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due to lack of oxygen when the blood flow to the brain is impaired by blockage or
rupture of an artery to the brain. A CVA is also referred to as a stroke. It is a condition in
which neurologic deficits result from decreased blood flow to localized area of the brain.
Neurologic deficits are determined by the area of brain involved, size of affected area,
length of time blood flow is decreased or stopped. Major loss of blood supply to brain
can cause disability or death.
Classification of CVA
o Ischemic stroke
Occurs when the blood supply to a part of the brain is interrupted or totally occluded.
Commonly due to thrombosis or embolism.
Thrombotic (large vesse)l Stroke
The most common cause of ischemic stroke which is cause primarily with
atherosclerosis- fatty materials deposit on large vessel walls that eventually
causes stenosis of the artery. The blood swirls around the irregular surface of
the plagues causing platelets to adhere and vessel becomes obstructed.
Lacunar (small vessel) Stroke
Endothelium of smaller vessel is primarily affected due to
hypertension leading to arteiosclerosis and stenosis. Infarcts are usually
located in the deeper, noncortical parts of the brain or in the brainstem.
Embolic Stroke
The occlusion of a cerebral artery by an embolus or moving blood clot
which forms outside the brain, detaches and travels through the cerebral
circulation where it lodges and causes an obstruction. Other sources of emboli
include tumor, fat, bacteria and air.
Hemorrhagic Stroke
This results from rupture of a cerebral vessel causing bleeding into the brain
tissues. Bleeding results with edema compression of the brain contents or spasm of the
adjacent blood vessels. This is often secondary to hypertension and most common after
age 50. Other factors includes ruptured intracranial aneurysms, trauma, erosion of blood
vessels by tumors, arteriovenous malformations, anticoagulant therapy and blood
disorders. This usually produce extensive residual functional loss and slowest recovery.
Clinical manifestations
o Stroke manifestations can be correlated with the cause and with the area of
the brain in which perfusion is affected
Manifestations of thrombotic stroke develop over minutes to hours
to days (slow onset is related to increasing size of the thrombus)
Embolic strokes occur suddenly and without warning
Hemorrhagic stroke occurs rapidly with manifestations developing
over minutes to hours
o General findings unrelated to specific vessel sites includes headache,
vomiting, seizures and changes in mental status
o Early warnings of impending ischemic stroke includes
Transient hemiparesis
Loss of speech
Hemisensory loss
Specific deficits after stroke
o Motor deficits
Affects connections involving motor areas of cerebral cortex, basal
ganglia, cerebellum, peripheral nerves
Produce effects in contralateral side ranging from mild weakness
to severe limitation
Hemiplegia (paralysis of half of body)
Hemiparesis (weakness of half of body)
Apraxia (inability to perform a previously learned skilled task in
the absence of paralysis)
Flaccidity (absence of muscle tone or hypotonia)
Spasticity (increased muscle tone usually with some degree of
weakness)
Muscles of the thorax and abdomen are usually not affected
because they are innervated from both cerebral hemispheres
o Communication disorders
Diagnostic tests
CT scan without contrast: determine hemorrhage, tumors, aneurysms,
ischemia, edema, tissue necrosis, shifting in intracranial contents.
Reference:
http://www.enotes.com/nursing-encyclopedia/cerebrovascular-accident
http://www.medterms.com/script/main/art.asp?articlekey=2676