I. Textbook Discussion & Schematic Diagram of The Diagnosis A.Definition Cerebrovascular Disease (CVA), An Ischemic

I.
Textbook Discussion & Schematic Diagram of the Diagnosis
A.Definition
Cerebrovascular Disease
A cerebrovascular accident (CVA), an ischemic stroke or brain attack, is a sudden loss

of brain function resulting from a disruption of the blood supply to a part of the brain.
Cerebrovascular accident or stroke is the primary cerebrovascular disorder in the

United States.
A cerebrovascular accident is a sudden loss of brain functioning resulting from a
disruption of the blood supply to a part of the brain.
It is a functional abnormality of the central nervous system.
Cryptogenic strokes have no known cause, and other strokes result from causes
such as illicit drug use, coagulopathies, migraine, and spontaneous dissection of the
carotid or vertebral arteries.
The result is an interruption in the blood supply to the brain, causing temporary or
permanent loss of movement, thought, memory, speech, or sensation.
Classification
Strokes can be divided into two classifications.
Ischemic stroke. This is the loss of function in the brain as a result of a disrupted
blood supply.
Hemorrhagic stroke. Hemorrhagic strokes are caused by bleeding into the brain
tissue, the ventricles, or the subarachnoid space.
Prevention
Healthy lifestyle. Leading a healthy lifestyle which includes not smoking,
maintaining a healthy weight, following a healthy diet, and daily exercise can reduce
the risk of having a stroke by about one half.
DASH diet. The DASH (Dietary Approaches to Stop Hypertension) diet is high
in fruits and vegetables, moderate in low-fat dairy products, and low in animal
protein and can lower the risk of stroke.
Stroke risk screenings. Stroke risk screenings are an ideal opportunity to lower
stroke risk by identifying people or groups of people who are at high risk for stroke.
Education. Patients and the community must be educated about recognition and
prevention of stroke.
Low-dose aspirin. Research findings suggest that low-dose aspirin may lower the
risk of stroke in women who are at risk.
Complications
If cerebral oxygenation is still inadequate; complications may occur.
Tissue ischemia. If cerebral blood flow is inadequate, the amount of oxygen

supplied to the brain is decreased, and tissue ischemia will result.
Cardiac dysrhythmias. The heart compensates for the decreased cerebral blood
flow, and with too much pumping, dysrhythmias may occur.
Assessment and Diagnostic Findings
Any patient with neurologic deficits need a careful history and complete physical and neurologic
examination.
CT scan. Demonstrates structural abnormalities, edema, hematomas, ischemia, and

infarctions. Demonstrates structural abnormalities, edema, hematomas, ischemia,
and infarctions. Note: May not immediately reveal all changes, e.g., ischemic infarcts
are not evident on CT for 812 hr; however, intracerebral hemorrhage is immediately
apparent; therefore, emergency CT is always done before administering tissue
plasminogen activator (t-PA). In addition, patients with TIA commonly have a normal
CT scan
PET scan. Provides data on cerebral metabolism and blood flow changes.
MRI. Shows areas of infarction, hemorrhage, AV malformations, and areas of
ischemia.
Cerebral angiography. Helps determine specific cause of stroke, e.g., hemorrhage
or obstructed artery, pinpoints site of occlusion or rupture. Digital subtraction
angiography evaluates patency of cerebral vessels, identifies their position in head
and neck, and detects/evaluates lesions and vascular abnormalities.
Lumbar puncture. Pressure is usually normal and CSF is clear in cerebral
thrombosis, embolism, and TIA. Pressure elevation and grossly bloody fluid suggest
subarachnoid and intracerebral hemorrhage. CSF total protein level may be elevated
in cases of thrombosis because of inflammatory process. LP should be performed if
septic embolism from bacterial endocarditis is suspected.
Transcranial Doppler ultrasonography. Evaluates the velocity of blood flow
through major intracranial vessels; identifies AV disease, e.g., problems with carotid
system (blood flow/presence of atherosclerotic plaques).
EEG. Identifies problems based on reduced electrical activity in specific areas of
infarction; and can differentiate seizure activity from CVA damage.
Skull x-ray. May show a shift of pineal gland to the opposite side from an
expanding mass; calcifications of the internal carotid may be visible in cerebral
thrombosis; partial calcification of walls of an aneurysm may be noted in
subarachnoid hemorrhage.
ECG and echocardiography. To rule out cardiac origin as source of embolus (20%
of strokes are the result of blood or vegetative emboli associated with valvular
disease, dysrhythmias, or endocarditis).
Laboratory studies to rule out systemic causes: CBC, platelet and clotting
studies, VDRL/RPR, erythrocyte sedimentation rate (ESR), chemistries
(glucose, sodium).
B. Signs and symptoms
According to Textbook Manifested by the patient

Numbness or weakness of the face
Change in mental status
Trouble speaking or understanding
speech
Visual disturbances
Homonymous hemianopsia
Loss of peripheral vision
Hemiparesis
Hemiplegia
Paralysis
Ataxia
Dysarthriqa
Paresthesia
Expressive aphasia
Receptive aphasia
Global aphasia
Dysphagia

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I. Textbook Discussion & Schematic Diagram of The Diagnosis A.Definition Cerebrovascular Disease (CVA), An Ischemic

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I.

Textbook Discussion & Schematic Diagram of the Diagnosis

A cerebrovascular accident (CVA), an ischemic stroke or brain attack, is a sudden loss

Cerebrovascular accident or stroke is the primary cerebrovascular disorder in the

Strokes can be divided into two classifications.

If cerebral oxygenation is still inadequate; complications may occur.

Tissue ischemia. If cerebral blood flow is inadequate, the amount of oxygen

Assessment and Diagnostic Findings

CT scan. Demonstrates structural abnormalities, edema, hematomas, ischemia, and

According to Textbook Manifested by the patient

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