBROVASCULARACCIDENT (CVA) Tanja Čujić Iva Ferček Petra Črnac Mentor: A. Žmegač Horvat

  2. WHO: CVA - neurological deficit of cerebrovascular cause that persists beyond 24 hours or is interrupted by death within 24 hours Classification • ischemic (80%): thrombotic, embolic • hemorrhagic

  3. Embolic stroke • blockage of an artery by an embolus An embolus is... • thrombus • fat • air • cancer cells • clumps of bacteria • amniotic fluid

  4. embolus - arises from elsewhere, most commonly from the heart • source must be identified • symptoms - maximal at start • symptoms may be transient

  5. Paradoxical embolism • atrial septal defect

  6. Cardiac causes • atrial fibrillation • rheumatic disease • artificial heart valves • dilated cardiomyopathy • Libman-Sacks endocarditis • infective endocarditis • marantic endocarditis • left atrial myxoma

  7. Pathophysiology • depletion of oxygen and glucose • failure of energy-dependent processes • major cause of neuronal injury: GLUTAMATE • influx of calcium • failure of mitochondria

  8. Symptoms • location and extension • hemiplegia or muscle weakness • numbness • reduction of sensation Prognosis: disability emotional problems Prevention better than cure!

  9. THROMBOTIC STROKE part of the brain supplied by the clotted blood vessel is deprived of blood and oxygen blockage of an artery in the brain by a clot (thrombosis) - most common cause of stroke cells of that part of the brain die

  10. RISK FACTORS: • high blood pressure (hypertension) • high cholesterol • diabetes • smoking

  11. TIA • mini-stroke • short-lived episode (less than 24 hours) of neurological dysfunction caused by a loss of blood supply • some develop slowly, others rapidly

  12. TIA vs stroke • all TIAs resolve within 24 hours • strokes take longer to resolve • with strokes, complete function may never return → more permanent and serious problem • TIAs can occur once, multiple times, or precede a permanent stroke

  13. although most TIAs last only a few minutes, all TIAs should be evaluated with the same urgency as a stroke in an effort to prevent recurrences and/or strokes • aTIA should be considered an emergency because there is no guarantee that the situation will resolve and function will return

  14. TIA can cause: • temporary visual loss • problems with movement or sensation on one side of the body • paralysis of the arm, leg, and face, all on one side • double vision, dizziness • loss of speech, understanding and balance

  15. References: • www.medicinenet.com/stroke/article.htm • www.post-gazette.com • doctor2008.wordpress.com

  16. HEMORRHAGIC STROKE

  17. Subarachnoid hemorrhage What is it? • A disruption in the normal blood supply to the brain due to the rupture of blood vessels with intracerebral or subarachnoid hemorrhage • 15% to 20% of strokes Lobar hemorrhage

  18. Pathophysiology • A small blood vessel inside the brain becomes weak and bursts • Blood seeps into the brain tissue • The flow of blood after the blood vessel ruptures directly damages brain cells • An expanding hematoma causes compression of tissue which results in tissue injury

  19. The three major causes of hemorrhagic stroke: • High blood pressure (hypertension) → HYPERTENSIVE INTRACEREBRAL HEMORRHAGE • Ruptured arterial aneurysms • ARTERIOVENOUS MALFORMATIONS (AVMs) • Also very common in head trauma Hypertensive basal ganglionic hemorrhage Berry aneurysm

  20. Risk factors • Advanced age • Cigarette smoking (active and passive) • Heavy alcohol consumption and drug use • Diabetes mellitus • Lack of physical activity, obesity and unhealthy diet • Some apply only to women (pregnancy, childbirth, menopause) Arteriovenous malformation

  21. Symptoms • Sudden start (seconds or minutes) • Depend on the area of the brain affected • The most common signs of a stroke are: • weakness down one side of the body, ranging from numbness to paralysis that can affect the arm and leg • weakness down one side of the face, causing the mouth to droop • speech may be difficult or become difficult to understand • swallowing may be affected • loss of muscle coordination or balance • brief loss of vision • severe headache • confusion

  22. Diagnosis • Medical history • Physical examination • Face-arm-speech test (FAST) for early recognition: • Facial weakness: can the person smile? Has the mouth or eye drooped? • Arm weakness: can the person raise both arms? • Speech problems: can the person speak clearly and understand you? • Test these symptoms CT scan of a patient who has had a left middle cerebral artery stroke. The arrow indicates the location of the stroke.

  23. CT and MRI are both considered first-choice options for identifying hematomas (arrowheads) caused by hemorrhagic stroke • CAT scan of the brain is often done to show bleeding into the brain • Patients with intracerebral hemorrhage require neurosurgical evaluation to detect and treat the cause of the bleeding

  24. Treatment • The first few days after a stroke: • Patients are monitored and their blood pressure, blood sugar, and oxygenation are kept at optimum levels • The next phase of treatment: • Recovery through rehabilitation • Part of the stroke patient's routine: • Daily rehabilitation exercises and a correct diet

  25. Important! • Prevention (treat high blood pressure, diabetes, high cholesterol, and heart disease if present, follow a low-fat diet, quit smoking, exercise regularly...) • Anticoagulants and antithrombotics, key in treating ischemic stroke, can make bleeding worse and cannot be used in intracerebral hemorrhage

  26. References • www.wikipedia.org • www.netdoctor.co.uk • www.medterms.com • http://jama.ama-assn.org

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