cerebrovascular accident cva (stroke), angin ahmar (malay)
TRANSCRIPT
Cerebrovascular AccidentCerebrovascular Accident
CVACVA
Cerebrovascular AccidentCerebrovascular Accident Results from ischemia to a part of the brain or Results from ischemia to a part of the brain or
hemorrhage into the brain that results in death of brain hemorrhage into the brain that results in death of brain cellscells. .
#1 leading cause of disability #1 leading cause of disability 25% with initial stroke die within 1 year25% with initial stroke die within 1 year 50-75% will be functionally independent50-75% will be functionally independent 25% will live with permanent disability25% will live with permanent disability
Physical, cognitive, emotional, & financial impactPhysical, cognitive, emotional, & financial impact
Cerebrovascular AccidentCerebrovascular AccidentRisk FactorsRisk Factors
Age Age – Occurrence doubles each decade >55 years– Occurrence doubles each decade >55 years
GenderGender – Equal for men & women; – Equal for men & women; Heredity Heredity – family history, prior transient – family history, prior transient
ischemic attack, or prior stroke increases riskischemic attack, or prior stroke increases risk
Cerebrovascular AccidentCerebrovascular AccidentRisk FactorsRisk Factors
High blood pressure DiabetesCigarette smoking ObesityHigh blood cholesterol Physical InactivityHeart Disease
CVA – Risk FactorsCVA – Risk Factors
Cerebrovascular AccidentCerebrovascular AccidentPathophysiologyPathophysiology
AtherosclerosisAtherosclerosis: major cause of CVA: major cause of CVA Thrombus formation & emboli developmentThrombus formation & emboli development
Abnormal filtration of lipids in the intimal layer of the arterial Abnormal filtration of lipids in the intimal layer of the arterial wallwall
Plaque develops & locations of increased turbulence of blood - Plaque develops & locations of increased turbulence of blood - bifurcationsbifurcations
Increased turbulence of blood or a tortuous areaIncreased turbulence of blood or a tortuous area Calcified plaques rupture or fissureCalcified plaques rupture or fissure Platelets & fibrin adhere to the plaquePlatelets & fibrin adhere to the plaque Narrowing or blockage of an artery by thrombus or emboliNarrowing or blockage of an artery by thrombus or emboli Cerebral Infarction: blocked artery with blood supply cut Cerebral Infarction: blocked artery with blood supply cut
off beyond the blockageoff beyond the blockage
CVA SIGN & SYMPTOMS? CVA SIGN & SYMPTOMS? Sudden numbness or weakness of face, arm, or leg, Sudden numbness or weakness of face, arm, or leg,
especially on one side of the body. especially on one side of the body. Sudden confusion or trouble speaking or understanding Sudden confusion or trouble speaking or understanding
speech. speech. Sudden trouble seeing in one or both eyes. Sudden trouble seeing in one or both eyes. Sudden trouble walking, dizziness, or loss of balance or Sudden trouble walking, dizziness, or loss of balance or
coordination coordination Sudden severe headache with no known cause. Sudden severe headache with no known cause.
Cerebrovascular AccidentCerebrovascular AccidentTransient Ischemic AttackTransient Ischemic Attack
Temporary focal loss of neurologic function Temporary focal loss of neurologic function
Caused by ischemia of one of the vascular territories of Caused by ischemia of one of the vascular territories of the brainthe brain Microemboli with temporary blockage of blood flowMicroemboli with temporary blockage of blood flow
Lasts less than 24 hrs – often less than 15 minsLasts less than 24 hrs – often less than 15 mins Most resolve within 3 hoursMost resolve within 3 hours Warning sign of progressive cerebrovascular diseaseWarning sign of progressive cerebrovascular disease
Cerebrovascular AccidentCerebrovascular Accident Transient Ischemic AttackTransient Ischemic Attack
Diagnosis: Diagnosis: CT without contrast CT without contrast
Confirm that TIA is not related to brain lesions Confirm that TIA is not related to brain lesions Cardiac EvaluationCardiac Evaluation
Treatment:Treatment: Medications that prevent platelet aggregationMedications that prevent platelet aggregation
ASA, PlavixASA, Plavix Oral anticoagulantsOral anticoagulants
Cerebrovascular AccidentCerebrovascular AccidentClassificationsClassifications
Ischemic StrokeIschemic Stroke ThromboticThrombotic EmbolicEmbolic
Hemorrhagic StrokeHemorrhagic Stroke Intracerebral HemorrhageIntracerebral Hemorrhage Subarachnoid HemorrhageSubarachnoid Hemorrhage
AneurysmAneurysm
Cerebrovascular AccidentCerebrovascular AccidentThrombotic StrokeThrombotic Stroke
Cerebrovascular AccidentCerebrovascular AccidentEmbolic StrokeEmbolic Stroke
Cerebrovascular AccidentCerebrovascular AccidentHemorrhage Stroke Hemorrhage Stroke
Intracerebral HemorrhageIntracerebral Hemorrhage
Rupture of a vesselRupture of a vessel Hypertension – most important causeHypertension – most important cause Others: vascular malformations, coagulation Others: vascular malformations, coagulation
disorders, anticoagulation, trauma, brain tumor, disorders, anticoagulation, trauma, brain tumor, ruptured aneurysmsruptured aneurysms
Sudden onset of symptoms with progressionSudden onset of symptoms with progression Neurological deficits, headache, nausea, vomiting, Neurological deficits, headache, nausea, vomiting,
decreased LOC, and hypertensiondecreased LOC, and hypertension Prognosis: poor – 50% die within weeksPrognosis: poor – 50% die within weeks 20% functionally independent at 6 months20% functionally independent at 6 months
Cerebrovascular AccidentCerebrovascular AccidentHemorrhage Stroke Hemorrhage Stroke
Intracerebral HemorrhageIntracerebral Hemorrhage
Cerebrovascular AccidentCerebrovascular AccidentHemorrhagic-SubarachnoidHemorrhagic-Subarachnoid
Hemorrhagic Stroke–Subarachnoid HemorrhageHemorrhagic Stroke–Subarachnoid Hemorrhage
Intracranial bleeding into the cerebrospinal fluid-Intracranial bleeding into the cerebrospinal fluid-filled space between the arachnoid and pia mater filled space between the arachnoid and pia mater membranes on the surface of the brain membranes on the surface of the brain
Cerebrovascular AccidentCerebrovascular AccidentClinical ManifestationsClinical Manifestations
Motor Function ImpairmentMotor Function Impairment Caused by destruction of motor neurons in the Caused by destruction of motor neurons in the
pyramidal pathway (brain to spinal cord)pyramidal pathway (brain to spinal cord) MobilityMobility Respiratory functionRespiratory function Swallowing and speechSwallowing and speech Gag reflexGag reflex Self-care activitiesSelf-care activities
Cerebrovascular AccidentCerebrovascular AccidentClinical ManifestationsClinical Manifestations
Right Brain – Left Brain DamageRight Brain – Left Brain Damage
Cerebrovascular AccidentCerebrovascular AccidentClinical ManifestationsClinical Manifestations
AffectAffect Difficulty controlling emotionsDifficulty controlling emotions Exaggerated or unpredictable emotional responseExaggerated or unpredictable emotional response Depression / feelings regarding changed body Depression / feelings regarding changed body
image and loss of functionimage and loss of function
Cerebrovascular AccidentCerebrovascular AccidentClinical ManifestationsClinical Manifestations
Intellectual FunctionIntellectual Function Memory and judgment Memory and judgment
Left-brain stroke: cautious in making Left-brain stroke: cautious in making judgmentsjudgments
Right-brain stroke: impulsive & moves quickly Right-brain stroke: impulsive & moves quickly to decisionsto decisions
Difficulties in learning new skillsDifficulties in learning new skills
Cerebrovascular AccidentCerebrovascular AccidentTreatment GoalsTreatment Goals
Prevention – Health Maintenance Focus:Prevention – Health Maintenance Focus: Healthy dietHealthy diet Weight controlWeight control Regular exerciseRegular exercise No smokingNo smoking Limit alcohol consumptionLimit alcohol consumption Route health assessmentRoute health assessment Control of risk factorsControl of risk factors
Cerebrovascular AccidentCerebrovascular AccidentTreatment GoalsTreatment Goals
PreventionPrevention Drug TherapyDrug Therapy Surgical TherapySurgical Therapy RehabilitationRehabilitation
Cerebrovascular AccidentCerebrovascular AccidentTreatment GoalsTreatment Goals
Drug TherapyDrug Therapy Measures to prevent the development of a Measures to prevent the development of a
thrombus or embolus for “At Risk” patients:thrombus or embolus for “At Risk” patients:
Antiplatelet AgentsAntiplatelet Agents AspirinAspirin PlavixPlavix CombinationCombination
Cerebrovascular AccidentCerebrovascular AccidentWarning Signs of StrokeWarning Signs of Stroke
Sudden weakness, paralysis, or numbness of the Sudden weakness, paralysis, or numbness of the face, arm, or leg, especially on one side of the face, arm, or leg, especially on one side of the bodybody
Sudden dimness or loss of vision in one or both Sudden dimness or loss of vision in one or both eyeseyes
Sudden loss of speech, confusion, or difficulty Sudden loss of speech, confusion, or difficulty speaking or understanding speechspeaking or understanding speech
Unexplained sudden dizziness, unsteadiness, loss Unexplained sudden dizziness, unsteadiness, loss of balance, or coordinationof balance, or coordination
Sudden severe headacheSudden severe headache
Cerebrovascular AccidentCerebrovascular AccidentRehabilitationRehabilitation
Assess: Swallowing; Communication; Assess: Swallowing; Communication; Complications; motor and sensory functionComplications; motor and sensory function
Action: Coordinate resources:Action: Coordinate resources: Speech Therapy—assess swallowingSpeech Therapy—assess swallowing Physical Therapy—ambulation/strengtheningPhysical Therapy—ambulation/strengthening Bowel/BladderBowel/Bladder Appropriate self-help resourcesAppropriate self-help resources
Cerebrovascular AccidentCerebrovascular AccidentRehabilitationRehabilitation
Comprehensive plan – Comprehensive plan – Physical Medicine & Rehabilitation / Inpatient RehabPhysical Medicine & Rehabilitation / Inpatient Rehab
Learn techniques to self-monitor & maintain physical Learn techniques to self-monitor & maintain physical wellnesswellness
Demonstrate self-care skillsDemonstrate self-care skills Exhibit problem-solving skills with self-careExhibit problem-solving skills with self-care Avoid complications of strokeAvoid complications of stroke CommunicationCommunication Maintain nutrition & hydrationMaintain nutrition & hydration Use community resourcesUse community resources Family cohesivenessFamily cohesiveness
SEKIAN TERIMA KASIHSEKIAN TERIMA KASIH