October 10, 2022

Cerebrovascular Accident: Pathophysiology and Assignment

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Pathophysiology of Cerebrovascular Accident

Article by Robyn Broyles (11,561 pts )
Edited & published by Leigh A. Zaykoski (60,578 pts ) on Nov 30, 2009

A cerebrovascular accident (CVA) or stroke is caused by an acute lack of blood supply to part of the brain. There are two major types of stroke: ischemic, in which a blockage (usually a blood clot) reduces or halts blood flow, and hemorrhagic, in which bleeding in the brain triggers a response that restricts blood supply elsewhere. The pathophysiology of cerebrovascular accident is different for these two types of stroke.

Pathophysiology of Ischemic Stroke

An ischemic stroke may be caused by a blood clot that occurs in the affected artery (thrombosis), a blood clot that traveled from another part of the body (embolism), or a blockage due to damage to the arterial wall (lacunar infarct). Blockage of a single artery can often be compensated for by other arteries in the blood vessel network, call collaterals. Artherosclerosis (hardening of the arteries), other damage to arteries, and natural variations in the collateral network can prevent the collateral system from compensating fully. The result is a loss of perfusion, or blood supply, to an area of the brain (ischemia).

Arteriovenous malformations (AVMs), abnormal tangles of blood vessels in which arteries flow directly into veins, are another possible cause of ischemic stroke. AVMs can press directly on brain tissue, blocking blood flow.

Pathophysiology of Hemorrhagic Stroke

The main type of hemorrhage that can lead to stroke is subarachnoid hemorrhage. In this type of bleed, which usually results from head trauma or a ruptured aneurysm, there is uncontrolled bleeding between the innermost two of the three meninges (membranes lining the brain), the pia mater and the arachnoid mater.

The blood that pools or collects in a subarachnoid bleed is called a hematoma. Ischemia (lack of blood flow) from the hematoma is a secondary problem. It is caused by constriction of the arteries (vasospasm) as a protective response to reduce bleeding. About 25% of patients with subarachnoid hemorrhages will experience stroke symptoms resulting from secondary ischemia.

Another common type of brain hemorrhage is an intracerebral hemorrhage, in which an artery inside the brain tissue fails due to high blood pressure and begins to bleed. It usually results from hypertension, but other causes of burst intracerebral arteries include various types of aneurysm, brain tumors, and blood clotting disorders. Symptoms of intracerebral hemorrhages can mimic symptoms of ischemic stroke, especially for smaller bleeds, but the two problems have different etiologies and treatments.

References

The Merck Manual of Diagnosis and Therapy: Entries on Ischemic Stroke, Subarachnoid Hemorrhage, and Intracerebral Hemorrhage

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PATHOPHYSIOLOGY of CVA (Stroke)

DiabeticNephropathyAcceleratedatherosclerosisRenalDiseaseProduction of glucose from proteinand fat storesWasting of leanbody massWeight lossFatigueAcidosisAcetone breathInc. KetonesSmall vesseldiseaseNeuropath Impaired immunefunction(decrease level of morphonuclear leukocytes)Infection Delayed woundhealinDiabeticRetinopathyInc. serum glucose levelGlycoprotein cellwall depositsInc. osmolaritydue to glucose

Destruction of alpha and betacells of the pancreasFailure to produce insulinProduction of excess glucagonPolydipsiaPolyphagiaPolyuriaWeightLossModifiable Factors Non Modifiable FactorsAge, Family History of CVA,Family History of DM, Sex(Men), RaceSmoking, Obesity, Hypertension, High CholesterolLevel, Excessive Alcohol Consumption, DrugAddiction, High Dose of estrogen OC, DiabetesMellitus, Atrial Fibrillation, Type A personality,Sedentary Life Style

HypertensionIncrease LDL levelsSymmetrical loss of protectivesensationNumbnessand tinglingin theextremitiesWasting of intrinsic Charcotchanges injointsAutonomicneuropathyDry cracked skinGastro paresisImpotenceNeurogenicbladder Loss of visionBlindnessCerebral ischemiaLong termEschemia(>10-15mins) Short termEschemia(<10-15mins)

TemporaryDeficitPermanentDeficitDecreased Tissueperfusion (brain)HemiparesisLoss of speechHemisensory lossCerebral HypoxiaSyncope/ VertigoCEREBROVASCULARACCIDENTThrombusEmboliNopermanentdamageIrreversibledamageMID CEREBRALARTERYANTERIORCEREBRAL A.POSTERIORCEREBRAL A.VERTEBROBASILARARTERY Cerebrovascular Accident: Pathophysiology and Assignment

Hemiparesis/ HemiplegiaAphasiaDysarthiaDysphagiaApraxiaVisual ChangesAtaxiaAgnosia Hemisensory lossHorner’sS ndromeUnilarteral NeglectIncontinence

DEFINITION OF DISEASE]

Cerebrovascular accident (CVA) is the medical term for what is commonly termed as stroke. It refers to the injury to thebrai n that occurs when flow of blood to brain tissue is interruptedby a clogged or ruptured artery, causing brain tissue to die becauseof lack of nutrients and oxygen.A stroke (sometimes called a cerebrovascular accident(CVA)) is the rapidly developing loss of brain function(s) due todisturbance in the blood supply to the brain, caused by a blockedor burst blood vessel. This can be due to ischemia (lack of glucoseand oxygen supply) caused by thrombosis or embolism or due to ahemorrhage. As a result, the affected area of the brain is unable tofunction, leading to inability to move one or more limbs on oneside of the body, inability to understand or formulate speech, or inability to see one side of the visual field. A stroke is a medicalemergency and can cause permanent neurological damage,complications, and death.

Stroke is a term used to describe neurologicchanges caused by an interruption in the blood supply topart of the brain. Two major types of stroke are ischemic andhemorrhagic. Ischemic stroke is caused by thrombotic or embolic blockage of blood flow to the brain. Bleeding into thebrain tissue or the subarachnoid space causes ahemorrhagic stroke. Ischemic strokes account for about 83%of all strokes. The remaining 17% of strokes arehemorrhagic.Cerebrovascular disorders are the third leadingcause of death in United States and account for about 164,000 mortalities annually. An estimated 550,000 strokespeople experience a stroke each year. When second strokesare considered in the estimates, the incidence increases to700, 000 per year in the united States alone. Stroke is aleading cause of adult disability and leading primarydiagnosis for long term care. More than four million strokesurvivors are living with varying degrees of disability in theUnited States. Along with a high mortality rate, strokesproduce significant morbidity in people who survive them.(Joyce M. Black et al Medical Surgical Nursing 7

editionElsevier Suanders 2005)Vascular Disease which includes C.V.A. is thesecond leading cause of death in the Philippines with a totalof 51,680 according to DOH 2004. Along with this are 37,092who survived with it.(http://www.doh.gov.ph/kp/statistics/morbidity)New therapies can now prevent or limit the extentcan now prevent or limit the extent of damage to brain tissuecaused by acute ischemic stroke. Thrombolytic therapy mustbe administered as soon as possible after onset of thestroke; a treatment window 3 hours from the onset of manifestations has been established. To convey this senseof urgency regarding the evaluation and treatment of stroke,health care professionals now refer to stroke as brain attack.Public education is focused on prevention, recognition of manifestation, and early treatment of brain attack. (Joyce M.Black et al Medical Surgical Nursing 7th edition Elsevier Suanders 2005)Diabetes Mellitus is a chronic systemic diseasecharacterized by either a deficiency of insulin or a decreasedability of the body to use insulin Diabetes mellitus issometimes referred to as “high sugars” by both clients andhealth care providers. The notion of associating sugar withdiabetes is appropriate because the passage of largeamounts of sugar-laden urine is characteristic of poorlycontrolled diabetes. However high levels of blood glucoseare only one component of the pathologic process andclinical manifestation associated with DM. DM can beassociated serious complications, but people with diabetescan take preventive measures to reduce the likelihood of such occurrences. (Joyce M. Black et al Medical SurgicalNursing 7th edition Elsevier Suanders 2005)

Modifiable and Non Modifiable Factors1. Modifiable

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PATHOPHYSIOLOGY of CVA (Stroke)

Hemiparesis/ HemiplegiaAphasiaDysarthiaDysphagiaApraxiaVisual ChangesAtaxiaAgnosia Hemisensory lossHorner’sS ndromeUnilarteral NeglectIncontinence

DEFINITION OF DISEASE]

http

://www.doh.gov.ph/kp/statistics/morbidity)New therapies can now prevent or limit the extentcan now prevent or limit the extent of damage to brain tissuecaused by acute ischemic stroke. Thrombolytic therapy mustbe administered as soon as possible after onset of thestroke; a treatment window 3 hours from the onset of manifestations has been established. To convey this senseof urgency regarding the evaluation and treatment of stroke,health care professionals now refer to stroke as brain attack.Public education is focused on prevention, recognition of manifestation, and early treatment of brain attack. (Joyce M.Black et al Medical Surgical Nursing 7

edition Elsevier Suanders 2005)Diabetes Mellitus is a chronic systemic diseasecharacterized by either a deficiency of insulin or a decreasedability of the body to use insulin Diabetes mellitus issometimes referred to as “high sugars” by both clients andhealth care providers. The notion of associating sugar withdiabetes is appropriate because the passage of largeamounts of sugar-laden urine is characteristic of poorlycontrolled diabetes. However high levels of blood glucoseare only one component of the pathologic process andclinical manifestation associated with DM. DM can beassociated serious complications, but people with diabetescan take preventive measures to reduce the likelihood of such occurrences. (Joyce M. Black et al Medical SurgicalNursing 7

edition Elsevier Suanders 2005)

Modifiable and Non Modifiable Factors1. Modifiable

Increased hunger and food intake. Because glucose cannotenter cells of the satiety center of the brain without insulin,the satiety center in the hypothalamus is stimulated resultingin a “hunger sensation” as if there were very little bloodglucose, resulting in an exaggerated appetite.BODY MALAISEThis is due to the decreased glucose uptake by the tissuesleading to decreased energy production.GLYCOSURIAThe kidney filters the blood, making it to its normal state.Glucose was filtered out and excreted in the urine. Due tothe excess glucose ad compared to the kidney threshold,which results to the excretion of glucose in the urine.BLURRED VISIONDiabetes can affect the lens, vitreous, and retina, causingvisual symptoms. Visual blurring may develop acutely as thelens changes shape with marked changes in blood glucoseconcentrations. This effect, which is caused by osmoticfluxes of water into and out of the lens, usually occurs ashype

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