Cerebrovascular Accident Vs. Stroke

What is a cerebrovascular accident?

If there is a blood clot in one of the blood vessels supplying to the brain and it leads to rupturing of the blood vessel - it can result in a lack of blood supply to the brain tissue, causing it to get damaged. This scenario would be defined as a cerebrovascular accident.¹ It can lead to a range of neurological symptoms such as hemiparesis (weakness or immobility on one side of the body), visual difficulties, sensory problems and aphasia (difficulty in speaking).²

Why is a stroke called a cerebrovascular accident?

A stroke is medically referred to as a cerebrovascular accident. During a stroke, the blood supply to the brain is cut off and this can be life-threatening. 

Types of cerebrovascular accident

There are three types of strokes or cerebrovascular accidents, namely:

Ischaemic stroke:  An ischemic stroke occurs when the blood vessel supplying to the brain gets obstructed. This can happen due to fatty deposits within the vessel walls. These deposits, also known as plaque, can rupture and lead to clots or cerebral thrombosis. Ischemic strokes can also be caused by embolisms - blood clots that originate somewhere else, like in the blood vessels supplying the heart, chest or neck, but lodge/get stuck in the vessels supplying the brain.³

Hemorrhagic stroke: This occurs when the blood vessels supplying the brain suddenly rupture and begin bleeding into the brain, compressing the brain structures. Therefore the areas of the body that are controlled by the compressed structure stop functioning properly. There are two types of hemorrhagic stroke - a. Intracranial - when the bleeding occurs inside the brain b. Subarachnoid - when the blood occurs in the area between the brain and the membranes surrounding it.⁴ 

Transient ischemic attack: This is usually referred to as a mini-stroke but it is essentially a warning sign for the possibility of a full-fledged stroke. Similar to an ischemic stroke,  this occurs when the blood supply to the brain is cut off for a temporary period of time.⁵

Symptoms of a cerebrovascular accident

A stroke or cerebrovascular accident can present in many ways but there is an acronym to look out for the most concerning ones:⁶

Face - Drooping of one side of the face, with an inability to smile and/or move mouth or eyes.

Arms - inability to move or lift their arms in addition to weakness and numbness on one of the sides.

Speech - Difficulty understanding in addition to slurring of speech.

T - This does not refer to a symptom but is rather to remind you that time is of the essence and you need to call 999/911 ASAP.

Other symptoms may include:⁶

1. Dysphagia (difficulty swallowing solids and liquids)
2. Dizziness
3. Confusion 
4. Loss of consciousness

Diagnosis of a cerebrovascular accident

There are a range of diagnostic tools for Stroke:⁷

One of the first ones includes a CT scan, which is essentially used to differentiate between the type of stroke the patient may have had (ischemic or hemorrhagic)

An MRI scan can be used in addition or in place of a CT scan. Since MRIs have the ability to illustrate brain matter and tissue in more detail, they can help to identify strokes that may have occurred in tricky or secluded areas of the brain.

Strokes can affect speech and also one’s ability to swallow (dysphagia). This means it might be essential to carry out a swallow test where the patient is first given a few teaspoons of water and if they can swallow it fine, they are then given half a glass of water. If your physician identifies that the patient has issues with swallowing, they may refer them to a speech and language therapist. 

Treatment for a cerebrovascular accident

Time is the most important factor for surviving a stroke. If a patient reaches the hospital within 3 hours of suffering an ischemic stroke, they are given something known as a thrombolytic drug - known as alteplase or tissue plasminogen activator -  which is essentially used to break up the clots. Receiving TPA or alteplase significantly improves the chances of recovering completely or with lesser disability than those who don't receive it. Over the long term, patients might be asked to take aspirins (blood thinners), anti-coagulants  (such as warfarin; these help prevent blood clots and statins (these help reduce cholesterol levels).

For a hemorrhagic stroke, the treatment might include the above plus some surgical procedures (depending on the severity), such as Craniotomy, which involves removing a section of the skull to enable the physician to access the source of bleeding. Once the bleeding is controlled and stopped, the section removed is replaced with an artificial metallic plate.

Long term outlook for a cerebrovascular accident

The prognosis of stroke is complicated. Within three months of first getting a stroke, the chances of getting another stroke are on average, approximately 5% but can vary from over 10% to less than 1%. This number increases to 11.1% at 1 year (after the first stroke), 26.4% after 5 years, and 39.4% after 10 years.⁸

It is also very common for people to suffer from stroke-related disabilities - at 90 days, 10% of young adults and 30% of adults (>65 years of age) suffer moderately severe disability. The statistics for those who suffer through hemorrhagic stroke are particularly grim - at 3-6 months after the incident, only 20-30% of people are able to live independently. 

Prevention of a cerebrovascular accident

Some of the best ways to prevent a stroke or a cerebrovascular incident include:⁸

1. Lowering your blood pressure - The aim should be to maintain your blood pressure around 120/80 but if you are hypertensive, your physician would be able to explain the ideal levels to you. You should aim to maintain that number
2. Losing weight - This means that you should ensure that you are in an appropriate BMI range, according to your height, weight and age. You should determine your weight goals after speaking with your physician
3. Keep active regularly and exercise - this will help you keep your blood pressure low and will also help you maintain your weight
4. If you drink, ensure that it is in moderation and if you smoke, it would be best to make a plan to quit smoking as soon as possible. This is because smoking is not only linked to stroke but also to many other fatal diseases. Quitting smoking would help you improve your health instantly
5. A healthy diet is quite important too: aim to have relatively low fat, low salt and high fibre diet

Summary

In essence, therefore, stroke is a particularly harmful condition, and it can occur spontaneously. Always remember the FAST symptoms and if you notice anyone undergoing any of those - immediately call the ambulance. Depending on the type of stroke, the physician will treat you immediately with medications but will also ask you to undertake lifestyle changes and might prescribe medications for long-term management. The outlook for stroke is quite dim, especially in terms of quality of life. It is therefore better to undertake preventative measures and make appropriate lifestyle and diet changes to ensure that you are at your healthiest.