CVA Lecture Notes

Cerebrovascular Accident (CVA)

• Definition: occurs when blood flow is interrupted

• Causes lack of oxygen to brain tissues, resulting in cell death.

Transient Ischemic Attack (TIA)

• Commonly referred to as a "mini-stroke".
    - TIA characteristics:
      - Typically resolves within 24 hours, but symptoms may not last that long.
      - Indicates a brief interruption of blood flow to the brain.
      - Patients with a TIA are at an increased risk for more severe strokes, as well as recurrent TIAs.

Types of Strokes (Cerebrovascular Accident - CVA)

• Two main types of strokes:
      1. Ischemic Stroke
          - Caused by blood clots blocking blood flow.
          - Commonly associated with cardiac issues.
          - Subtypes:
              - Embolic Stroke: A clot that breaks free and travels until it causes a blockage.
                - Important definitions:
                  - Embolus: A floating clot.
                  - Embolism: A clot that has lodged and is stuck.
      2. Hemorrhagic Stroke
          - Caused by a rupture of a blood vessel or leakage of blood into the brain tissue.
          - Most commonly caused by hypertension and can result from:
              - Aneurysm (weak blood vessel bursts).
              - Arteriovenous malformation (AVM).
          - Consequences: Excess blood contacts brain tissue, leading to complications due to increased intracranial pressure (ICP).
          - Surgical treatments include:
              - Endovascular procedures via an artery from the groin to the brain.
              - Open cranial surgery to place clips on an aneurysm to control bleeding.

Risk Factors for Strokes

• Modifiable Risk Factors:
      - High blood pressure (hypertension): Primary risk factor for strokes, can be controlled with medication.
      - Diet and exercise: Both are vital in managing blood pressure and overall cardiovascular health.
      - High cholesterol: Linked to increased stroke incidence.
      - Diabetes: Individuals with poorly controlled levels are at increased risk.

• Non-modifiable Risk Factors:
      - Gender: Younger women have a higher risk of strokes than men due to various life stages and risk factors associated with pregnancy and contraceptive use.
      - Age: As age increases, so does the risk of stroke for both genders, although men tend to experience strokes at younger ages.

Recognizing a Stroke

• Signs and Symptoms can typically be remembered using the acronym FAST:
      - F: Face drooping
      - A: Arm weakness (ask them to raise their arms; one arm may drop).
      - S: Speech difficulties (slurred or confused speech).
      - T: Time to call emergency services (time is critical).

Treatments

• tPA (Tissue Plasminogen Activator)
      - Administered within three hours of stroke onset for ischemic strokes to dissolve clots and restore blood flow.
      - Patients at risk for DVT (Deep Vein Thrombosis) may require blood thinners to manage risks associated with immobility.

Epidemiology of Strokes

• Strokes are the fourth leading cause of death in the United States with one occurring approximately every 40 seconds.
      - Heart disease is a primary contributor to stroke risk.

• Recent statistics indicate that stroke survivors may experience long-term complications like DVT, leading to increased mortality.

Physical Deficits from Strokes

• Common deficits include:
      - Hemiplegia: Full paralysis on one side of the body.
      - Hemiparesis: Weakness on one side of the body.
      - Hypertonicity: Abnormally strong muscle tone or resistance to stretch.
      - Spasticity: Resistance to movement that is velocity-dependent, often triggered by rapid stretches.
      - Flaccidity: Lack of tone in muscles leading to weakness.

Cognitive and Sensory Impact from Strokes

• Wernicke's Aphasia: Difficulty understanding language but can speak fluently.

• Broca's Aphasia: Difficulty producing speech but understand what is being said.

• Dysarthria: Weakness in the muscles used for speech resulting in slurred or slow speech.

• Ataxia: Lack of coordination affecting voluntary movements across various body areas.

Managing Shoulder Subluxation

• Occurs in approximately 73% of stroke survivors, particularly in the acute phase after a stroke.

• Management techniques include:
      - Positioning to prevent weakness and dislocations.
      - Ensuring awareness of the affected arm to prevent neglect.
      - Use of braces or sling to stabilize during transfers only, not as long-term solutions.
      - Provide education to both patients and caregivers about managing their affected limb to prevent further complications.

Rehabilitation Techniques

• Passive Range of Motion (PROM): Important for maintaining muscle flexibility and preventing contractures.

• Weight Bearing Activities: Critical for enhancing muscle engagement and promoting functional use of the affected side.

• Kinesio Tape: Can be used for stabilization and support but understand it's not a cure-all and might not suit every patient.

Emotional and Behavioral Changes

• Emotional regulation can be severely impacted following a stroke.
      - Individuals may experience inappropriate emotional responses, such as laughing when they should be serious or becoming easily agitated.

• Caregiver education is crucial to support emotional adjustment for patients and their families.

Conclusion and Study Preparation

• Reinforce key terms regarding types of strokes, associated risk factors, recognition, and effective management strategies.

• Prepare for a CVA test covering all major concepts discussed, including definitions, risk factors, signs and symptoms, and rehabilitation strategies.

• Stay updated with new research and best practices in stroke care and management as part of continuous learning for health professionals.