Lesson 1, Topic 1
In Progress

Vascular Diseases and Disorders

April 11, 2024

Vascular Diseases and Disorders

Learning Objective: Examine vascular diseases and disorders that impact the nervous system, including the signs, symptoms, etiology, diagnostic procedures, and treatments.

Vascular diseases and disorders that affect the nervous system tend to affect the brain. These can include aneurysms and hemorrhages, which can lead to strokes.

Cerebrovascular Accident

Learning Objective: Describe a cerebrovascular accident, including the signs, symptoms, etiology, diagnostic procedures, and treatments.

A cerebrovascular accident (CVA), also called a stroke, is the fifth leading cause of death in the United States and a major cause of serious disability. Strokes can occur at any age but usually occur in older adults. A stroke is a medical emergency. There are three types of strokes:

• Ischemic stroke: Occurs when the arterial blood flow to part of the brain is blocked. The brain cells start to die after a few minutes. This is the most common type of stroke. There are two common types of ischemic stroke:

• Thrombotic stroke: A blood clot forms in an artery, blocking the blood to part of the brain.
• Embolic stroke: A blood clot or other debris forms elsewhere in the body and moves into the brain arteries, blocking the blood flow.

• Hemorrhagic stroke: Occurs when an artery in the brain leaks or ruptures. The leaked blood puts pressure on the surrounding brain cells, causing damage. High blood pressure and aneurysms can cause hemorrhagic strokes. There are two types of hemorrhagic stroke:

• Intracerebral hemorrhage: The most common type; occurs when a cerebral aneurysm ruptures.
• Subarachnoid hemorrhage: Bleeding occurs in the subarachnoid space, usually caused by small aneurysms.

FIGURE 22.12  Hydrocephalus. From Kliegman R, Stanton BF, St. Geme JW, et al: Nelson textbook of pediatrics, ed 19, St. Louis, 2011, Saunders.

FIGURE 22.13  Ventriculoperitoneal shunt. From Shiland B: Mastering healthcare terminology, ed 5, St. Louis, 2015, Elsevier.

• Transient ischemic attack (TIA): Also called a “ministroke” because it lasts for only a few minutes. The blood supply to a part of the brain is briefly blocked. Symptoms are similar to stroke symptoms but do not last as long (e.g., 1 to 24 hours).

Risk factors for CVAs include the following:

• Family history of stroke
• Cardiovascular disease, hypertension, and high cholesterol
• Diabetes
• Cigarette smoking, heavy or binge drinking, and use of illicit drugs (e.g., cocaine and methamphetamines)
• Being overweight and physical inactivity

The symptoms of a CVA relate to the part of the brain affected. The individual may not have all the symptoms:

• Confusion or mental changes
• Speech difficulty (trouble forming words, difficult to understand, or using words that do not make sense)
• Numbness of the face, arm, or leg, usually on one side of the body
• Problem seeing in one or both eyes
• Trouble walking, lack of coordination or balance, or arm weakness
• Sudden, severe headache
• Facial drooping
• Hemiparesis (weakness on one side of the body) and hemiplegia (one-sided paralysis)

The emergency department providers will perform physical and neurologic examinations. Blood tests and imaging tests (CT, MRI, and cerebral angiogram) will indicate the type of stroke. The type of stroke determines the treatment:

• Ischemic strokes are treated with clot-dissolving medications (e.g., a tissue plasminogen activator) that help the body break down the clot that is blocking the artery. The clot can also be removed by surgery if needed.
• Hemorrhagic strokes are treated with antihypertensives and surgical repair of the vessel. If the person is taking an anticoagulant or antiplatelet medication, medications to reverse the effects may be given.
• TIAs are treated with antihypertensive, anticoagulant, and antiplatelet medications. The goal is to prevent a future stroke.

Additional treatments address the life-changing complications of a stroke. Physical, occupational, and speech therapies may be used to help with disabilities.

FIGURE 22.14  Encephalocele. From Lesperance MM: Cummings pediatric otolaryngology, ed 2, St. Louis, 2022, Elsevier.

22.8

Critical Thinking Application

Bella continues to help Daniela on breaks during work. Today, Daniela is learning directional terms. Bella encourages Daniela to repeat the term and definition as she points to that part of her body. How else might Daniela learn the directional terms and the opposite pairs?

Hematoma

Learning Objective: Describe a hematoma, including the signs, symptoms, etiology, diagnostic procedures, and treatments.

The most common cranial hematomas include these:

• Epidural hematoma: A collection of blood between the skull and the dura mater (FIGURE 22.15).
• Subdural hematoma: A collection of blood between the dura mater and the arachnoid mater, which causes pressure on the brain.
• Intraparenchymal or intracerebral hematoma: A collection of blood pools in the brain.

The pressure outside the brain increases the intracranial pressure (ICP) (the pressure in the skull). With increased ICP, both the nervous system and blood vessel tissues are under pressure, which can be life-threatening. Thus, a cranial hematoma is a medical emergency.
Head trauma is the most common cause of hematomas. An intraparenchymal hematoma can also be caused by a leaking aneurysm, high blood pressure, or a tumor. These conditions can cause blood to leak into the brain. The following are signs and symptoms of an epidural hematoma:

• Confusion, dizziness, altered level of alertness, or drowsiness
• Enlarged pupil, severe headache
• Loss of consciousness, followed by alertness, and then deterioration of alertness
• Nausea and vomiting
• Weakness in part of the body

Imaging procedures are the best method to determine the location and size of the hematoma. Imaging procedures used include a head CT scan, MRI, and angiogram to diagnose blood vessel conditions. The treatment goals include controlling symptoms and minimizing permanent damage. Emergency surgery to remove the hematoma (craniotomy), surgery to reduce the ICP, and life support measures are done. Medications to prevent seizures and to help reduce the ICP are also given.