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A stroke is damage to part of the brain when its blood supply is suddenly reduced or stopped.

A stroke may also be called a cerebral vascular accident, or CVA. The part of the brain deprived of blood dies and can no longer function. Blood is prevented from reaching brain tissue when a blood vessel leading to the brain becomes blocked (ischemic) or bursts (hemorrhagic). The symptoms of a stroke differ, depending on the part of the brain affected and the extent of the damage. Symptoms following a stroke come on suddenly and may include: weakness, numbness, or tingling in the face, arm, or leg, especially on one side of the body trouble walking, dizziness, loss of balance, or coordination inability to speak or difficulty speaking or understanding, trouble seeing with one or both eyes, or double vision, confusion or personality changes, difficulty with muscle movements, such as swallowing, moving arms and legs, loss of bowel and bladder control, severe headache with no known cause, and loss of consciousness. Admitted patients usually have symptoms of paralysis or one sided weakness and sometimes family brought their patients to the hospital with severe symptoms. CVA is usually related to lifestyle behavior. Diets rich in fats, cholesterol, sodium, sugar are one of the factors. Added to that is smoking and lack of exercise. As you can see, this factor brings up hypertension or increased blood pressure. What happens is that too much fat and cholesterol may pile up in the blood vessels in the brain. Just imagine a water hose in your garden, if you run the faucet and apply pressure to the hose by clamping it. A pressure builds up in the end of the hose. A blocked vessel may cause oxygen depletion in the brain, also known as brain hypoxia. At 5 minutes of oxygen deprivation, the brain cells could die causing a loss of function to the affected part.

Most dangerous vessels are the one that connects to the respiratory center of the brain or the medulla oblongata. If its affected, certainly the patients will develop respiratory distress. ANATOMY AND PHYSIOLOGY THE BRAIN In order to understand how stroke occurs and the damage it can cause, it is useful to understand the basic anatomy of the brain. The signs and symptoms of a stroke depend on which region of the brain is affected and how severely. 6

The brain has three primary components. Each is responsible for different functions: The Cerebrum: The cerebrum is the largest and most developmentally advanced portion of the brain. It controls a number of higher functions, including speech, emotion, the integration of sensory

stimuli, initiation of the final common pathways for movement, and fine control of movement. It is divided into a left and a right hemisphere. The left hemisphere controls the majority of functions on the right side of the body, while the right hemisphere controls most of functions on the left side of the body. Thus, injury to the left cerebral hemisphere produces sensory and motor deficits on the right side, and vice versa. Eye movement will determine if the hypothalamus is still functioning. The cerebrum is composed of the frontal, parietal, temporal, and occipital lobes:

The frontal lobe is involved in planning, organizing, problem solving and selective attention. The portion known as the prefrontal cortex controls personality and various higher cognitive functions such as behavior and emotions. The back of the frontal lobe consists of the premotor and motor areas, which produce and modify movement.

The left and right parietal lobes contain the primary sensory cortex, which controls sensation (touch and pressure), and a large association area that controls fine sensation (judgment of texture, weight, size, and shape). Damage to the right parietal lobe can cause visuo-spacial deficits, making it hard for the patient to find his/her way around new or even familiar places. Damage to the left parietal lobe may disrupt a patients ability to understand spoken and/or written language.

The left and right temporal lobes, located around ear level, allow a person to differentiate smells and sounds. They also help in sorting new information and are believed to be responsible for short-term memory. The right lobe is primarily involved in visual memory (i.e., memory for faces and pictures). The left lobe is primarily involved in verbal memory (i.e., memory for words and names).

The occipital lobe processes visual information. It is mainly responsible for visual reception and contains association areas that help in the visual recognition of shapes and colors. Damage to this lobe can cause visual deficits.

The Cerebellum: The cerebellum is the second largest area of the brain. It controls reflexes, balance and certain aspects of movement and coordination. The Brain Stem: The brain stem is responsible for a variety of automatic functions that are critical to life, such as breathing, digestion and heart beat as well as alertness and arousal (the state of being awake). THE HEART

Heart is a hollow muscular organ that pumps blood through the body. The heart, blood, and blood vessels make up the circulatory system, which is responsible for distributing oxygen and nutrients to the body and carrying away carbon dioxide and other waste products. The heart is the circulatory system's power supply. It must beat ceaselessly because the body's tissuesespecially the brain and the heart itself-depend on a constant supply of oxygen and nutrients delivered by the flowing blood. If the heart stops pumping blood for more than a few minutes, death will result. The human heart is shaped like an upside-down pear and is located slightly to the left of center inside the chest cavity. About the size of a closed fist, the heart is made primarily of muscle tissue that contracts rhythmically to propel blood to all parts of the body. This rhythmic contraction begins in the developing embryo about three weeks after conception and continues throughout an individual's life. The muscle rests only for a fraction of a second between beats. Over a typical life span of 76 years, the heart will

beat nearly 2.8 billion times and move 169 million liters (179 million quarts) of blood.

FUNCTION OF THE HEART The heart's duties are much broader than simply pumping blood continuously throughout life. The heart must also respond to changes in the body's demand for oxygen. The heart works very differently during sleep, for example, than in the middle of a 5-km (3-mi) run. Moreover, the heart and the rest of the circulatory system can respond almost instantaneously to shifting situations-when a person stands up or lies down, for example, or when a person is faced with a potentially dangerous situation

Pathophysiology

CEREBROVASCULAR ACCIDENT (HEMORRHAGIC) Definition: is an umbrella term that refers to any functional abnormality of the Central Nervous System that occurs when the normal blood supply to the brain is disrupted.

_________________________________________________________ Predisposing Factor: Precipitating Factor: Diabetes Mellitus Lifestyle ( Smoking) AGE 70 yrs. Old (loss of _________________________________________________________ Diet (sweet, fatty and salty blood vessel elasticity)

GENDER ( Female) FAMILY (hereditary) foods)

Insufficient insulin secretion/ production of the pancreas

Accumulation of glucose in the blood stream Increase fat deposit on the walls of the blood vessels

Increase viscosity of blood/ sluggish flow of blood

Narrowing of blood vessel (coronary Decrease blood flow through the coronary.

Atherosclesro sis Pressure on the wall of blood vessel

Evaluate level of blood glucose/ increase concentration of sugar in blood

CORONARY Decrease blood flow to the Increase blood pressure HCVD

Increase Peripheral Vascular Some fragments joins in circulation Goes to small vessels and clog (deep penetrating arteries especially lacunar region) Obstruction/ interruption of O2 supply due to decreased blood supply Lacunar infarct Decrease oxygen supply to basal ganglia (L) INFARCTIO N

S/sx: CBG monitoring: 103166mg/dL

Influences autonomic nervous system Responsible for cerebellar function Also affects motor skills of chewing & swallowing (DYSPHAGIA) Difficulty in chewing & swallowing could lead to decrease appetite Causing weight loss

s/s: 160/9 0 and above

Severe elevation in BP w/o progressive target organ Hypertensi on