Cerebrovascular Accidents (CVAs) (Essay Sample)

Student’s Name Professor’s Name Course Date Week 3 Discussion Cerebrovascular Accidents (CVAs) Cerebrovascular Accident (CVA), commonly referred to as a stroke, is the interruption of the cerebral arterial blood supply, which can result from either total vessel occlusion or cerebral vessel rapture. Since CVAs causes infarction of the brain, they are commonly referred to as brain attack. CVAs can be categorized as either ischemic or hemorrhagic stroke, depending on the pathophysiology. According to the Centers for Disease Control and Prevention (CDC), CVAs incidences and mortality rates are high in the south-eastern United States; in every 40 seconds, someone experiences CVA, and in every 40 minutes, someone succumbs to it (Story 465). CVAs' risk factors include smoking, dyslipidemia, oral contraceptive usage, hypertension, obesity, and physical inactivity. The pathophysiology, incidence and prevalence, clinical manifestations, evaluation, and treatment vary based on the type of stroke – ischaemic and hemorrhagic stroke. Ischaemic Strokes. Ischaemic strokes are the most prevalent among the different types of strokes. According to Global Burden of Disease (GBD), 87% of stroke cases are usually ischemic (thrombotic, embolic, and lacunar), and 13% are hemorrhagic (Mahdi et al. 7). The clinical manifestation of ischaemic strokes – thrombotic, embolic, and lacunar- varies based on the blocked artery. However, if the part that is damaged is unilateral, the symptoms will be exhibited on the contralateral side. First, if the left frontal lobe (Broca’s area) is affected, the patient is likely to have trouble speaking. Secondly, if the left temporal lobe (Wernicke’s area), which contains motor neurons involved in speech compression, is affected, the patient might use words and sentences that do not make sense. Other clinical manifestations of ischaemic stroke include weakness, ataxia, and vision loss.  Thrombotic Stroke (Cerebral Thrombosis) Thrombotic stroke falls under the ischemic category and results from blockage of a blood vessel that supplies brain tissue with nutrient and oxygen-rich blood. In most cases, the blockages happen in the arteries entering the brain or smaller vessels, intracranial vessels. Embolic Stroke An embolic stroke is a type of ischaemic stroke resulting from fragments that break from a thrombus formed outside the brain. Commonly, an embolic stroke occurs when the embolic portion in the heart breaks and the fragments travel to the brain. Embolic stroke differs from thrombotic stroke based on the origin of the clot. In a thrombotic stroke, the clot originates in the brain vessels, whereas in an embolic stroke, the clot originates from outside the brain vessel. Lacunar Stroke (lacunar Infarcts) Lacunar strokes are ischaemic strokes caused by thrombus, which are less than 15mm in diameter. In most cases, lacunar strokes affect small cerebral arteries, such as arteries supplying deep brain regions. In terms of clinical manifestations, lacunar strokes result in reduced motor and sensory deficits compared to other types of strokes (Craft et al. 197). The mortality and morbidity of lacunar strokes are lower than that of other types of strokes.  Hemorrhagic Stroke. A hemorrhagic stroke happens when there is bleeding in the brain, not neuronal damage, which occurs in ischaemic stroke. It results in the formation of hematoma by a localized collection of blood outside a vessel. According to GBD, hemorrhagic stroke accounts for 13% of stroke cases (Mahdi 8). Hemorrhagic stroke can either be intracerebral, which accounts for about 15% of all strokes, or subarachnoid, which accounts for about 5% (Craft et al. 197). Intracerebral hemorrhagic stroke is associated with hypertension, whereas subarachnoid hemorrhagic stroke causes a large hematoma. Clinical manifestation of hemorrhagic stroke includes numbness, paralysis of arm or leg, difficulty in speaking or understanding, loss of vision, headache, and difficulty swallowing.  Evaluation and Treatment of CVAs The evaluation of hemorrhagic and ischaemic strokes requires knowledge of a patient’s medical history, especially information relating to common risk factors, such as hypertension. In addition, information regarding the time that the symptoms started is necessary for establishing the type of stroke and suitable treatment option. Diagnosis of CVAs involves a physical examination, head CT scan, cerebral arteriogram, serum clotting studies, and head MRI (Story 465). A brain scan is usually carried out to ascertain stroke diagnosis and eliminate the possibility of other health conditions, such as tumors. An MRI scan is carried out to establish whether it is an ischaemic or hemorrhagic stroke. Medical practitioners rely on cerebral angiography and CT scan to identify the blocked areas, aneurysm, and abnormal vessel anatomy.  The most common treatment option for ischaemic stroke (thrombotic, lacunar, and embolic) is thrombolytic therapy, which involves using thrombolytic agents to dissolve blood clots and aspirin to limit platelet activity (Story 466). In addition, treatment procedures, such as angioplasty and carotid endarterectomy, can be used to treat ischemic stroke. However, in the case of hemorrhagic stroke, thrombolytic therapy cannot be used since it will worsen the condition. Instead, hemorrhagic stroke treatment should be focused on controlling intracranial pressure, preventing rebleeding, and preventing ischemia and hypoxia of the neural tissues. After recovery, a patient may need assessment by Aged Care Assessment Teams (ACATs) to establish assistance programs eligibility.  Dementia of Alzheimer Type (DAT) Dementia is a clinical syndrome caused by different forms of brain pathology, and the most common type is the dementia of Alzheimer type (DAT). DAT is a progressive and fatal neurodegenerative condition that reduces cortical aspects of cognition, such as memory, language, and praxis (Prigatano 72). In addition, DAT is associated with gradual impairment in carrying out normal living activities, behavioral symptoms, and neuropsychiatric symptoms. Studies show that DAT is prevalent among the elderly an...