Cerebrovascular accident

A stroke is caused by the interruption of the blood supply to the brain, usually because a blood vessel bursts or is blocked by a clot. This cuts off the supply of oxygen and nutrients, causing damage to the brain tissue

1. CEREBROVASCULAR
ACCIDENT
Aditya Johan .R, M.Fis

2. Introduction
•Alsocalled“brainattack”,cerebralinfarction,cerebralhemorrhage,
ischemicstrokeorstroke
•Astrokeiscausedbytheinterruptionofthebloodsupplytothe
brain,usuallybecauseabloodvesselburstsorisblockedbyaclot.
Thiscutsoffthesupplyofoxygenandnutrients,causingdamageto
thebraintissue

3. •Cells with CBF <10ml/100g tissue/min will die within minutes of a stroke -
the ‘core’
•Cells with CBF <25ml/100g tissue/min can remain viable for several hours
-the ‘penumbra’

4. What happens when blood supply to brain is reduced?
•Certain functional changes occur once blood flow to the brain
decreases.
•Critical values for loss of synaptic transmission, corresponding to loss
of neuronal function, are between 15 and 18 ml/100 gram/minute
•The threshold for membrane pump failure. and thus for loss of
cellular integrity and cell death, is approximately 10 ml/100 gram/
minute
•It is generally assumed that if CBF stays above 18 ml/100 g/min but
below 20–25 ml/100 g/min neurons will survive but may not
function

6. Causes
CEREBRALTHROMBOSIS
abloodclotorplaqueblocksanarterythatsuppliesavitalbrain
center
CEREBRALHEMORRHAGE/ANEURYSM
anarteryinthebrainbursts,weakenstheaneurysmwall;severerise
inBPcausinghemorrhageandischemia
CEREBRALEMBOLISM
abloodclotbreaksofffromathrombuselsewhereinthebody,
lodgesinabloodvesselinthebrainandshutsoffbloodsupplytothat
partofthebrain

8. Types
ISCHEMIC STROKE
Occurs when a clot or a mass clogs a blood vessel, cutting off the
blood flow to brain cells.
The underlying condition for this type of obstruction is the
development of fatty deposits lining the vessel walls. This condition is
called atherosclerosis.
Almost 85% of strokes are ischemic

9. Atherosclerosis
•“hardeningofthearteries”
•“athero”–gruelorpaste
•“sclerosis”–hardness
•It’stheprocessinwhichdepositsoffattysubstances,cholesterol,
cellularwasteproducts,calciumandothersubstancesbuildupinthe
innerliningofanartery
•Thisbuildupiscalledplaque

10. Types
HEMORRHAGICSTROKE
•Resultsfromaweakenedvesselthatrupturesandbleedsintothesurrounding
brain.
•Thebloodaccumulatesandcompressesthesurroundingbraintissue.
•About15%ofallstrokesbutresponsiblefor30%ofstrokedeaths
2TYPES
SUBARACHNOIDHEMORRHAGE(SAH)
occurswhenabloodvesselonthesurfaceofthebrainrupturesandbleedsinto
thespacebetweenthebrainandtheskull
INTRACEREBRALHEMORRHAGE(ICH)Occurswhenabloodvesselbleedsintothe
tissuedeepwithinthebrain.

11. Stages of CVA
Transient Ischemic Attack
sudden and short-lived attack
Is a "mini stroke" that occurs when a blood clot blocks an artery for a short
time.
Reversible ischemic neurologic deficit (RIND)
similar to TIA, but symptoms can last up to a week
Stroke in evolution (SIE)
Gradual worsening of symptoms of brain ischemia
Completed stroke (CS)
symptoms of stroke stable over a period and rehab can begin

12. Signs & symptoms
In embolism
• Usually occurs without warning
• Client often with history of cardiovascular disease
In thrombosis
• Dizzy spells or sudden memory loss
• No pain, and client may ignore symptoms
In cerebral hemorrhage
• May have warning like dizziness and ringing in the ears (tinnitus)
• Violent headache, with nausea and vomiting
Sudden Onset CVA
• Usually most severe
• Loss of consciousness
• Face becomes red
• Breathing is noisy and strained

13. Major effect of CVA
•HEMIPLEGIA–most common result of CVA
Paralysis of one side of the body
May affect other functions, such as hearing, general sensation and
circulation
The degree of impairment depends on the part of the brain affected
• Stages:
Flaccid–numbness and weakness of affected side
Spastic–muscles contracted and tense, movement hard
Recovery–therapy and rehab methods successful

14. Brunnstrom stages of motor recovery

15. ACT FAST
F –FACE
• Ask the person to smile. Does one side of the face droop?
A –ARMS
• Ask the person to raise both arms. Does one arm drift downward?
S –SPEECH
• Ask the person to repeat a simple sentence. Does the speech sound
slurred or strange?
T –TIME
• Call 911 Immediately

17. Supranuclear lession

18. Pyramidal Tracts

19. Overactivity of reticulospinal (Extra-pyramidal)

20. Medications

21. THANK YOU