Saturday, January 14, 2006

cerebral vascular accident (CVA, stroke)

A stroke is a sudden onset of neurologic deficit due to disruption of vascular function. This may be caused by partial or total blockage of blood vessels to the brain by a hemorrhage, or blood clot, of the brain.
In the United States 50 percent of the people suffering their first stroke are 70 or older. Stroke is more prominent in males than females.
There are three groups who are at a high risk for stroke. People with transient or mild neurologic events, those with a cardiac disease that predisposes to embolism, and asymptomatic people with a carotid bruit (indicating a blockage) comprise this group. Those who have experienced TIAs (transient ischemic attacks) also have a high risk for stroke. TIAs are indications of cerebrovascular disease and are a warning that a CVA could occur at any time.
Stroke caused by an embolism occurs suddenly. When a stroke is caused by a cerebral embolism, there is usually not a loss in consciousness although there is an alteration in the state of consciousness. Some neurologic symptoms such as hemiplegia (paralysis of one side of body), aphasia (inability to speak), or hemianopia (loss of side vision of both eyes) may also be noted. Stroke caused by hemorrhage may occur suddenly or may be slowly progressive. It is generally caused by an aneurysm that bursts or a congenital malformation of the vessel. Nausea, vomiting, headaches, and stiff neck are symptoms of this type of hemorrhagic stroke.
Symptoms of a stroke depend upon the cause of the stroke as well as the part of brain affected. Generally the symptoms include a decrease in the level of consciousness, sensory loss on one side, paralysis, visual field loss, speech defects, mental confusion, hypertension, headache, nausea, vomiting, and difficulty breathing. Hypertension is the single most important risk factor for stroke. Other factors include heart disease, diabetes, smoking, and hyperlipemia (elevated blood cholesterol).
Once a stroke has occurred, there is nothing that can be done to restore the dead brain tissue. Treatment includes preventing the recurrence of stroke with anticoagulation medication and medical control of the hypertension. Agents are available to control cerebral edema. Some forms of aneurysms and hemorrhages can be treated surgically. Rehabilitation is important to maximize the degree of functional adaptation and self-care. Physiotherapists and speech therapists may also help with the person's rehabilitation. CVAs can cause permanent damage to the brain. Because of the seriousness of strokes, high-risk patients should be well informed about the possible warning signals and symptoms of a cerebral vascular accident.
Scherer, J. C. Introductory Medical-Surgical Nursing, 3rd ed. Philadelphia: J. B. Lippincott Co., 1982.
Steinberg, F. U. Care of the Geriatric Patient, 6th ed. St. Louis: C. V. Mosby Co., 1983.


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