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A Cerebrovascular accident (CVA) is damage to part of the brain when its blood supply
is suddenly reduced or stopped. A Cerebrovascular accident are most commonly called stroke.
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.


 


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 Cerebrovascular accidents (CVA) or ³brain attack¶¶ is a sudden loss of
function resulting from disruption of the blood supply to a part of the brain. The term
³brain attack´ is being used to suggest to health care practitioners and the public that a
stroke is an urgent health care issue similar to a heart attack.

 

  
 
<Y Ý  


 are caused by atherosclerotic plaques in the
large blood vessels of the brain. Thrombus formation and occlusion at the site of
the atherosclerosis result in ischemia and infarction (deprivation of blood supply)
<Y     

 
 affect one or more vessels and
are the most common type of ischemic stroke. Small artery thrombotic strokes are
also called lacunar strokes because of the cavity that is created after the death of
infracted brain tissue.
<Y V

 
 are associated with cardiac dysrhythmias, usually
atrial fibrillation. Embolic strokes can also be associated with valvular heart
disease and thrombi in the left ventricle. Emboli originate from the heart circulate
to the cerebral vasculature, most commonly the left middle cerebral Artery,
resulting in a stroke. Embolic strokes may be prevented by the use of
anticoagulation therapy in patients with atrial fibrillation.
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no known cause.
<Y  


such as illicit drug use, coagulopathies, migraine and
spontaneous dissection of the carotid or vertebral arteries.

<Y 
 
 is primarily caused by intracranial or subarachnoid hemorrhage.
 Hemorrhagic strokes are caused by bleeding into the brain tissue, the
ventricles, or the subarachnoid space.
 Primary intracerebral hemorrhage from a spontaneous rupture of small
vessels accounts for approximately 80% of hemorrhagic strokes and is
caused chiefly by uncontrolled hypertension.
 Subarachnoid hemorrhage results from a ruptured intracranial aneurysm
(weakening in the arterial wall) in about half the causes.

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<Y •umbness or weakness of the face, arm, or leg, especially on one side of the body.
<Y Confusion or change in mental status
<Y Trouble speaking or understanding speech
<Y Visual disturbances
<Y ¬ifficulty walking, dizziness, or loss of balance or coordination
<Y Sudden severe headache
<Y # 
<Y Homonymous hemianopsia
<Y Ýoss of peripheral vision
<Y ¬iplopia
<Y &

# 
<Y Hemiparesis
<Y Hemiplegia
<Y Ataxia
<Y ¬ysarthria
<Y ¬ysphagia
<Y 
# 
<Y Paresthesia
<Y # 
<Y Expressive aphasia
<Y Êeceptive aphasia
<Y ~lobal aphasia
<Y V
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<Y Short and long term memory loss
<Y ¬ecreased attention span
<Y mpaired ability to concentrate
<Y Poor abstract reasoning
<Y altered judgment
<Y


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<Y loss self control
<Y Emotional liability
<Y ¬ecreased tolerance to stressful situations
<Y ¬epression
<Y |ithdrawal
 <Y ear, hostility and anger
<Y eeling of isolation


 

<Y Severe headache (exploding headache)
<Y Vomiting
<Y Early sudden change in level of consciousness
<Y Possible focal seizures due to frequent brain stem involvement
<Y Pain and rigidity of the back of the neck (nuchal rigidity)
<Y Visual disturbances (loss, ¬iplopia, ptosis) occur if the aneurysm is adjacent to the
oculomotor nerve.
<Y Tinnitus
<Y ¬izziness
<Y Hemiparesis

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˜Y Aphasia
˜Y Êight hemiparesis
˜Y Êightsided sensory loss
˜Y Êight visual field defect
˜Y Poor right conjugate gaze
˜Y ¬ysarthria
˜Y ¬ifficulty reading, writing, or calculating

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˜Y •eglect of left visual field

˜Y Extinction of leftsided stimuli
˜Y Ýeft hemiparesis
˜Y Ýeftsided sensory loss
˜Y Ýeft visual field defect
˜Y Poor left conjugate gaze
˜Y ¬ysarthria
˜Y Spatial disorientation


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The cerebellum is involved in the coordination of voluntary motor movement, balance
and equilibrium and muscle tone. t is located just above the brain stem and toward the back of
the brain. t is relatively well protected from trauma compared to the frontal and temporal lobes
and brain stem.
Cerebellar injury results in movements that are slow and uncoordinated. ndividuals with
Cerebellar lesions tend to sway and stagger when walking.
¬amage to the cerebellum can lead to: 1) loss of coordination of motor movement
(asynergia), 2) the inability to judge distance and when to stop (dysmetria), 3) the inability to
perform rapid alternating movements (adiadochokinesia), 4) movement tremors (intention
tremor), 5) staggering, wide based walking (ataxic gait), 6) tendency toward falling, 7) weak
muscles (hypotonia), 8) slurred speech (ataxic dysarthria), and 9) abnormal eye movements
(nystagmus).
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The cerebrum is the part of the brain that occupies the top and front portions of the skull.
t is responsible for control of such abilities as movement and sensation, speech, thinking,
reasoning, memory, sexual function, and regulation of emotions. The cerebrum is divided into
the right and left sides, or hemispheres.
¬epending on the area and side of the cerebrum affected by the stroke, any, or all, of the
following body functions may be impaired:
˜Y movement and sensation
˜Y speech and language
 ˜Y eating and swallowing
˜Y vision
˜Y cognitive (thinking, reasoning, judgment and memory) ability
˜Y perception and orientation to surroundings
˜Y selfcare ability
˜Y bowel and bladder control
˜Y emotional control
˜Y sexual ability
Ý 


The limbic system is a set of evolutionarily primitive brain structures located on top of
the brainstem and buried under the cortex. Ýimbic system structures are involved in many of our
emotions and motivations, particularly those that are related to survival. Such emotions include
fear, anger, and emotions related to sexual behavior. The limbic system is also involved in
feelings of pleasure that are related to our survival, such as those experienced from eating and
sex.


 

An area located in the frontal lobe usually of the left cerebral hemisphere and associated
with the motor control of speech. Also called 
  .
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Ý 
The temporal lobes are involved in the primary organization of sensory input (Êead,
1981). ndividuals with temporal lobes lesions have difficulty placing words or pictures into
categories.
Ýanguage can be effected by temporal lobe damage. Ýeft temporal lesions disturb
recognition of words. Êight temporal damage can cause a loss of inhibition of talking.
The temporal lobes are highly associated with memory skills. Ýeft temporal lesions result
in impaired memory for verbal material. Êight side lesions result in recall of nonverbal material,
such as music and drawings.


Ý 
¬amage to the left parietal lobe can result in what is called "~erstmann's Syndrome." t
includes rightleft confusion, difficulty with writing (agraphia) and difficulty with mathematics
(acalculia). t can also produce disorders of language (aphasia) and the inability to perceive
objects normally (agnosia).
¬amage to the right parietal lobe can result in neglecting part of the body or space
(contralateral neglect), which can impair many selfcare skills such as dressing and washing.
Êight side damage can also cause difficulty in making things (constructional apraxia), denial of
deficits (anosagnosia) and drawing ability.



Ý 
The occipital lobes are the center of our visual perception system. They are not
particularly vulnerable to injury because of their location at the back of the brain, although any
significant trauma to the brain could produce subtle changes to our visualperceptual system,
such as visual field defects and scotomas. The Peristriate region of the occipital lobe is involved
in visuospatial processing, discrimination of movement and color discrimination (|estmoreland
et al., 1994). ¬amage to one side of the occipital lobe causes homonomous loss of vision with
exactly the same "field cut" in both eyes.


Ý 
The frontal lobes are considered our emotional control center and home to our
personality. There is no other part of the brain where lesions can cause such a wide variety of
symptoms. The frontal lobes are involved in motor function, problem solving, spontaneity,
memory, language, initiation, judgement, impulse control, and social and sexual behavior. The
frontal lobes are extremely vulnerable to injury due to their location at the front of the cranium,
proximity to the sphenoid wing and their large size.






















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(V
 or V is a neurological scale that aims to give a reliable,
objective way of recording the conscious state of a person for initial as well as subsequent
assessment.

~lasgow Coma Scale

+  , - . /

 ¬oes not Opens eyes in Opens eyes Opens eyes •A •A
open eyes response to in response spontaneously
painful stimuli to voice
 Makes no ncomprehensible Utters Confused, Oriented, •A
sounds sounds inappropriate disoriented converses
words normally

&

 Makes no Extension to Abnormal lexion Ýocalizes Obeys
movements painful stimuli flexion to |ithdrawal painful commands
(decerebrate painful to painful stimuli
response) stimuli stimuli
(decorticate
response)

The scale comprises three tests: eye, verbal and motor responses. The three values
separately as well as their sum are considered. The lowest possible ~CS (the sum) is 3 (deep
coma or death), while the highest is 15 (fully awake person).

   


ndividual elements as well as the sum of the score are important. Hence, the score is expressed
in the form "~CS 9 = E2 V4 M3 at 07:35".

~enerally, brain injury is classified as:

˜Y Severe, with ~CS ” 8
˜Y Moderate, ~CS 9  12
˜Y Minor, ~CS • 13

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 elevate head of bed 20 degrees unless
 shock is present.
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1. •eurological
a. nclude assessment of recurrent CVA, increased intracranial
pressure, hyperthermia.
b. Continued coma negative prognostic¶ sign
2. Cardiovascular shock and arrhythmias, hypertension.
3. Ýungs Pulmonary emboli.
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1
1. ¬uring acute stages, quiet environment and minimal handling to prevent
further bleeding.
2. Upper motor lesion spastic paralysis, flexion deformities, external rotation
of hip.
3. Position schedule 2hours on unaffected side, 20minutes on affected side.
4. Complications common with hemiplegia frozen shoulder, footdrop.

1&   turn and provide skin care1
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encourage selfhelp.
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1. Encourage selffeeding.
2. ood should be placed in unparalyzed side of mouth.
3. Tube feedings or gastrostomy feeding may be necessary.
1"  .
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1. Bladder control may be regained within three to five days.
2. Êetention catheter may not be part of treatment regimen.
3. Offer urinal or bedpan every two hours day and night.
61%



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1. Behavior changes as consciousness is regained loss of memory, emotional
liability, confusion, language disorders.
2. Êeorient, reassure, and establish means of communication.
71%

  

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1
1. Comprehensive program begins during acute phase and follows through
convalescence.
2. ~uidelines to assist client with lesion left hemisphere.
a. ¬o not underestimate ability to learn.
b. Assess ability to understand speech.
c. Act out, pantomime communication; use client¶s term to
communicate; speak in normal tone of voice.
d. ¬ivide tasks into simple terms; give frequent feedback.
 3. ~uidelines to assist client with lesion right hemisphere.
a. ¬o not overestimate abilities.
b. Use verbal cues as demonstrations; pantomimes may confuse.
c. Use slow, minimal movements and avoid clutter around client.
d. ¬ivide tasks into simple steps; elicit return demonstration of skills.
e. Promote awareness of body and environment on affected side.

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·
 
± purpose is to remove the atherosclerotic plaque from the inner
lining of the carotid artery.
·
8  2± bypasses the blocked artery by making a
graft or a bypass from the first artery to the second artery.
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less invasive procedure in removing blood clot