CVA

Cerebral Vascular Accident (CVA)

Introduction

  • Presenter: Amanda Couitt, PT, DPT

Objectives

  • Understand the etiology of CVA

  • Identify types of CVA

  • Recognize functional deficits and symptoms related to the location of the lesion in CVA

Arteries of the Brain

  • Major arteries involved in cerebral blood flow include:

    • Anterior Cerebral Artery

    • Middle Cerebral Artery

    • Posterior Cerebral Artery

    • Ophthalmic Artery

    • Internal Carotid Artery

    • Basilar Artery

    • Vertebral Artery

Arterial Blood Flow and Correlating Tissue

  • Understanding which arteries supply blood to specific areas of the brain is essential for evaluating CVA implications.

    • Anterior, Middle, Posterior, Basilar, Internal Carotid, Ophthalmic, and Vertebral arteries each play unique roles in cerebral perfusion.

Overview of Cerebral Vascular Accident (CVA)

  • Commonly referred to as a stroke.

  • Can be caused by two main mechanisms:

    • Ischemia (blockage): Limits or occludes blood flow to the brain leading to tissue damage.

    • Hemorrhage (bleed): Causes cell death and increases pressure within the skull.

  • Functional impairments and limitations depend on the location of the brain damage.

Ischemic Stroke

  • Defined as: Blood clot lodged in an artery supplying the brain.

  • Two types of ischemic strokes:

    • Embolic Stroke: Clot forms in the circulatory system and travels to brain.

    • Thrombotic Stroke: Clot forms directly within a brain artery.

Embolic Stroke

  • Process: A blood clot or plaque forms in the circulatory system and migrates to the brain.

  • Atherosclerosis: The buildup of fatty plaque in arteries that can lead to embolic strokes.

    • Etymology: "athero" = pasty material; "sclerosis" = abnormal hardening of tissue.

Thrombotic Stroke

  • Occurs when a blood clot forms within an artery supplying blood to the brain, disrupting blood flow and contributing to cell death.

Hemorrhagic Stroke

  • Occurs when blood vessels in the brain burst, spilling blood into the surrounding tissues.

    • Effects:

    • Increased pressure on nearby tissues leading to cell death.

  • Types of hemorrhagic strokes include:

    • Intracerebral Hemorrhage: Bleeding directly into brain tissue.

    • Subarachnoid Hemorrhage: Bleeding into the space between the brain and the skull.

    • Aneurysm: Weakened area causing arterial bulging and potential rupture.

Intracerebral Hemorrhage

  • Caused by the bursting of a blood vessel bleeding into brain tissue; often linked to hypertension.

    • Etymology: "Hyper" = high; "tension" = pressure in the vessels.

Subarachnoid Hemorrhage

  • A blood vessel bursts near the brain's surface, leading to leakage between the brain and skull.

  • Effects:

    • Causes arterial spasms that reduce blood flow, potentially leading to a stroke.

Aneurysm

  • Defined as a weak spot in an arterial wall that can swell, potentially rupturing and spilling blood into brain tissue.

  • Results in increased pressure and possible reduced perfusion, leading to cell death.

  • smokers are at a higher risk of developing aneurysms due to the damaging effects of nicotine and other harmful substances on blood vessels.

Transient Ischemic Attack (TIA)

  • Brief period during which blood flow to the brain is temporarily blocked or decreased.

  • Symptoms typically resolve within 24 hours and may include:

    • Numbness

    • Weakness

    • Loss of vision

    • Trouble speaking

    • Loss of balance or coordination.

Risk Factors for CVA

  • Common risk factors include:

    • High Blood Pressure

    • Diabetes

    • Smoking

    • Alcohol and Drug Use

    • Obesity

    • Diet

    • Coronary Artery Disease

    • Hyperlipidemia

    • Atrial Fibrillation

    • Peripheral Artery Disease

    • Age

    • Previous TIA

    • Genetics

    • Environmental factors such as air pollution.

    • Other conditions include:

    • Migraine

    • Sleep Apnea

    • Lupus

    • Sickle Cell Disease

    • Chronic Stress

Recognizing Stroke: FAST/BEFAST Acronym

  • Acronym used for quick identification and treatment of stroke:

    • Facial Drooping

    • Arm Weakness

    • Speech Difficulty

    • Time to Call for assistance.

Common Symptoms of CVA

  • Include:

    • Hemiplegia (complete paralysis on one side)

    • Hemiparesis (weakness on one side)

    • Aphasia (language impairment)

    • Ataxia (lack of coordination)

    • Dysphagia (difficulty swallowing)

    • Apraxia (difficulty with motor planning)

    • Paresthesia (burning or prickling sensation in the hands).

Aphasia and Cerebral Cortex Involvement

  • Two principal types of Aphasia:

    • Broca's Aphasia: Affects speech production.

    • Wernicke's Aphasia: Affects language comprehension.

Right Cerebral CVA

  • Effects observed include:

    • Left-sided neglect: Inattention causing the person to ignore left-sided stimuli.

    • Short-term memory challenges.

    • Decision-making difficulties and impulsive behavior.

    • Lack of insight into deficits and impaired spatial awareness.

Left Hemisphere of the Cerebral Cortex

  • Primarily affects speech and language in most individuals.

    • Symptoms may include the following:

    • Speech difficulties (aphasia).

    • Cautiousness and slowness in reactions.

    • Potential visual neglect on the right side.

    • Facial weakness and unclear speech; swallowing difficulties.

    • Impacts on logic and analytical capabilities.

Hemiplegic Gait

  • Describes the walking patterns seen in individuals with hemiplegia following a stroke.

Symptoms of a Stroke in the Brain Stem

  • Symptoms related to cranial nerve deficits may include:

    • Altered smell, taste, hearing, or vision (total or partial).

    • Eyelid drooping (ptosis).

    • Ocular muscle weakness.

    • Difficulty swallowing.

    • Altered breathing and heart rate.

Cerebellar Stroke

  • Symptoms include:

    • Altered walking (ataxic gait). Ataxic gait is defined as an unsteady, uncoordinated walk that results from damage to the cerebellum, affecting balance and posture.

    • Movement coordination issues.

    • Possible vertigo and balance difficulties.

Prognosis Following a Stroke

  • Stroke disables approximately 75% of survivors, affecting physical, mental, emotional, or a combination of these domains.

  • Prognosis varies widely based on:

    • Size and location of the lesion.

    • Type of dysfunction corresponding to areas of brain damage.

Additional Deficits/Signs/Symptoms Associated with CVA

  • Common consequences include:

    • Pressure sores

    • Pneumonia

    • Incontinence

    • Behavioral changes

  • Emotional problems may arise, either from direct damage to emotional centers or adaptation challenges, resulting in:

    • Anxiety/Panic Attacks

    • Flat Affect

    • Mania

    • Apathy

    • Psychosis

Prognosis of Post-Stroke Depression

  • Depression affects 30% to 50% of stroke survivors, potentially leading to:

    • Lethargy

    • Irritability

    • Sleep disturbances

    • Lowered self-esteem

    • Withdrawal from social interactions.

Rehabilitation Post-CVA

  • Core components of rehabilitation include:

    • Physical Therapy (PT)

    • Occupational Therapy (OT)

    • Speech-Language Pathology (SLP)

  • Assistive technologies may assist recovery (e.g., wheelchairs, walkers, canes).

  • PT focuses on improving joint range of motion, strength, and functional tasks (bed mobility, transferring, walking).

  • OT concentrates on activities of daily living (ADLs) such as bathing, dressing, eating, as well as instrumental activities (I-ADLs) like home management and community reintegration.

  • Collaboration between PT and OT aims to enhance awareness and use of the hemiplegic side.

Constraint-Induced Movement Therapy

  • A rehabilitation approach using repetitive practice to promote use and adaptation of the hemiplegic limb during functional tasks, fostering lasting changes.

Role of Speech and Language Pathology in Rehabilitation

  • SLP interventions target:

    • Speech production disorders (e.g., dysarthria, apraxia).

    • Aphasia and cognitive-communication impairments.

    • Dysphagia (swallowing difficulties) management.