Cerebrovascular Accident Notes

Cerebrovascular Accident (Stroke)

What is a Cerebrovascular Accident?

  • A Cerebrovascular Accident (CVA) is the medical term for a stroke.
  • A stroke occurs when blood flow to the brain is interrupted.
  • Two main subtypes:
    • Ischemic stroke
    • Hemorrhagic stroke

Basic Facts About Strokes

  • Major health issue in the United States and worldwide.
  • 4th leading cause of death.
  • Approximately 795,000795,000 people have a stroke each year.
  • Approximately 116,000116,000 of those will die.

Vasculature of the Brain

  • Key arteries:
    • Anterior cerebral artery
    • Middle cerebral artery
    • Posterior cerebral artery
    • Internal carotid artery
    • Basilar artery
    • Anterior inferior cerebellar artery
    • Posterior inferior cerebellar artery
    • Vertebral artery
    • Anterior communicating artery
    • Posterior communicating artery

Symptoms of Stroke

  • Hemiparesis (weakness on one side of the body)
  • Hemianopia (visual field loss) or other sudden vision changes/loss
  • Sudden loss of balance, weakness, or numbness, especially if unilateral
  • Unilateral facial droop
  • Sudden onset of language problems (receptive or expressive)
  • Sudden confusion or disorientation

Ischemic Stroke

  • Most common type of stroke (approximately 80%80\% of all strokes).
  • Caused by blockage of a blood vessel.
    • Clot (embolism or thrombosis)
    • Stenosis (narrowing of a blood vessel)

Risk Factors for Ischemic Stroke

  • Age
  • Gender: Females at higher risk earlier in life, males later in life.
  • Hypertension (high blood pressure)
  • Hyperlipidemia (high cholesterol)
  • Cigarette smoking
  • Alcohol consumption
  • Obesity
  • Lack of exercise

Treatment for Ischemic Stroke

  • Tissue Plasminogen Activator (TPA)
    • Used to clear clots
    • Normal compound in the blood clot cascade to heal wounds (removes clot after wound has healed).
  • Anticoagulants
    • Heparin
    • Warfarin
  • Thrombectomy
    • Physical removal of clot with a surgical device.

Hemorrhagic Stroke

  • Involves bursting of a blood vessel in the brain.
  • Different than a subdural hematoma (TBI).
  • Subtypes:
    • Intracranial hemorrhage
    • Subarachnoid hemorrhage

Risk Factors for Hemorrhagic Stroke

  • Age
  • Males at higher risk
  • Use of drugs such as cocaine, amphetamines, opiates, etc.
  • Smoking
  • Heavy alcohol use
  • Vascular disease

Treatment for Hemorrhagic Stroke

  • Antihypertensives
    • Beta-blockers
    • ACE inhibitors
    • Calcium channel blockers
  • Surgery
    • Clip
    • Coil
  • Use of TPA is inappropriate.

Differential Diagnosis

Transient Ischemic Attack (TIA)

  • Essentially a mini-stroke.
  • Stroke symptoms, though symptoms resolve within 24 hours.
  • No evidence of damage on imaging.

Other Possible Disorders to Consider

  • Brain tumor
  • Classic migraine
  • Syncope (fainting)
  • Hypoglycemia and other metabolic issues
  • Psychological disorders