Lecture Notes: Cerebral Vascular Accident (CVA)

Introduction to CVA

• Definition: Interruption of blood flow to the brain, also known as stroke.
• Categories:
  • Hemorrhagic: Bleeding in the brain, high mortality, risk of re-bleeding.
  • Ischemic: Clot-based, can be thrombotic (stationary) or embolic (wandering clot).

Hemorrhagic CVA

• Causes:
  • Uncontrolled hypertension
  • Cerebral aneurysms
  • Use of anticoagulants
  • Bleeding disorders
• Diagnostics:
  • CT scan (shows dense white matter)
  • MRI (further assessment)
  • Coagulation labs and CBC
  • Angiogram (detects vascular abnormalities)
• Symptoms:
  • Changes in consciousness
  • Nuchal rigidity (stiff neck)
  • Photophobia, irritability, nausea
  • "Worst headache of my life"

Ischemic CVA

• Preceded by TIA (transient ischemic attack): Symptoms last <24 hours.
• Risk Factors:
  • Hypertension, MI history, coronary artery disease
  • AFib, heart disease, smoking, hyperlipidemia
  • Diabetes, obesity, sleep apnea (modifiable)
• Diagnostics:
  • CT scan, MRI, angiogram
  • Carotid Doppler (checks arterial plaque)
  • CBC

Signs and Symptoms

• Acronym: BFAST:
  • Balance: Loss of balance, dizziness
  • Eyes: Blurry/double vision
  • Face: Drooping on one side
  • Arms: Unilateral weakness
  • Speech: Difficulty
  • Time: Immediate hospital care needed

Right vs. Left-Sided CVA

• Right-Sided CVA:
  • Affects left side (left hemiparesis)
  • Spatial/perceptual deficits, impulsive behavior
  • Falls risk, memory deficits
• Left-Sided CVA:
  • Affects right side (right hemiparesis)
  • Dysphagia, speech dysfunction
  • Slow, cautious behavior, memory deficits, depression

Aphasia

• Expressive (Broca's): Difficulty expressing, aware and frustrated
• Receptive (Wernicke's): Difficulty understanding, unaware
• Global: Both expressive and receptive, worse prognosis

Visual Field Cuts

• Peripheral vision loss common
• Less common: Central vision loss, both eyes usually affected

Treatment

• Hemorrhagic Stroke:
  • Possible surgery
  • Hypertension treatment
  • Calcium channel blockers (controversial)
• Ischemic Stroke:
  • TPA (clot-buster) if within 4-6 hours of onset
  • Heparin, Coumadin, aspirin, or Plavix
  • Carotid endarterectomy

Nursing Considerations

• Safety: Support affected limbs, avoid dislocation
• Independence: Encourage self-care
• Emotional Support: Support groups
• Seizure Precautions:
  • Suction and padded rails
• Nutrition: Dysphagia diet, ensure clear mouth

Patient Education

• Risk Factor Modification
• Re-bleeding/Vasospasm Risks
• Therapy for Left-Sided Neglect

Reminder: If you have any questions, reach out to Ben and the instructor.