Case Study: CVA (Stoke)

At Davao Medical Center - Medicine ward, we have the highest mortality rate among all wards at the hospital. Mostly we have terminal cases such as cerebrovascular accident (CVA) or commonly known as stroke and the most fatal of them all is the hemorraghic type or CVA bleed and sad to say that some of them die.

Admitted patients usually have symptoms of paralysis or one sided weakness and sometimes family brought their patients to the hospital with severe symptoms. CVA is usually related to lifestyle behavior. Diets rich in fats, cholesterol, sodium, sugar are one of the factors. Added to that is smoking and lack of exercise. As you can see, this factors bring up hypertension or increased blood pressure. 

What happens kasi is that too much fat and cholesterol may pile up in the blood vessels in the brain. Just imagine a water hose in your garden, if you run the faucet and apply pressure to the hose by clamping it. A pressure builds up in the end of the hose and eventually the hose will burst. The same thing that happens to our blood vessels in the brain, a pressure will build up and booomm! Your brain has bleeding. A blocked vessel may cause oxygen depletion in the brain, also known as brain hypoxia. At 5 minutes of oxygen deprivation, the brain cells could die causing a loss of function to the affected part. 

Most dangerous vessels is the one that connects to the respiratory center of the brain or the medulla oblongata. If its affected, certainly the patients will develop respiratory distress and we intubate the patient or we place a tube on the patients mouth to assist them in breathing and hook them to continous ambubagging or a mechanical ventilator. 

 Its really difficult to manage this case at the hospital especially in our ward. Supposedly, the patients should be placed in a non-stimulating environment or in a calm environment. Ideally, it should be noise-free, on dim light place. However, manipulating the environment is so difficult to achieve especially with the current set up in the hospital. We really can’t prevent noise and visitors from coming in. Plus, to relieve increased intracranial pressure, patients should be placed on moderate high back rest but our beds are sira. hehe.

We can’t also blame the patients and the watchers if they are noncompliants to the laboratory and medicines. Usually, CVA patients are subject for CT Scan and that cost about P2500. Many patients are poor and really can’t afford to buy medicines. Surgery too is a very costly procedure. 

A cerebrovascular accident (CVA) is a life-changing disease for you and your family. Accepting that you have had a CVA is hard. You and those close to you may feel angry, sad, or frightened. These feelings are normal.

Can a cerebrovascular accident be prevented?

• Take your high blood pressure medicine regularly.
• Do not smoke or drink too much alcohol. Alcohol is found in beer, wine, liquor, like vodka or whiskey, and other adult drinks. Different people have different ideas about what too much means. It is important to remember that how often you drink is as important as how much you drink.
• If you have atrial fibrillation (an irregular or fast heart beat), you may need to take antithrombotic medicine. Having a recent heart attack may also require you to take antithrombotics.
• Keep your blood cholesterol level in a normal range. Eat foods low in fat to decrease the risk of developing plaque (fatty deposits) in your blood vessels. If you have hyperlipidemia (high blood cholesterol level), talk to your caregiver about ways to lower it.
• Monitor and control your blood sugar level if you have diabetes.