SCHEMATIC PATHOPHYSIOLOGY of CVA

Predisposing Factors: Contributing Factors:

 Age (commonly 65 years old  Hypertension
and above)  Heart Disease
 Heredity  Diabetes Mellitus
 Race (more common in  High cholesterol level
African-Americans)  Obesity
 Gender (more common in  Heavy alcohol
Males) consumption
 Cigarette smoking
 Sedentary lifestyle
 Aneurysm
 Head Injury
Precipitating Factor
ATHEROSCLEROSIS
Cerebral artery Cardiovascular artery atherosclerosis
atherosclerosis
Formation of plaque deposits
Formation of
plaque deposits Formation of thrombus

Detachment of the thrombus;

Thrombosis becomes an embolus

Travels and lodges in the cerebral arteries

Lysed or moved thrombus from vascular wall

Occlusion of
Leaking of blood from the fragile vascular wall /
cerebral blood
Rupture of the blood vessel
vessels

Cerebral hemorrhage

Hematoma that gradually enlarges

Compression on the nearby blood vessels

Sx: dizziness,
confusion,
Cerebral Hypoperfusion headache

Blood seeps into Impaired distribution of Oxygen and Glucose

the ventricles
Tissue hypoxia and cellular starvation

Cerebral ischemia
Obstruction of the
CSF passageway Initiation of the Ischemic Cascade

Failure in the production of ATP for energy

Failure of energy processes dependent

(ion pumping)
 Depolarization of neurons Anaerobic metabolism
by the mitochondria
Intracellular calcium levels get too high

Release of excitatory amino acid Generates large

neurotransmitter glutamate amounts of lactic
Accumulation of acid
CSF in the ventricles Calcium influx
Metabolic
Generation of harmful chemicals like acidosis
free radicals, reactive oxygen species and
calcium-dependent enzymes

Ventricles dilate behind Breakdown of cell membrane

the point of obstruction
Breakdown of mitochondria

Apoptosis

Infarction with necrosis

Transient Ischemic Attack

If managed: If not managed:

Treatment Brain sustains an irreversible cerebral damage

Structural integrity loss of brain tissue and blood vessels

Recovery Breakdown of the protective blood-brain barrier

Cerebral edema

Compression of tissue

Sx: Headache, decreased LOC,

vomiting, impaired sensory and Increased ICP
motor function, changes in vital
signs
Impaired perfusion and function

Middle Anterior Posterior Internal Vertebro- Antero- Postero-

Cerebral cerebral Cerebral Carotid basilar inferior inferior
Artery Artery Artery Artery System Cerebellar Cerebellar

Lateral Frontal Occipital Branches Cerebellum Cerebellum

hemisphere Lobe lobe; into and brain
, frontal, anterior ophthalmic, stem
parietal and PCA,
and medial
anterior
temporal portion of choroidal,
lobes, basal temporal ACA, MCA
ganglia lobe
 Sx: Sx: Sx: Sx: Sx:
Sx:
foot and leg Mild contralateral Alternating Ataxia, paralysis
hemiparesis deficits contralateral hemiparesis motor of the larynx and
or hemiplegia, greater than hemiparesis, with facial
the arm, foot
weaknesses, soft palate, loss
altered sensory loss, asymmetry,
drop, gait ataxic gait, of sensation in
consciousness, pupillary homonymous
disturbances, contralateral face, sensation
homonymous dysfunction, hemianopsia,
deviation of hemisensory changes on
hemianopsia, loss of ipsilateral
eyes toward impairments, trunk and limbs,
inability to turn conjugate periods of
affected side, double vision, nystagmus,
gaze, blindness,
eyes toward expressive homonymous dysarthria,
aphasia, nystagmus, aphasia if
affected side, loss of depth dominant hemianopsia, Horner’s
confusion,
vision changes, perception, hemisphere nystagmus, syndrome,
amnesia, flat
dyslexia, affect, cortical is involved, paralysis, hiccups and
dysgraphia, apathy, blindness, Mild dysarthria, coughing,
aphasia, shortened homonymous Horner’s memory loss, vertigo, tinnitus,
agnosia, attention hemianopsia, syndrome disorientation, nausea and
span, loss of dyslexia, tinnitus, vomiting
memory mental memory hearing loss,
deficits, acuity, deficits, visual vertigo,
vomiting apraxia, hallucinations dysphagia,
incontinence
coma, altered
swallowing,
taste and smell

If managed: If not managed:

Poor cerebral perfusion Continued insufficiency of blood flow

Poor improvement Further compression of tissues

Cerebral death
Poor prognosis (coma)

Loss of neural feedback mechanisms

Supportive
care Cessation of physiologic functions

Cardiovascular Pulmonary GIT GUT Endocrin

System System e
System

Loss of Relaxatio Failure of Relaxation of Neurogenic Abnormal

cardiac n of the intestines and bladder thermoregulation,
muscle venous diaphragm sphincters Increased
function valves and secretions,
accessory Impaired ability to
muscles for Loss of synthesize WBC
Loss of sphincte
Sx: breathing for fighting
bowel r control
Bradycardia infection, Inability
control
Sx: Sx: of the pancreas to
Hypotensio Apnea produce digestive
n enzymes,
Impaired
Decreased regulation of
cardiac output blood calcium
levels

Systemic Failure

DEATH