Patient name: ABC
Age: 32 yrs. Old
Date of Admission: February 07, 2013
Admitting diagnosis: CVA prob. Thromboembolic Infarct
GCS: 11 (Lethargic)
V/S taken as follows:
BP= 110/80 mmHg
RR= 24 CPM
PR= 82 BPM
Temperature= 38.0 ͦC
* Past medical history of Bell’s Palsy
* Mild Stoke
Cerebrovascular accident (CVA) or Stroke, is the rapid loss of brain function due to disturbance in the blood supply to the brain. This can be due to ischemia (lack of blood flow) caused by blockage (thrombosis, arterial embolism), or a hemorrhage. As a result, the affected area of the brain cannot function, which might result in an inability to move one or more limbs on one side of the body, inability to understand or formulate speech, or an inability to see one side of the visual field. A stroke is a medical emergency and can cause permanent neurological damage and death. It is the third leading cause of death behind heart disease and cancer. Stokes can be divided into two major categories: Ischemic (85%) in which vascular occlusion and significant hypoperfusion occur and hemorrhage (15%), in which there is extravasation of blood into the brain or subarachnoid space. THROMBOSIS
Types of CVA
Strokes can be classified into two major categories: Ischemic and Hemorrhagic. Ischemic strokes are those that are caused by interruption of the blood supply, while Hemorrhagic strokes are the ones which result from rupture of a blood vessel or an abnormal vascular structure. * Ischemic Stroke
In an ischemic stroke, blood supply to part of the brain is decreased, leading to dysfunction of the brain tissue in that area results from a blockage. The blockage may result from atherosclerosis or blood clot formation. Signs appear on opposite side of the body from where stroke occurred. Affects structures on same side of the body if cranial nerves are damaged.
There are four reasons why this might happen:
1. Thrombosis (obstruction of a blood vessel by a blood clot forming locally) 2. Embolism (obstruction due to an embolus from elsewhere in the body) 3. Systemic hypoperfusion (general decrease in blood supply, e.g., in shock) 4. Venous thrombosis.
Stroke without an obvious explanation is termed "cryptogenic" (of unknown origin); this constitutes 30-40% of all ischemic strokes. Risk factors
* Advance age
* Hypertension (most important modifiable)
* Cardiac disease including Atrial fibrillation and Valvular disease * Hypercholesterolemia*
* Alcohol or cocaine*
* Cigarette smoking*
* Familial Hyperlipidemia
* Family History of stroke
* History of transient ischemic attacks*
* Increased alcohol intake*
* Obesity, sedentary lifestyle
* Sickle cell disease
* Use of hormonal contraceptives
In thrombotic stroke a thrombus, (blood clot) usually forms around atherosclerotic plaques. Since blockage of the artery is gradual, onset of symptomatic thrombotic strokes is slower. A thrombus itself (even if non-occluding) can lead to an embolic stroke if the thrombus breaks off, at which point it is called an "embolus." Two types of thrombosis can cause stroke: * Large vessel disease (Ex. internal carotids, vertebral) * Small vessel disease involves the smaller arteries inside the brain: branches of the circle of Willis, middle cerebral artery, stem, and arteries arising from the distal vertebral and basilar artery. * Sickle-cell anemia, which can cause blood cells to clump up and block blood vessels, can also lead to stroke. A stroke is the second leading killer of people under 20 who suffer from sickle-cell anemia.
An embolic stroke refers to the blockage of an artery by an arterial embolus, a travelling particle or debris in the arterial bloodstream originating from elsewhere. An embolus is most frequently a...