Cerebrovascular Accident Stroke

About cerebrovascular accident

In medicine - a loss of blood flow to part of the brain, which impairs brain tissue. Cerebrovascular accidents are caused by blood clots and damaged blood vessels in the brain. Symptoms include dizziness, weakness, numbness on one side of the body, and problems with writing, talking or understanding language. The risk of cerebrovascular accident is increased by high blood pressure, smoking, heart disease, older age, diabetes, high cholesterol, atherosclerosis and a family history of cerebrovascular accident. Also called CVA and stroke.¹

Symptoms of cerebrovascular accident

If you or someone you're with may be having a stroke, pay close attention to the time the symptoms began. Some treatment alternatives are most effective when given soon after a stroke begins.

Signs and symptoms of stroke contain:

• Difficulties with speaking and understanding what people are saying. You may experience disorientation, slur words or have difficulty understanding speech
• Numbness or paralysis of the leg, arm or face. You may develop sudden weakness, numbness or paralysis in the arm, leg or face. Additionally, this usually affects just one side of the body. Try to lift both your arms over your head at the same time - if one of the arms begins to fall, you may be having a stroke. Also, one side of your mouth may hang down when you try to smile
• Problems seeing in one or both eyes. You may suddenly have blackened or blurred vision in one or both eyes, or you may see double
• Headache. A sudden, severe headache, which may be accompanied by dizziness, vomiting or altered consciousness, may indicate that you're having a stroke
• Trouble walking. You may stumble or lose your balance. You may also have sudden dizziness or a loss of coordination²

Conditions, causes and treatment

Cerebrovascular conditions

The word cerebrovascular consists of two parts: "cerebro" which refers to the big part of the brain, and "vascular" which means veins and arteries. Jointly, the word cerebrovascular relates to blood flow in the brain. The term cerebrovascular disease includes all conditions in which a part of the brain is permanently or temporarily affected by ischemia or bleeding and one or more of the cerebral blood vessels are engaged in the pathological process. Cerebrovascular disease consists of vascular malformations, vertebral stenosis, stroke, aneurysms, carotid stenosis and intracranial stenosis.

Restrictions in blood flow may happen from blockage (embolism), vessel narrowing (stenosis), clot formation (thrombosis) or blood vessel rupture (hemorrhage). Lack of adequate blood flow (ischemia) affects brain tissue and may cause a stroke.³

Causes of cerebrovascular accident

There are two main sources of stroke: a blocked artery (ischemic stroke) or bursting or leaking of a blood vessel (hemorrhagic stroke). Some people may have only a temporary interruption of blood flow to the brain, known as a transient ischemic attack (TIA), that doesn't cause continuing symptoms.

• Ischemic stroke

This is the most popular type. It occurs when the brain's blood vessels become blocked or narrowed, causing severely decreased blood flow (ischemia). Narrowed or blocked blood vessels are created by fatty deposits that build up in blood vessels or by blood clots or other debris that carry through the bloodstream, most usually from the heart, and reside in the blood vessels in the brain.

• Haemorrhagic stroke

Haemorrhagic stroke happens when a blood vessel in the brain breaks or leaks. Brain haemorrhages can result from many conditions that alter the blood vessels. Factors related to hemorrhagic stroke consist of:

• Uncontrolled high blood pressure
• Ischemic stroke leading to haemorrhage
• Bulges at fragile spots in your blood vessel walls (aneurysms)
• Trauma (ie. car accident)
• A less prevailing source of bleeding in the brain is the rupture of an uneven tangle of thin-walled blood vessels (arteriovenous malformation).
• Overtreatment with blood thinners (anticoagulants)
• Protein deposits in blood vessel walls that cause weakness in the vessel wall (cerebral amyloid angiopathy)
• Transient ischemic attack (TIA)

A transient ischemic attack (TIA): sometimes known as a ministroke - is a temporary period of symptoms very much alike to those in a stroke. A TIA doesn't cause permanent damage. It is caused by a momentary decrease in blood supply to part of the brain, which may last as little as five minutes.

Like an ischemic stroke, a TIA happens when a clot or debris reduces or blocks blood flow to a section of the nervous system.²

Treatment for cerebrovascular accident

Treatment depends on the type of stroke you have, including which area of the brain was affected and what caused it.

Strokes are often treated with medications. This includes drugs to prevent and dissolve blood clots, reduce cholesterol levels and reduce blood pressure.

In some cases, procedures may be necessary to remove blood clots. Surgery may also be needed to treat brain swelling and reduce the risk of further bleeding if this was the cause of your stroke.⁴

Diagnosis and prevention

How is cerebrovascular accident diagnosed

Strokes are usually diagnosed by performing physical tests and studying images of the brain created during a scan.

When you first arrive at the hospital with a suspicion of a stroke, the doctors will want to find out as much as they can about your symptoms.

Several tests can be done to prove the diagnosis and establish the cause of the stroke.

These may include: 

• a blood test to find out your blood glucose level and cholesterol
• checking your pulse for an irregular heartbeat
• taking a blood pressure measurement
• brain scans

Even if the physical symptoms of a stroke are clear, brain scans should also be done to establish:

• if the stroke has been caused by a clogged artery (ischaemic stroke) or burst blood vessel (haemorrhagic stroke)
• which area of the brain has been distressed

The severity of the stroke and possible outcome

The two main imaging method used to evaluate the brain in people who have had a suspected stroke are: a CT scan and an MRI scan. Other investigations may include;

• swallow tests
• heart and blood vessel tests:
  • Carotid ultrasound
  • Echocardiography⁵

Can I prevent a cerebrovascular accident? If so, how?

Knowing your stroke risk factors, following your doctor’s recommendations and embracing a healthy lifestyle are the best steps you can take to prevent a stroke. If you've had a stroke or a transient ischemic attack (TIA), these processes might help prevent another stroke. The follow-up care you receive in the hospital  may play an important role.

Many stroke prevention actions are the same as actions to prevent heart disease. In general, healthy lifestyle recommendations consists of:

• Controlling high blood pressure (hypertension). This is one of the most vital things you can do to reduce your stroke risk. If you've had a stroke, decreasing your blood pressure can help prevent a subsequent stroke or TIA. Healthy lifestyle changes and medications are usually used to treat high blood pressure
• Lowering the amount of saturated fats and cholesterol in your diet. Eating less fats and cholesterol, especially saturated fats and trans fats, may reduce buildup in the arteries. If you can't control your cholesterol level through dietary changes alone, your doctor may prescribe a cholesterol-decreasing medication
• Quitting tobacco use. Smoking raises the risk of stroke for smokers and non-smokers exposed to secondhand smoke. Quitting tobacco use decreases the risk of stroke
• Managing diabetes. Exercise, diet and losing weight can help you keep your blood glucose in a healthy spectrum. If lifestyle circumstances don't seem to be enough to control your diabetes, your doctor may prescribe diabetes medication
• Maintaining a healthy weight. Being overweight assists with other stroke risk factors, such as cardiovascular disease, high blood pressure and diabetes
• Eating a diet rich in vegetables and fruits. A diet including five or more daily servings of vegetables or fruits may lower the risk of stroke. The Mediterranean diet, which accentuates fruits, olive oil, nuts, vegetables and whole grains, may be helpful
• Exercising regularly. Aerobic exercise decreases the risk of stroke in many ways. Exercise can lower blood pressure, raise the levels of good cholesterol, and improve the overall health of the heart and blood vessels. It also helps you reduce stress, lose weight and control diabetes. Gradually work up to at least 30 minutes of moderate physical activity, such as swimming, walking, bicycling or jogging, on most, if not all, days of the week
• Drinking alcohol in moderation, if at all. Heavy alcohol consumption raises the risk of high blood pressure, ischemic strokes and hemorrhagic strokes. Alcohol may also come into reaction with other drugs you're taking. Still, drinking small to average amounts of alcohol, ie. one drink a day, may help prevent ischemic stroke and lower the blood's clotting tendency
• Treating obstructive sleep apnea (OSA)
• Avoiding illegal drugs. Certain street drugs, such as cocaine and methamphetamine, are established risk factors for a TIA or a stroke²

Summary

People who survive a stroke are usually left with long-term problems caused by injury to their brain. Some people need a long time of rehabilitation before they can recover their old independence, while many never fully recover and need ongoing help after their stroke.

Some people will carry on to need some form of help or care with their daily activities.⁴