Coping with CVA

Hi all and thank you for stopping by for another “Coping with..” blog.

This time we are going to give you a little insight on how to cope with Cerebro Vascular Accident (CVA) after you or a loved one has been diagnosed. There are allot of factors (that you may not be aware of) that can trigger a CVA. The effects and prognoses of CVA can be different per person. You can experience different kinds of complications and emotional changes after a CVA. In this blog we will give you more insight on this. But first let me start by giving you a short description on what CVA is. Once you understand it, the easier it becomes to deal with it.

Cerebro Vascular Accident is caused by the interruption of the blood supply to the brain, usually because a blood vessel bursts or is blocked by a cloth. 

Symptoms of a CVA depends on the area of the brain that is affected. The most common symptom is weakness or paralysis of one side of the body with partial or complete loss of movement or sensation in a leg or arm. There can be speech problems and weak face muscles, causing drooling. 

There are two different types of CVA: ischemic and hemorrhagic

Ischemic CVA: An artery to the brain may be blocked by a clot (thrombosis) which typically occurs in a blood vessel that has previously been narrowed due to atherosclerosis ("hardening of the artery"). When a blood clot breaks loose, it can travel through the circulation and lodge in an artery of the brain, plugging it up and stopping the flow of blood; this is referred to as an embolic stroke.

Hemorrhagic CVA :is either a brain aneurysm burst or a weakened blood vessel leak. Blood spills into or around the brain and creates swelling and pressure, damaging cells and tissue in the brain. 

The diagnosis of a CVA involves a medical history and a physical examination. Tests are done to search for treatable causes of a stroke and help prevent further brain damage. 

Test that are done are:

  • A CT scan of the brain to show bleeding into the brain

  • A soundwave 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 soundwave 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. 

The National Stroke Association has created an easy method to help you remember, and act on, the signs of a stroke: “FAST” method.

Face: Does one side of your face droop when you smile? Arms:When you lift both arms, does one arm drift back down?

Speech: Does your speech sound odd?

Time:If you see these signs in yourself or some-one else call your emergency line immediately.

TIME IS BRAIN…… (Article publisbed April, 2018)

In 1993, neurologist Camilo R. Gomez, MD, coined a phrase that for a quarter century has been a fundamental rule of stroke care: "Time is brain!".

"Unquestionably the longer therapy is delayed, the lesser the chance that it will be successful," Dr. Gomez wrote in an editorial 25 years ago. "Simply stated: time is brain!"

But the "time is brain" rule is not as simple as it once seemed, Dr. Gomez now argues in his most recent paper, published in the August, 2018 Journal of Stroke & Cerebrovascular Diseases (published online April 25). Dr. Gomez is a Loyola Medicine stroke specialist and nationally known expert in minimally invasive neuro-endovascular surgery.

It is still true that stroke outcomes generally are worse the longer treatment is delayed so it remains critically important to call 911 immediately after the first signs of stroke. But, Dr. Gomez reports, the effect of time can vary greatly among patients. Depending on the blood circulation pattern in the brain, emergency treatment could greatly help one patient, but be too late for another patient treated at the same time.

"It's clearly evident that the effect of time on the ischemic process is relative," Dr. Gomez wrote. About 85 percent of strokes are ischemic, meaning the stroke is caused by a blood clot that blocks blood flow to an area of the brain. Starved of blood and oxygen, brain cells begin dying.

Traditionally, there was little physicians could do to halt this ischemic process, so there was no rush to treat stroke patients. But in his groundbreaking editorial, Dr. Gomez wrote that rapid improvements in imaging technologies and treatments might enable physicians to minimize stroke damage during the critical first hours.

"It is imperative that clinicians begin to look upon stroke as a medical emergency of a magnitude similar to that of myocardial infarction (heart attack) or head trauma," he wrote.

As new treatments such as the clot-busting drug tPA became available, doctors did indeed begin treating strokes as emergencies. In select patients, intravenous tPA was shown to stop strokes in their tracks by dissolving clots and restoring blood flow. Initially, tPA was recommended in select patients within three hours of the onset of symptoms. This therapeutic window later was lengthened to 4.5 hours.

But Dr. Gomez said there should be no hard-and-fast rule governing when therapy can be given because strokes progress differently in different patients. Time is not the only important factor. Also critical is the blood circulation pattern in the brain.

After an ischemic stroke strikes, a core of brain tissue begins to die. Around this core is a penumbra of cells that continue to receive blood from surrounding arteries in a process called collateral circulation. Collateral circulation can keep cells in the penumbra alive for a time before they too begin to die. Good circulation slows down the rate at which the cells die.

In his latest project, Dr. Gomez used computational modeling to identify four distinct types of ischemic stroke based on the collateral circulation. "It is no longer reasonable to believe that the effect of time on the ischemic process represents an absolute paradigm," Dr. Gomez wrote. "It is increasingly evident that the volume of injured tissue within a given interval after the time of onset shows considerable variability, in large part due to the beneficial effect of a robust collateral circulation."

Dr. Gomez added that this computational modeling "represents a first step in our journey to enhance clinical decisions and predictions under conditions of considerable uncertainty."

Story Source: Materials provided by Loyola University Health System

Most common risk factors for a CVA

Age: CVA can occur in all age groups.  Studies show the risk of stroke doubles for each decade between the ages of 55 and 85.  

Gender:  Men have a higher risk for CVA in young and middle age, but rates even out at older ages and it is known that more women die from CVA.  

Family history of stroke:  Stroke seems to run in some families.  Several factors may contribute to familial stroke.  Members of a family might have a genetic tendency for stroke risk factors, such as an inherited high blood pressure (hypertension) or diabetes.  

Some of the most important treatable risk factors are:

High blood pressure, or hypertension.  Hypertension is by far the most potent risk factor for stroke. If your blood pressure is high, you and your doctor need to work out an individual strategy to bring it down to the normal range. Controlling blood pressure will also help you avoid heart disease, diabetes, and kidney failure.

Cigarette smoking.  Cigarette smoking causes about a two-fold increase in the risk of ischemic stroke and up to a four-fold increase in the risk of hemorrhagic stroke.  It has been linked to the buildup of fatty substances (atherosclerosis) in the carotid artery, the main neck artery supplying blood to the brain. Cigarette smoke makes your blood thicker and more likely to clot. Smoking also promotes aneurysm formation. Heart disease.  Common heart disorders such as coronary artery disease, valve defects, irregular heart beat (atrial fibrillation), and enlargement of one of the heart's chambers can result in blood clots that may break loose and block vessels in or leading to the brain. Warning signs or history of TIA or stroke.  If you experience a TIA or If you have had a stroke in the past, it's important to reduce your risk of a second stroke. Your brain helps you recover from a stroke by asking the unaffected brain regions to do double duty. That means a second stroke can be twice as bad. Diabetes.  Having diabetes is the equivalent of aging 15 years. This causes destructive changes in the blood vessels throughout the body, including the brain. Also, if blood glucose levels are high at the time of a CVA, then brain damage is usually more severe and extensive than when blood glucose is well-controlled. Cholesterol imbalance. A high cholesterol level can lead to atherosclerosis, which is the major cause of blood vessel narrowing, leading to both cardiovascular and cerebral stroke.  Physical inactivity and obesity. Obesity and inactivity are associated with hypertension, diabetes, and heart disease, which are risk factors for CVA

After having CVA the highest priority is to prevent any complications from happening so that you can resume to some self-care activities.

The most common complications after having a CVA are:

Brain edema: swelling of the brain after a stroke. Pneumonia:causes breathing problems, a complication of many major illnesses. Pneumonia occurs as a result of not being able to move as a result of the stroke. Swallowing problems after stroke can sometimes result in things ‘going down the wrong pipe’, leading to aspiration pneumonia. 

Seizures:abnormal electrical activity in the brain causing convulsions. These are common in larger cases of CVA. 

Clinical depression:a treatable illness that often occurs with stroke and causes unwanted emotional and physical reactions to changes and losses. This is very common after a CVA or may be worsened in someone who had depression before the stroke. Bedsores:pressure ulcers that result from decreased ability to move and pressure on areas of the body because of immobility. Limb contractures:shortened muscles in an arm or leg from reduced ability to move the affected limb or lack of exercise.

Deep venous thrombosis (DVT) — blood clots form in veins of the legs because of immobility from stroke. 

Right after a CVA, a survivor may respond one way, yet weeks later respond differently. Some survivors may react with sadness; others may be cheerful. These emotional reactions may occur because of biological or psychological causes due to CVA. 

These changes may vary with time and can interfere with rehabilitation, this varies per person. 

Most of the time survivors react to challenges, different kinds of fears, frustrations while dealing with the effects after CVA, all this is normal. It’s a process that one must go through, and it’s tough. Talking about the effects of the CVA and acknowledging these feelings helps survivors deal with their emotions.

Most common emotional changes are:

  • Rapid mood changes

  • Crying or laughing that doesn’t match a person’s mood

  • Crying or laughing at unusual times or that lasts longer than seems appropriate

After you or a loved have gone through this, the most important thing to remember is to have allot of patience. Your life is forever changed and it takes time to process everything that has happened. Do not forget that in a split of a second some-one’s life or your life has changed forever. But this does not mean that this is the end life or that there is no hope in getting better. Trust in your process of rehabilitation and never ever give up on your journey of getting better and making the best out of each situation. 

So take a deep breath, take everything one day at a time, never lose hope and have faith!

Hope this was helpful. Thank you for stopping by.

Nurse Kim

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