cerebrovascular disease (emphasis on cva)

8/10/2019 Cerebrovascular Disease (Emphasis on CVA)

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Cerebrovascular Disease

(emphasis on CVA)

By: Olynsie Morris

10/0537/1686

BMR 3106



What is CVD and CVA?

CVD is a group of diseases that affect blood

vessels, especially those that supply the brain.

Just remember, the word ‘cerebrovascular ’

refers to blood flow in or to your brain.

A cerebrovascular accident (CVA) or stroke isthe result of an impeded blood supply to some

part of the brain.

The lack of oxygen causes damage to the brain.

The long-term effects of a stroke depend on

what part of the brain is involved and on how

much tissue is affected.



Types of strokeA stroke can happen in

two main ways.Either:

there is a blood clot or

plaque that blocks ablood vessel in the

brain (ischemic)

OR

a blood vessel in the

brain ruptures

(hemorrhagic).



Blocked Artery: Ischemic Stroke

Strokes caused by a blood clot is called an ischemic stroke.

In everyday life, blood clotting is beneficial. When you are

bleeding from a wound, blood clots work to slow and

eventually stop the bleeding.

In the case of stroke, however, blood clots are dangerous

because they can block arteries and cut off blood flow.

About 4 out of every 5 strokes are ischemic (i.e. 80%).



Bleeding in the brain (hemorrhagic stroke)

Strokes caused by a break in the wall of a blood vessel in the

brain are called hemorrhagic strokes. This causes blood to leakinto the brain, again preventing the delivery of oxygen and

nutrients.

Hemorrhagic stroke can be caused by a number of disorderswhich affect the blood vessels, including long-standing

hypertension and cerebral aneurysms.

An aneurysm is a weak or thin spot on a blood vessel wall. The

weak spots that cause aneurysms are usually present at birth.

Aneurysms develop over a number of years and usually don’t

cause detectable problems until they break.

About 1 in every 5 strokes is hemorrhagic.



Mini Stroke (TIA)

A transient ischemic attack (TIA) is sometimes termed a minor

stroke or “mini stroke”.

When the signs of stroke are present but go away within 24 hours,

the term TIA is used.

The causes and symptoms of a transient ischemic attack (TIA) are

similar to those of a stroke. TIA episodes usually last only a few

minutes but may last for several hours. They generally disappear

quickly and unfortunately, are often ignored. Just like a stroke, a TIA

will require emergency treatment.

About 1 in 5 people who have a TIA will have a major stroke within

the next three months and a large part of the risk occurs in the first

few days. TIA should never be ignored.



Aetiology (ischemic)

The most common causes of ischemic strokes include:

Thrombotic stroke – this occurs when a blood clot

(thrombus) forms in one of the arteries that supply blood to

your brain. A clot may be caused by fatty deposits (plaque)

that build up in arteries and cause reduced blood flow(atherosclerosis) or other artery conditions.

Embolic stroke – this occurs when a blood clot or other

debris forms away from your brain (commonly in your heart) and is swept through your bloodstream to lodge in narrower

brain arteries. This type of blood clot is called an embolus.



Aetiology (hemorrhagic)

Brain hemorrhages can result from many conditions thataffect your blood vessels, including uncontrolled high blood

pressure (hypertension) and weak spots in your blood

vessel walls – which can lead to aneurysms.

A less common cause of hemorrhage is the rupture of an

abnormal tangle of thin-walled blood vessels

(arteriovenous malformation) present at birth.



Table of

causes



Pathophysiology

The two major mechanisms causing brain damage instroke are ischemia and hemorrhage.

The commonality between them is the fact that they

both are caused by blockage or occlusion of bloodvessels.

The main cause of this is ATHEROSCLEROSIS.



ATHEROSCLEROSIS

Firstly, atherosclerosis is a type ofarter iosclerosis

.

Atherosclerosis is the building up of fatty plaques in

the arteries which reduces blood flow hence

reducing oxygen and nutrient delivery to vital organs.

It shouldn’t be confused with the general term

arter iosclerosis which is the thickening, hardening

and loss of elasticity of the walls of arteries.



Before Atherosclerosis



Beginning of Atherosclerosis



Blocked Artery



Diagnosis

To recognise if someone has suffered a stroke, perform

the FAST (Face, Arms, Speech, Time) test:

Look at their face:

Ask them to smile.

If they have had a stroke, they may only be able to

smile on one side; the other side of the mouth may

droop.

Ask them to raise both arms:

If they have had a stroke, they may only be able to lift

one arm.



Find out whether they can speak:

Ask them to speak.

If they have had a stroke, they may struggle to respond

appropriately.

Time to call 911/912:

Call 911 for emergency help.

Tell the operator you have used the FAST test andsuspect a stroke.

Keep them comfortable and supported.



Treatment (Surgery)

Carotid endarterectomy, also called carotid artery surgery, is

a procedure in which blood vessel blockage (fatty plaque) is

surgically removed from the carotid artery.



Management

The good news is that 80 % of all strokes are preventable.

It starts with managing key risk factors, including high

blood pressure, cigarette smoking, atrial fibrillation and

physical inactivity.

More than half of all strokes are caused by uncontrolled

hypertension, making it the most important risk factor to

control.

Exercise and eating healthy foods play significant roles in

preventing and recovering from stroke and other heart

disorders.



Medical Management

Medical treatments may be used to control high blood pressure

and/or manage atrial fibrillation among high-risk patients. Those

medicines include:

Anticoagulants/Antiplatelets

Antiplatelet agents such as aspirin and anticoagulants, such as

warfarin, interfere with the blood's ability to clot and can play animportant role in preventing stroke.

Antihypertensives

Antihypertensives are medications that treat high blood pressure.

Depending on the type of medication, they can lower blood

pressure by opening the blood vessels, decreasing blood volume

or decreasing the rate and/or force of heart contraction. (e.g.

Captopril)



Medical Management (Prevention)

Exercise and You

Exercise has been repeatedly proven to benefit your

whole body, including the cardiovascular system.

Lack of physical activity increases the risk of prematuremortality in general, and of coronary heart disease,

hypertension, some cancer, and diabetes.

Regular aerobic repeated rhythmic movements, suchas walking, cycling, swimming and other exercise

strengthens the heart and lungs. It also tends to raise the

level of HDL - good cholesterol and promotes general

wellbeing and relaxation.



Management (Recovery)

Physiotherapy

Physical therapy has proven to be extremely useful in

the recovery of stroke patients.

Additionally, it is quite imperative that a stroke patientbegin therapy as soon as it is medically safe for the

patient as this will increase the likelihood of a full or

close to full recovery.

Across the globe, and increasingly popular here in

Guyana, doctors and physical therapists (& RA’s) are

working hand in hand so that the patient can regain

optimum function.



ReferencesClinical Methods: The History, Physical, and Laboratory

Examinations; 3rd edition; Walker HK, Hall WD, Hurst JW,

editors; Boston: Butterworths; 1990.

http://strokefoundation.com.au/what-is-a-stroke/types-

of-stroke/

http://www.ncbi.nlm.nih.gov/books/NBK378/

http://www.world-heart-federation.org/cardiovascular-health/heart-disease/different-heart-diseases/

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