Cerebral Vascular Accidents

Prepared by, Mike McMahon (03/03/06)

CVA??

StrokeCerebrovascular diseaseCerebral infarctionCerebral hemorrhageBrain attack

CERBRAL VASCULAR ATTACK or CVA

Stroke Stats(Canadian Figures from 2002)

4th leading cause of death in Canada.Strokes affect more women than men.Risk of CVA doubles for every decade after 55 years of age.

100 Strokes

• 10 % completely recover• 25% have minor

impairments• 40% have moderate

impairments• 10% severely disabled

requiring admittance to long term care facilities

• 15% die!

MinorImpairment

ModerateImpairment

SeverlyDisabled

Death

CompleteRecovery

The Brain: The Command CenterA complex organ.Made up of over 100 billion nerve cells.Functions to control everything the body does.Different areas of the brain control different functions.Right side of the brain controls the left side of the body and vice versa.

What is a CVA

An interruption of the blood flow to the brain.If blood flow stops for more than a few seconds that area of the brain is deprived of oxygen: Brain cells can die causing permanent damage.

Symptoms of a CVA

Depends upon the area of the brain affected.Usually a sudden development of one or more of the

following:Weakness/Paralysis of an arm,leg,side of face, or any part of the body.Visual changes/disturbances.Slurred speech or difficulty in understanding speech.Difficulty in reading or writing.Swallowing difficulties or drooling.

Symptoms of a CVA cont’d

Vertigo.Loss of balance or coordination.Personality Changes.Mood Changes (Depression).Drowsiness, lethargy. Loss of Consciousness.Uncontrollable eye movements or eye-drooping.Memory loss.

The Brain

Right and Left HemispheresRight Sided Brain

DamageChanges:

Left sided paralysisAttention span and focusin Memory Spatial relationshipsProblem-solving Orientation Ability to recognize faces

Left Sided Brain Damage

Changes:Right sided paralysisLoss of speechInability to understand wordsInability to understand written wordsScientific function and reasoning

Cerebral Vascular Accidents(CVAs)

CVAs

TIAs

Ischemic Hemorrhagic

ThrombosisEmbolus

Stroke

Transient Ischemic Attacks:Mini Strokes

Present with signs and Symptoms similar to stroke.May last a few minutes or several hoursSigns and symptoms completely resolve within 24 hours.Warning sign of impending stroke.Need to be assessed by a doctor.Need to reduce their risk factors.

Cerebral Vascular Accidents(CVAs)

CVAs

TIAs

Ischemic Hemorrhagic

ThrombosisEmbolus

Stroke

Ischemic Strokes

Hemorrhagic Stroke:Ruptured Aneurysm

Hemorrhagic Stroke:Aneurysms

Developing Aneurysm

Hemorrhagic Stroke

Causes of a CVA

Risk factors for CVAs

HTN (greatest risk factor)SmokingCADDietDiabetesSome Rx MedicationsCocaine Alcohol abuse

AgeSexFamily HistoryBleeding DisordersPregnancyPost PregnancyBleeding disorders

Modifiable Non-Modifiable

Aside from Supporting Vital Functions…

The Most Important element of pre-hospital care for a CVA Patient is to identify the CVA and to rapidly transport patient for definitive care.

Pre-hospital Managementof CVA Patients

Maintain a patent A/W.Support ventilatory efforts as needed.Provide supplemental high flow O2.

Provide Reassurance to Patient and family.Inform the patient.Protect any paralyzed limbs.

History GatheringIncident History

Previous Neurological symptoms (TIAs??).Previous Neurological deficits.Initial Symptoms and progression.Altered LOCs ?Precipitating Factors.Dizziness.Palpitations.

Past Medical HistoryHypertensionDiabetesCardiac DiseasePrevious StrokeOral Contraceptive UseSickle Cell Disease

Remember some findings may be subtle. Use family to confirm if necessary

The End