1. Cerebral Vascular Disease
(CVD)
Speaker: 马圣念

2. 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.

3. Anatomy of Cerebral
Vascular 1
-Internal Carotid
Artery System
-Vertebral Basilar
Arterial System
-Willis Circulation

4. Anatomy of Cerebral
Vascular 2

5. 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.

6. Anatomy of Cerebral
Vascular 4

7. Etiology of CVD
• High Blood Pressure
• High Blood Cholesterol
• High Body Mass Index
(BMI)

8. Risk Factors of CVR
Non modifiable Modifiable
• Age • Hypertension
• Male sex • Diabetes
• Race • Smoking
• Heredity • Hyperlipidemia
• Excess Alcohol
• Heart disease (AF)
• Hypercoagulability

9. Epidemiology of CVD

10. Classification of CVD
• Cerebral Infarction, CI
(or called Cerebral Ischemic Stroke)
• Intracerebral
Hemorrhage, ICH
• Subarachnoid
Hemorrhage
• Transient Ischemic
Attack, TIA

11. 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.

12. • Middle Cerebral
Artery (MCA)
• Internal Carotid
Artery (ICA)

13. Infarction Stages 1
Immediate (<24 hours)
No Change : gross, micro  Na/K loss, Ca+ influx.

14. Infarction Stages 2
Acute stage (< 1week)
Oedema, loss of grey/white matter border.
Inflammation, Red neurons, necrosis, neutrophils

15. Cerebral Edema
Normal Edema

16. Cerebral Edema

17. Infarction Stages 3
Late stage (> 1 weeks)
Removal of tissue by macrophages
Fluid filled cysts with dark grey margin (gliosis)

18. 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

19. Principle of Therapy
• Early thrombolytic
• Adjustment of blood pressure
• Prevention of brain edema
• Anticoagulant therapy
• Vascular dilatation
• Brian nutrition therapy
• Surgeon therapy
• Interventional therapy

20. Principle of Nursing
• Medication Nursing
• Prevention of Asphyxia
• Mental Nursing
• Health Education

21. 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.

24. • Middle Cerebral
Artery (MCA)
• Lenticulostriate
artery

26. 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)

27. 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.

28. 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

29. Principle of Therapy
• No movement, O2
• Adjustment of blood pressure
• Control of brain edema
• Application of hemostatic
• Surgeon therapy

30. Principle of Nursing
• Basic Nursing
• Prevention of Asphyxia
• Complications: Brain Herniation
• Complications: Upper Gastrointestinal
Bleeding

31. Subarachnoid
Hemorrhage
A subarachnoid hemorrhage (SAH)
is bleeding into the subarachnoid space

37. Principle of Diagnosis
• More among the youth, Female>Male
• Accidence in the emotional or physical
activtise
• CSF test
• CT, MRI test

38. UNESCO Training the Trainers in Information Literacy Workshop, September 3-5, Ankara-Turkey 38

39. Principle of Therapy
• No movement, O2
• Adjustment of blood pressure
• Application of hemostatic
• Surgeon therapy

40. Principle of Nursing
• Basic Nursing
• Prevention of Asphyxia
• Complications: Brain Herniation
• Complications: Upper Gastrointestinal
Bleeding

41. 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.

42. Three-Theory Etiology

43. 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.

44. Principle of Diagnosis
• Short onset-period
• Based on health history
• CT, DSA test

45. Principle of Therapy
• Application of hemostatic
• Calcium Channel Blockers (CCBs)
• Surgeon therapy

46. Principle of Nursing
• Basic Nursing (risk of injury)
• Medication Nursing
• Appropriate Exercises Recommendation
• Complications: Stroke

47. Thank you
for attention
马圣念