Cerebrovascular accident: clinical overview and management

CVA

Health - Nursing

A nursing overview of a cerebrovascular accident (CVA)

Pathophysiology: What is occurring in the body when a patient is experiencing a CVA?

A cerebrovascular accident (CVA), more commonly referred to as a stroke, is usually caused by a blockage of blood flow to the patient's brain, and the subsequent sudden death of brain cells due to lack of oxygen. The blockage can be caused by a build up of atherosclerosis plaque or a rupture of an artery running to the brain (Definition, 2009, Medicine net). Two primary kinds of stroke exist: an ischemic stroke that is "caused by a blocked brain artery and the resulting insufficient supply of blood to part of the brain" and a hemorrhagic stroke that is "caused by the rupture of a brain artery and bleeding into or around the brain" (Stroke, 2009, Mayo clinic)

What signs and symptoms would you observe from a patient having a CVA?

The fact that a patient is about to have a stroke is not always immediately obvious to casual or even medically-trained observers. The stroke may appear to occur suddenly, even though the conditions that precipitated the stroke have been building up over time. For example, an artery to the patient's brain can be blocked by a blood clot or as an indirect result of atherosclerosis or hardening of the arteries. This is called an embolic stroke: a blood clot or a piece of an atherosclerotic plaque detaches itself from the artery wall and travels through the circulatory system, plugging an artery of the brain. A blood clot can also form in a chamber of the heart when the heart beats irregularly. Bleeding in the brain from an aneurysm, a widening and weakening of a blood vessel in the brain, is another common cause of strokes (Definition, 2009, Medicine net).

The symptoms of the onset of the stroke will vary in severity and physical location in the patient's body, depending upon the cause. Some common symptoms that quickly manifest themselves to observers are weakness or paralysis of one side of the patient's body, loss of movement capabilities, and numbness or tingling in a limb or entire side of the body. There can be speech problems and signs of laxity in the facial or muscles. There may be a loss of muscular control, prompting the patient to drool. "A stroke involving the base of the brain can affect balance, vision, swallowing, breathing" and even cause unconsciousness (Definition, 2009, Medicine net).

Tests: What studies are available to confirm the diagnosis of a CVA?

The most common test of a patient suspected of having a CVA is a CT or MRI scan of the brain, particularly if ischemic stroke is suspected (Stroke: Tests and diagnosis, 2009, Mayo Clinic). Such tests can look for bleeding in the brain to determine what areas are affected and to rule out other causes of the patient's symptoms such as a brain tumor. A stroke due to bleeding in the brain is treated differently than a stroke caused by a shutting-off of the patient's blood supply in other areas of the body (Definition, 2009, Medicine net).

If a blood clot is suspected in another region of the body, "a sound wave of the heart (echocardiogram) may be done to look for a source of blood clots in the heart. Narrowing of the carotid artery (the main artery that supplies blood to each side of the brain) in the neck can be seen with a sound wave test called a carotid ultrasound. Blood tests are done to look for signs of inflammation which can suggest inflamed arteries. Certain blood proteins are tested that can increase the chance of stroke by thickening the blood" (Definition, 2009, Medicine net). With a carotid ultrasound a transducer can send high-frequency sound waves into the patient's neck to look for narrowing of the carotid arteries. In arteriography, a catheter is manipulated through the patient's major arteries to examine them after the arteries are injected with dye (Tests and diagnosis, 2009, Mayo Clinic).

What medicines, treatments, and/or surgeries are used for a patient who has had a CVA?

The cause of the stroke will determine the patient's course of treatment. For patients with strokes due to coronary factors, anticoagulants are often used to minimize blood clotting. Drugs that can dissolve blood clots may be useful in some patients, as can the administration of oxygen and medications that can help oxygen-starved brain cells survive. With ischemic strokes, blood-thinning drugs, such as aspirin, warfarin and heparin, can restore blood flow to the brain if they are given within three hours. Surgical removal of the clot or the insertion of a stent may be required to open up an artery narrowed by plaques. For a hemorrhagic stroke surgery may also be required, such as aneurysm clipping and arteriovenous malformation (AVM) removal (Treatments and drugs, 2009, Mayo Clinic).

Over the long-term, treating the cause of the stroke is essential. For example, patients with high blood pressure may be more apt to have stroke. Changes in diet, exercise, and prescriptions to treat this condition may be required, although immediately lowering elevated blood pressure into the may further reduce blood flow through narrowed arteries and make the symptoms of the stroke worse and is thus not advised. For diabetes patients, controlling blood sugar and lifestyle changes to mitigate the chance of elevated blood sugar and reoccurrence is essential.