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ALTERATIONS IN THE CENTRAL NERVOUS SYSTEM

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ALTERATIONS IN THE CENTRAL NERVOUS SYSTEM

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    1. ALTERATIONS IN THE CENTRAL NERVOUS SYSTEM Exemplar Cerebrovascular Accident(CVA) Introduction to CVA / Stroke Prevention

    2. Stroke (Brain Attack) Definition -Blood flow interrupted to an area of the brain -Ischemia to the part of the brain -Bleeding into brain tissue -The brain doesn’t store oxygen/ glucose and needs a constant flow of blood

    3. Cerebrovascular Accident Approximately 800,000 in USA annually (425,000=F; 370,000=M) * Third most common cause of death #1 leading cause of disability Physical, cognitive, emotional, & financial impact *http://www.stroke.org/site/News2?page=NewsArticle&id=9015&news_iv_ctrl=1222

    4. Transient Ischemic Attack (TIA) Temporary focal loss of neurologic function Caused by ischemia of one of the vascular areas of the brain Most resolve within 3 hours Difference of TIA vs. CVA is infarction* *Easton,JD, Saver,JL, Albers, GW, et al. Definition and evaluation of transient ischemic attack.Stroke. 2009; 40(6)2276-2293.

    5. Faculty animations from chtr 47 TIA

    6. Types of Strokes Ischemic stroke (87%) -Thrombotic stroke: atherosclerosis of blood vessel wall -Embolic stroke: dislodged clot from other area of body Hemorrhagic stroke (13%) Bleeding into brain tissue r/t ruptured aneurysm, arteriovenous malformation

    7. Faculty animation a fib cht 47

    8. Cerebrovascular Accident: Ischemic Thrombotic Lumen of the blood vessels narrows (atherosclerosis) - becomes occluded -infarction occurs Associated with HTN and Diabetes Mellitus

    11. Cerebrovascular Accident: Ischemic Embolic Stroke Embolus lodges in/ occludes a cerebral artery Infarction & cerebral edema develop Emboli R/T : atrial fibrillation -MI -valvular prostheses Severe symptoms occur rapidly– no collateral circulation Any age group Recurrence common if underlying cause not treated

    12. Cerebrovascular Accident Embolic Stroke

    13. Cerebrovascular Accident Hemorrhagic Subarachnoid Hemorrhage -Intracranial bleeding -Increases with age and more common in women Intracerebral Hemorrhage - rupture within the brain tissue Aneurysm -abnormal blood vessel wall which ruptures

    14. Cerebrovascular Accident Hemorrhage Stroke Intracerebral Hemorrhage

    15. Cerebrovascular Accident Populations at Risk Age – Occurrence doubles each decade >55 years Gender – Almost equal for men & women Race – African Americans, Hispanics, Native Americans, Asian Americans -- higher incidence Heredity – family history, prior transient ischemic attack, or prior stroke increases risk http://www.stroke.org/site/PageServer?pagename=RISK

    16. Pediatric Strokes Populations at Risk M>F; African American>White, Asian Medical Hx -sickle cell disease -heart disease (congenital or acquired) Signs & Symptoms -infant may have one sided seizure -older child has weakness/numbness

    17. Video on Pediatric Stroke http://abcnews.go.com/Health/video/year-stroke-survivor-10139867

    18. Cerebrovascular Accident Risk Factors Controllable Risks with Medical Treatment & Lifestyle Changes: High blood pressure Diabetes Cigarette smoking TIA (Aspirin) High blood cholesterol Obesity Heart Disease Atrial fibrillation Oral contraceptive use Physical inactivity Sickle cell disease Asymptomatic carotid Hypercoagulability stenosis

    19. Prevention Maintain healthy lifestyle -exercise -don’t smoke/alcohol in moderation Diet -low sodium, low cholesterol Control underlying medical problems -hypertension -diabetes mellitus -atrial fibrillation

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