Cerebral Vascular Disease

(CVD)

Speaker: 马圣念

What is the CVD?

Cerebrovascular disease is a group of brain

dysfunctions related to disease of the blood

vessels supplying the brain.

Hypertension is the most important cause

It damages the blood vessel lining,

endothelium, exposing the underlying

collagen.

Anatomy of Cerebral

Vascular 1

-Internal Carotid

Artery System

-Vertebral Basilar

Arterial System

-Willis Circulation

Anatomy of Cerebral

Vascular 2

Anatomy of Cerebral

Vascular 3

The weight of the brain:

2%~3%

Blood supply of the brain:

15%~20%

There is no reserve energy in brains.

Anatomy of Cerebral

Vascular 4

Etiology of CVD

• High Blood Pressure

• High Blood Cholesterol

• High Body Mass Index

(BMI)

Risk Factors of CVR

Non modifiable

• Age

• Male sex

• Race

• Heredity

Modifiable

• Hypertension

• Diabetes

• Smoking

• Hyperlipidemia

• Excess Alcohol

• Heart disease (AF)

• Hypercoagulability

Epidemiology of CVD

Classification of CVD

• Cerebral Infarction, CI (or called Cerebral Ischemic Stroke)

• Intracerebral

Hemorrhage, ICH

• Subarachnoid

Hemorrhage

• Transient Ischemic

Attack, TIA

Cerebral Infarction, CI

A Cerebral Infarction is the ischemic kind

of stroke due to a disturbance in the blood

vessels supplying blood to the brain.

• Middle Cerebral

Artery (MCA)

• Internal Carotid

Artery (ICA)

Infarction Stages 1

Immediate (<24 hours)

No Change : gross, micro Na/K loss, Ca+ influx.

Infarction Stages 2

Acute stage (< 1week)

Oedema, loss of grey/white matter border.

Inflammation, Red neurons, necrosis, neutrophils

Cerebral Edema

Normal Edema

Cerebral Edema

Infarction Stages 3

Late stage (> 1 weeks)

Removal of tissue by macrophages

Fluid filled cysts with dark grey margin (gliosis)

Principle of Diagnosis

• The middle aged people and the elder

• Hypertension, Hyperlipidemia, Diabetes, TIA

History

• Disease onsets in quiet situation

• Symptoms gradually worsened

• Hemiplegia, Aphasia, etc

• CT, MRI test

Principle of Therapy

• Early thrombolytic

• Adjustment of blood pressure

• Prevention of brain edema

• Anticoagulant therapy

• Vascular dilatation

• Brian nutrition therapy

• Surgeon therapy

• Interventional therapy

Principle of Nursing

• Medication Nursing

• Prevention of Asphyxia

• Mental Nursing

• Health Education

Intracerebral

Hemorrhage, ICH

A Cerebral Hemorrhage (or intracerebral

hemorrhage, ICH), is a subtype

of intracranial hemorrhage that occurs

within the brain tissue itself. Intracerebral

hemorrhage can be caused by brain trauma,

or it can occur spontaneously in hemorrhagic

stroke. Non-traumatic intracerebral

hemorrhage is a spontaneous bleeding into the

brain tissue.

• Middle Cerebral

Artery (MCA)

• Lenticulostriate

artery

Brain Herniation

-Cardiac arrest (no pulse)

-Coma

-Irregular breathing

-Irregular pulse

-Loss of all brainstem

reflexes (blinking, gagging,

pupils reacting to light)

-Progressive loss of

consciousness

-Respiratory arrest (no

breathing)

Brain Herniation

(abnormal posturing)

• Decorticate posturing: with elbows, wrists and fingers flexed, and legs

extended and rotated inward

• Brain herniation frequently presents with abnormal posturing. a

characteristic positioning of the limbs indicative of severe brain damage.

Principle of Diagnosis

• Over age-50 who has history of hypertenxion

• Accidence in the emotional or physical

activtise

• Emerging the symptoms of intracranial

pressure rising and disturbance of

consciousness

• CT, MRI test

Principle of Therapy

• No movement, O2

• Adjustment of blood pressure

• Control of brain edema

• Application of hemostatic

• Surgeon therapy

Principle of Nursing

• Basic Nursing

• Prevention of Asphyxia

• Complications: Brain Herniation

• Complications: Upper Gastrointestinal

Bleeding

Subarachnoid

Hemorrhage

A subarachnoid hemorrhage (SAH)

is bleeding into the subarachnoid space

Principle of Diagnosis

• More among the youth, Female>Male

• Accidence in the emotional or physical

activtise

• CSF test

• CT, MRI test

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Principle of Therapy

• No movement, O2

• Adjustment of blood pressure

• Application of hemostatic

• Surgeon therapy

Principle of Nursing

• Basic Nursing

• Prevention of Asphyxia

• Complications: Brain Herniation

• Complications: Upper Gastrointestinal

Bleeding

Transient Ischemic

Attack, TIA

A transient ischemic attack (often

colloquially referred to as “mini stroke”) is a

change in the blood supply to a particular area

of the brain, resulting in brief neurologic

dysfunction that persists, by definition, for less

than 24 hours.

Three-Theory Etiology

Typical Symptom

• Temporary loss of vision

• Difficulty speaking (aphasia)

• Weakness on one side of the body

• Numbness or tingling, usually on one side of

the body.

Principle of Diagnosis

• Short onset-period

• Based on health history

• CT, DSA test

Principle of Therapy

• Application of hemostatic

• Calcium Channel Blockers (CCBs)

• Surgeon therapy

Principle of Nursing

• Basic Nursing (risk of injury)

• Medication Nursing

• Appropriate Exercises Recommendation

• Complications: Stroke

马圣念

Thank you

for attention