CVA

• Stroke or brain attack
• Neurologic deficits occur as a result of decreased blood flow to localized area of brain
• Onset may be rapid or gradual

• Ischemia followed by cell death
• Result of severe and prolonged cerebral blood flow obstruction
• Resulting deficits predict location of stroke

• Transient ischemic attack (TIA)
• Thrombotic CVA
• Embolic CVA
• Hemmorhagic CVA

• Brief period of neurological deficits that reslove within 24hrs
• Frequently precursors to a permanent CVA
• Causes- inflammatory arterial disorders, sickle cell anemia, atherosclerotic changes in cerebral vessels, thrombosis, emboli

• Caused by thrombus occluding a cerebral vessel
• Tend to form atherosclerotic plaque in larger arteries wile BP is lower-sleep/rest
• Thrombosis occurs quickly but deficits progress slowly

• Caused by traveling blood clot
• Source of clot is elsewhere in body
• Sudden onset eith immediate symptoms
• If embolus not absorbed, deficits will be persistent

• Intracranial hemmorhage occurs when a blood vessel ruptures
• Often occurs in presence of long-term, poorly controlled hypertension
• Causes- ruptures intracranial aneurysm, embolic CVA, tumors, arteriovenous malformations, anticoagulant therapy, liver disease, DIC, thrombocytopenia
• This form often fatal due to rapidly increasing ICP
• Onset of symptoms is rapid
• Loss of consciousness usually occurs

• Vary according to cerebral vessel involved
• Sudden weakness, numbness or paralysis in your face, arm, or leg-typically on one side of your body
• Gait disturbance
• Slurred or garbled speech or difficulty understanding others
• Sudden blindness in one or both eyes, blurred, tunnel or double vision
• Dizziness, loss of balance or coordination

• CT/MRI- demonstrate hemorrhage, tumors, ischemia, edema, tissue necrosis
• Cerebral angiography detects abnormal vessel structure, vasospasm, stenosis of carotid artery/loss of vessel wall integrity
• Ultrasound evaluates blood flow
• Blood tests- CBC, Chem 7, firenogen level, PT aPTT

• Drug therapy-anti-platelet or anti-coagulant
• Imperitive NOT to disrupt clot that has formed following hemmorhagic CVA
• Surgery usually not indicated as treatment modality
• Rehab is crucial to improve deficits
• Stabilize pt
• Neurochecks, lab work, ECG, CT

• Antiplatelet agents
• Thrombolitic therapy
• Anticoagulant therapy
• Osmotic diuretics
• Diuretics
• Anticonvulsants

• HTN, obesity, sedentary lifestyle, atherosclerosis,A-fib, valvular disease, smoking, heavy alcohol use, cocaine,
• diabetes, high stree level, hyperlipidemia (LDL), high triglyceride, oral contraceptives, black males, over 55 yrs

• 81 mg asa
• monitor BP
• anti-hypertensives
• annual physical
• regular exercise
• stop smoking
• decrease alcohol intake
• diet changes (low fat, low cholesterol)

• Face-does face look uneven? Ask them to smile.
• Arm-Does one arm drift down? Ask them to raise both arms.
• Speech-Does their speech sound strange? Ask them to repeat a phrase.
• Time-Every second brain cells die. Call 911 at any sign of stroke.

If stroke occurs on left then stroke manifestations occur on the right and affect behaviors controlled by the right hemisphere of the brain

• Left- dominant, center for language, math skills, analytical thinking, aphasia, dyslexia, agraphia, acalculia, possible memory deficit
• Right- visual and spatial awareness, proprioception, pt disorientation to time and place, unaware of changes, personality changes

• Airway, oxygen therapy
• Thromolytics- if trtmnt sought within 3 hrs of ischemic stroke (streptokinase)
• Anticoagulants- heparin, lovenox, coumadin, arixtra, pradaxa
• Antiplatelets- plavix, ticlid
• TED hose

• Paralysis, loss of muscle mvmnt
• Difficulty talking or swallowing
• Memory loss, trouble understanding
• Pain
• Changes in behavior/self care

• First- initiate p physical conditioning regimen designed to regain pre-stroke levels of activity
• Second- prevent recurrent stroke and cardiovascular events
• Third- improve aerobic fitness