Cerebral Vascular Accident (CVA)

1. DIAGNOSTICS - Angiography / Arteriography - Blood and Urine Tests - Carotid Doppler - CT Scan - Echocardiogram - Electrocardiogram (ECG/EKG) - Magnetic Resonance Imaging (MRI) - Neurological Exam - Physical Exam

2. MANAGEMENT - Secondary prevention - Neurological assessment - Preventing complications - Pain assessment - Assess for dysphagia - Nutrition and hydration - Assess Cognition - Assess ability to perform ADLs - Monitor bowel and bladder function - Assess risk for depression - Assess readiness to learn

3. EFFECTS OF STROKE: - Recovery depends upon area of the brain that was affected and size of the damaged area

3.1. LEFT HEMISPHERE - weakness or paralysis on right side of body - difficulty reading, talking, thinking, doing math - difficulty learning or remembering new information

3.2. RIGHT HEMISPHERE - weakness or paralysis on left side of body - vision problems; difficulty distinguishing distance, depth, up and down, front and back - problems with short-term memory - forgetting/ignoring objects or people on left side - issues with judgement, impulsive acts

3.3. ADDITIONAL EFFECTS: - Depression - Lack of control over emotions - Issues with bladder control - Pain - Tiredness

4. RISK FACTORS

4.1. MODIFIABLE » HTN » Atrial Fibrilation » Physical Inactivity » Hyperlipidemia » Diabetes » Being Overweight » Stress » Excessive Alcool Consumption

4.1.1. PREVENTION - up to 80% of strokes can be prevented - manage modifiable risk factors: » treat hypertension » identify atrial fibrilation » quit smoking » limit alcohol consumption » lower cholesterol levels » control diabetes » Exercise » Weight loss » Minimize sodium and fat intake » Treat problems of circulation » Recognize and treat TIAs » Consider use of ASA or Clopidogrel

4.2. UNMODIFIABLE » Age (>65 years) » Family History » Prior Stroke, TIA, MI » Ethnicity (African American) » Sex (female)

5. COLLABORATIVE CARE: - Rehabilitation - Rehab Team - Discharge Planning - Medications - Lifestyle Modifications

6. PSYCHOSOCIAL IMPACT - Caregiver strain - Establishing new role within the family - Sexual concerns - Decrease in confidence - Change in self-perception and identity

7. TYPES

7.1. Ischemic Stroke

7.1.1. CAUSES - Thrombosis - Embolism

7.1.2. TREATMENT -Tissue Plasminogen Activator (tPA): thrombolytic - Plaque removal, vessel repair

7.2. Hemorrhagic Stroke

7.2.1. CAUSES - Ruptured Anneurysm - Arteriovenous Malformation

7.2.2. TREATMENT - Removal of pooled blood, vessel repair, clip to secure ruptured vessel

7.3. Transient Ischemic Attack (TIA)

7.3.1. Temporary Ischemia

7.3.2. Treatment - Antiplatelets - Anticoagulants

8. CLINICAL MANIFESTATIONS - numbness or weakness - hemiparesis, monoparesis - hemisensory deficits - facial droop - ataxia - aphasia - monocular or binocular vision loss - diplopia - vertigo - severe headache - decrease in LOC

8.1. Transient Ischemic Attack: - Signs and symptoms disappear after a few minutes - Requires intervention; do not ignore brief signs and symptoms

9. PREVALENCE IN CANADA - 3rd leading cause of death - 14,000 deaths annually - 315,000 living with the effects of stroke