Understanding Cerebrovascular Accident: Causes, Symptoms, and Interventions

This document provides an in-depth analysis of a case study on a patient with a cerebrovascular accident. It discusses the causes, symptoms, and interventions for a stroke, with a focus on the role of hypertension and diabetes mellitus. The document also explores surgical and medical management options for stroke patients.

Running head: NURSING
NURSING
Name of Student
Name of University
Author note

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Response to question 1:
Referring to the history of Mr. Known - hypertension and hyperglycemia has led to
the development of cerebrovascular accident in the patient.
The subject has been smoking about a pack of cigarettes, on a daily basis, for the last
40 years of his life and high levels of chain smoking has led to causation of hypertension that
in turn has resulted in cerebrovascular accident (CVA) in the patient (Haris, Hari & Faseel,
2018). Moreover, other than this risk behavior of chain smoking, hyperglycemia (that is high
blood glucose level) due to a long standing type 2 diabetes mellitus – has been another risk
factor to his development of cerebrovascular accident. The case is a clear presentation of
hemorrhagic stroke of the left and middle cerebral artery. As for etiology, increased blood
sugar levels due to diabetes mellitus ( in this case, type 2 diabetes mellitus) has a correlation
with the development of hypertension as increased levels of uncontrolled and free glucose in
blood, also leads to increased blood pressure and resultant hypertension (Wu et al., 2017).
Hence, combined etiologies of hypertension and diabetes mellitus, has led to rapture of the
blood vessels in the left cerebrovascular region.
Response to Question 2
The patient has presented with signs of hemorrhagic stroke as the onset of the
symptoms has been rapid and not very gradual. Moreover, the symptoms were very severe
and the patient had a history of hypertension (resulting from diabetes mellitus type 2 and
chain smoking on a daily basis over a period of 40 years). Hypertension generally lead to
hemorrhagic stroke and the report did not mention a gradual onset that is characteristic of the
ischemic stroke. The patient has signs of hemianopia, aphasia (Goldenberg & Randerath,
2015). facial drooping (Bennett et al., 2019). and the overall signs and symptoms presented in
association with the patient history, indicates to a hemorrhagic stroke rather than an ischemic

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stroke. The following table tallies the symptoms of ischemic and hemorrhagic stroke and
justifies the case study, in accordance with one.
Hemorrhagic stroke Ischemic stroke
Mr Known’s signs and
symptoms
In the patient,
There was right sided hemi-
paralysis or hemiplegia,
hemianopia and loss of
speech
 Hemianopia
(Ghannam, &
Subramanian, (2017).
 Facial drooping
 Aphasia (Kanade,
2018).
The onset was sudden
and severe
 In the Magnetic
Resonance
Imaging scan,
increased density
of middle and left
cerebral artery
was found.
 There was signs
In the patient,
There was right sided
hemiparalysis or hemiplegia,
hemi-anopsia and loss of
speech
• Hemianopia
• Facial drooping
• aphasia

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of edema.
Other signs and symptoms confusion or loss of alertness
nausea and vomiting
loss of consciousness
numbness in an arm or leg
seizures
loss of speech ability or
difficulty in understanding
the speech
sudden onset of severe
headache
changes or loss of vision
loss of balance in the affected
subject
or incoordination
presentation
suddenly becoming very
much unable to move
 Sudden and severe
onset
Stepwise deterioration and
progressive worsening
Waxing and waning
Loss of vision
(One or both eyes involved)
Trouble in walking,
dizziness,
loss of balance,
incoordination
Sudden confusion,
Sudden weakness or
numbness in either side of
the face, in either side of the
arm or either side of the legs
or both legs but usually
involving one side of the
body
 Gradual onset
Diagnosis – hemorrhagic stroke

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Response to question 3:
The medical, surgical and the pharmacological interventions are required :-
Hemorrhagic stroke Ischemic stroke
Mr Known’s signs and
symptoms
In the patient,
There was right sided hemi-
paralysis or hemiplegia,
hemianopia and loss of
speech
 Hemianopia
 Facial drooping
 Aphasia
The onset was sudden and
severe
 In the Magnetic
Resonance
Imaging scan,
increased density
of middle and left
cerebral artery
was found.
 There was signs
of edema.
In the patient,
There was right sided
hemiparalysis or hemiplegia,
hemi-anopsia and loss of
speech
• Hemianopia
• Facial drooping
• aphasia

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Other signs and symptoms confusion or loss of alertness
nausea and vomiting
loss of consciousness
numbness in an arm or leg
seizures
loss of speech ability or
difficulty in understanding
the speech
sudden onset of severe
headache
changes or loss of vision
loss of balance in the affected
subject
or incoordination
presentation
suddenly becoming very
much unable to move
 Sudden and severe
onset
Stepwise deterioration and
progressive worsening
Waxing and waning
Loss of vision
(One or both eyes involved)
Trouble in walking,
dizziness,
loss of balance,
incoordination
Sudden confusion,
Sudden weakness or
numbness in either side of
the face, in either side of the
arm or either side of the legs
or both legs but usually
involving one side of the
body
 Gradual onset

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Hemorrhagic stroke Ischemic stroke
Surgical management * Decompression surgery is
used to relieve pressure from
the brain that allows a
neurosurgeon to do away
with accumulated blood and
damaged blood containing
vessels (Rangel-Castilla et
al., 2015). Update on
transient cardiac The
procedures evacuate the
hematoma actually and
immediately, decreasing the
pressure and further
complications. This is a very
important procedure used to
treat the very root cause of
hemorrhagic stroke.
*Craniotomy with open
surgery – in this surgery, a
portion of skull is removed
and an open surgery is
performed to treat the actual
hematoma that was formed
*Mechanical embolectomy
– is an very advanced, and
minimally invasive
procedure in surgery that is
used to treat a certain
blockage within blood vessel.
The mechanical
embolectomy uses certain
devices for upto eight to
twelve hours at a stretch.
This surgical procedure is
very commonly used in
management of ischemic
stroke.
*Cerebral revascularization –
is known as bypass surgery,
is done in ischemic type
stroke caused by rather a
“cerebrovascular
insufficiency’. There is a
reduction in supply of
oxygen due to narrowed or
blocked carotid artery, in the

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and the ruptured blood vessel
is then repaired (Lam et al.,
2017).
*Simple aspiration: in this
procedure, a small hole is
drilled into the skull and the
presenting hematoma is
drained using the needle
(Watanabe et al., 2019).
Compared to previous
procedures, this surgery is
less invasive in nature but
with a slight disadvantage. It
does not allow full and
complete drainage of the
pooled blood.
* Endoscopic evacuation
(Reyna et al., 2019).
*Stereotactic aspiration uses
a form of computed
tomography (CT) (Wu et al.,
2017).
The last two procedures are
extremely common in
Hemorrhagic type CVAs
brain. Cerebral
revascularization surgery
allows fresh blood supply to
parts of the brain while
eliminates or decreases the
chances of further of further
strokes and transient
ischemic attacks.

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nowadays.
Medical or pharmacological
Management ●Controlling blood
pressure with
antihypertensives
●Stopping the medication
which lead to further
bleeding (eg, warfarin or
another blood thinner,
aspirin
 Risk and fall
management is
necessary,
 Checking any seizure
if there and applying
the right
anticonvulsant.
 Bed positioning and
patient positioning so
as to keep the blood
pressure in check.
 Dissolving any blood
clot.
 Dysphagia – Ryle’s
 Anti-hypertensives
 Thrombolytic agents
 Oxygenation
 Insulin
 Antipyretics
 Anticoagulants
 Low Molecular
Weight Heparin
 Danaparoid
 Warfarin
 Warfarin as vitamin
K antagonist

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or Nasogastric tube
can be used.
Response to Question 4:
From the hematological and biochemical report of Mr. Known, only the
biochemical change has been observed. The BGL levels are quite higher than the
normal value. While all the other parameters are quite normal and stable, the blood
glucose levels was still not under control and this poses a great threat to the further
degradation of patient’s health.
Response to Question 5:
In the case study, due to a left cerebrovascular accident, the patient has presented with
a lot of concerning signs and symptoms which are very relevant to the diagnosis of a stroke.
Predominantly in the right side of the body, the signs and symptoms were hemiplegia, facial
paralysis and the other symptoms included aphasia (complete loss of speech function). While
the history of the patient highlights cigarette smoking on a regular basis that too, as a chain
smoker for a period of 40 years – has led to hypertension that has again presented with
rapturing of middle and left cerebral vessels, resulting in a hemorrhagic stroke. The patient’s
blood glucose is still high due to type two diabetes mellitus. The patient also has congestive
heart failure and reduced circulation. Given the range of cardiovascular and neurological
complications presented by the patient, a number of intervention would be required. Firstly,
Mr Known require a proper stroke management that is monitoring of the vital signs,

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reducing the increased blood pressure with antihypertensive. A surgical procedure would be
necessary as the team is unable to dissolve the clot with medication. Neurological and
cardiovascular rehabilitation, in addition to the medical, surgical and nursing assessment
would be crucial to restore the depressed neurological functions such as motor loss (in
hemiplegia) and assisted movements to improve blood circulation in the whole body. Patient
mobility has to be maintained so as to prevent bed sores and ulcers, skin integrity has to be
maintained and the movement has to be reeducated (Manners, Steinberg & Shutter, 2017).
Sleep and relaxation has to be promoted to reduce the blood pressure. Mr. Known requires
intervention such as speech therapy for communication problems, physical therapy for facial
drooping and a proper cardiovascular management for congestive heart failure. Activities of
daily living have to be re-educated, the speech problems are to be managed and functional
independence has to be developed. Visual tracking exercises and balance training can be
given once the muscles and movements are re-educated.
Response to question 5
Hemianopia is state where there is blindness over the half of eye’s field or rather a
half functional of each eyes. Hemianopia is a common symptoms of cerebrovascular accident
associated with left and middle cerebral arteries that the subject in the case syudy, is
diagnosed with.

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References:-
Bennett, R. J., Wooten, A., Babbel, L., & Reel, B. A. (2019). Horner’s Syndrome with
Unilateral Brachial Plexus Blockade Mimicking Cerebrovascular Accident Following
Lumbar Combined Spinal Epidural Analgesia for Labor. Military Medicine.
Ghannam, A. S. B., & Subramanian, P. S. (2017). Neuro-ophthalmic manifestations of
cerebrovascular accidents. Current opinion in ophthalmology, 28(6), 564-572.
Goldenberg, G., & Randerath, J. (2015). Shared neural substrates of apraxia and
aphasia. Neuropsychologia, 75, 40-49.
Haris, F. B., Hari, P., & Faseel, P. (2018). CEREBROVASCULAR ACCIDENT AND ITS
ASSOCIATION WITH DURATION OF HYPERTENSION AND DIABETES
MELLITUS. Journal of Evolution of Medical and Dental Sciences, 7(2), 199-203.
Kanade, A. (2018). The importance of aphasia therapy: a retrospective study.
Lam, S., Hadley, C., Curry, D. J., & Pan, I. W. (2017). Perioperative Costs between
Stereotactic Laser Ablation and Craniotomy for Hypothalamic Hamartoma. Journal of
Pediatric Epilepsy, 6(04), 191-191.
Manners, J., Steinberg, A., & Shutter, L. (2017). Early management of acute cerebrovascular
accident. Current opinion in critical care, 23(6), 556-560.
Rangel-Castilla, L., Russin, J. J., Britz, G. W., & Spetzler, R. F. (2015). Update on transient
cardiac standstill in cerebrovascular surgery. Neurosurgical review, 38(4), 595-602.
Reyna, J. L., Song, R., Nistal, D. A., Dangayach, N. S., Mocco, J. D., & Kellner, C. P.
(2019). Endoscopic Evacuation of Intraventricular Hemorrhage During Minimally
Invasive Endoscopic Intracerebral Hemorrhage
Evacuation. Neurosurgery, 66(Supplement_1), nyz310_805.

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Watanabe, S., Oh-Shige, H., Oh-Iwa, I., Miyachi, H., Shimozato, K., & Nagao, T. (2019).
Reconsideration of three screening tests for dysphagia in patients with
cerebrovascular disease performed by non-expert examiners. Odontology, 1-7.
Wu, L., Yang, S., He, Y., Liu, M., Wang, Y., Wang, J., & Jiang, B. (2017). Association
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Wu, X., Durand, D., Kalra, V. B., Liu, R., & Malhotra, A. (2017). Letter to the Editor:
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