Perfusion Exemplar CVA

Cerebrovascular Accident/Stroke/CVA

Neurologic deficits result from a sudden decrease in blood flow or insufficient perfusion, to a localized area of the brain, more common in women or older than 65. Can be ischemic or hemorrhagic

CVA Pathophysiology

Impaired perfusion to specific areas of the brain leads to neuronal dysfunction and brain cell death

Cerebral hypoperfusion

Brain experienced a decrease in blood supply

Schemic stroke

Blood clot plugs a cerebral artery or narrowing of the vessel going to the brainHe

Hemorrhagic stroke

Blood vessel breaks and bleeds into the brain

Transient Ischemic Attack (TIA)

Mini stroke, damage is usually not permanent and resolves in 24 hours

Ischemic Stroke

Blockage or stenosis(narrowing) of cerebral artery due to clot, plaque, infarcts, thrombi, artery disease, emobolic

Thrombotic Ischemic Stroke

Occlusion of large vessel by thrombus, most common in resting or sleeping older adults. Lowers BP in sleep and leads to less pressure to push blood through narrowed artery, occurs rapidly but progresses slowly over 1-3 days

Embolic Stroke

Blood clot or clump of matter travels through the cerebral vessels becomes lodged in a vessel too narrow for further movement and area of brain becomes ischemic. Seen in younger patients and occurs when a patient awake and active.

Due to Afib, bacterial endocarditis, recent MI, rhematic heart disease. Sudden onset, immediate deficits, and can last for hours or days

Pathophysiology of Embolic Stroke

Blood flow to cerebral neurons decrease and cells and blood swells. Dead or dying cells surrounded by penumbra. Changes to cells happen over 4-5 minutes, can be gradual or rapid onset of neurologic deficits

Hemorrhagic Strokes Intracranial Hemorrhage

Ruptured cerebral blood vessel, occurs suddenly and often when the person is active. Hypertension is the biggest cause of this, poor outcome and rapid onset. Can lead to coma or death

Can also be caused by rupture of plaque or erosion of blood vessels

Risk Factors: Hypertension, smoking, dyslipidemia, diabetes, weight, drugs, alcohol, diet, exercise or Afib, Carotid artery disease(CAD), sleep apnea

CVA Treatment

CATT scan, Stroke Code, Alteplase (clot buster), mechanical thrombectomy

Brainstem CVA

Deficits in breathing, body temp, digestion, alertness/sleep, swallowing, locked in state

Frontal Lobe CVA

Deficits in Reasoning, judgment, speaking, voluntary motor activity

Cerebellum CVA

Deficits in balance, coordination, control of voluntary movement, fine muscle control

Cognitive and Behavioral Changes with CVA

LOC, Emotions, loss of self control, decreased stress tolerance, intellectual changes

CVA Communication

Deficits with speech and language, aphasia, Expressive (broca) unable to form words that are understandable, Receptive (Wernicke) unable to comprehend the spoken word, Dysarthria loss of muscular control of speech

CVA Motor Symptoms

Deficits with mild weakness to severe limitations, paralysis, inability to move independently

CVA Sensory Symptoms

Parasthesias (pins and needles), Pronator drift, Facial sensory loss

CVA Visual Field Deficits

Loss of half of a visual field (Homonymous hemianopsia), Loss of peripheral vision, Diplopia (double vision)

CVA Management

Warfarin (prevents blood clots), Apixaban (anticoag), Aspirin and clopidogrel (antiplatelets), Antihypertensives, Statins (cholesterol lowering drugs), Heparin (blood thinner)

PT/INR

Measures the time required for fibrin clot to form in a plasma sample

PTT

Evaluates clotting factors, monitors response to heparin therapy