What Are Cerebrovascular Accidents

Understanding cerebrovascular accidents

What is a cerebrovascular accident? 

In medicine, a loss of blood flow to any part of the brain damages brain tissue. Cerebrovascular accidents (CVA), also known as stroke, are caused by blood clots and damaged blood vessels in the brain. A stroke occurs when a blood vessel is blocked or ruptures, stopping blood flow to part of the brain. You should be aware of and watch out for important signs of stroke.

If you think you or someone close to you is having a stroke, seek medical attention immediately. The sooner treatment is started, the better the prognosis. A stroke that goes untreated for a long period of time can permanently damage the brain.

Types of cerebrovascular accident 

There are two types of stroke:

• Ischaemic 
• Haemorrhagic 

Other types of cerebrovascular accidents include:

• A transient ischemic attack (TIA) is sometimes called a "mini-stroke". It differs from the main types of stroke because blood flow to the brain is interrupted for a short period of time (usually no more than 5 minutes), usually due to blood clots or other particles blocking blood vessels supplying blood to the brain. TIAs, which can last from a few minutes up to 24 hours, is often a warning sign that a stroke may be occurring. Although usually mild and transient, the symptoms caused by a TIA are similar to those caused by a stroke.

• Fatty deposits called plaque can also build up in blood vessels and cause blockages.

• Haemorrhagic Stroke

A haemorrhagic stroke occurs when an artery in the brain loses blood or ruptures . The leaked blood puts too much pressure on the brain cells and damages them. Hypertension and aneurysms (balloon-like bulges in arteries that can dilate and rupture) are examples of conditions that can lead to haemorrhagic stroke

• Thrombotic Stroke

A thrombotic stroke is a stroke caused by a blood clot (thrombus) that forms in an artery that supplies blood to the brain. This type of stroke usually occurs in older people, especially those who have high cholesterol, atherosclerosis (fat and lipid buildup in the walls of blood vessels), or diabetes. Symptoms of a thrombotic stroke may appear suddenly during sleep or early in the morning. It may also appear gradually over hours to days.

It may be preceded by one or more TIAs.

• Lacunar infarct

Another type of stroke that occurs in the small blood vessels of the brain is called a lacunar infarct. The word “lacuna” is of Latin origin meaning 'hole' or 'cave'. Lacunar infarcts are common in people with diabetes and high blood pressure.

• Embolic Stroke

An embolic stroke is usually caused by a blood clot (emboli) that forms elsewhere in the body and travels through the bloodstream to the brain. Embolic strokes often result from heart disease or heart surgery and can occur rapidly without warning. About 15% of embolic strokes occur in people with atrial fibrillation (AF).

Symptoms 

• Sudden confusion, difficulty in speaking or understanding language
• Sudden loss of vision in one or both eyes
• Sudden difficulty walking, dizziness, or loss of balance Loss or adjustment
• Sudden severe headache of unknown cause

Diagnosis

To make a diagnosis, your doctor will:

1. Ask about your symptoms and medical history
2. Do a physical exam, including checking your mental alertness, coordination and balance. 
3. Check for numbness in the face and arms,or weakness the in legs
4. Check for problems with speaking and seeing
5. Do some tests: possible tests include an electrocardiogram (ECG) and echocardiogram

How can it be prevented?

If you've had a stroke or are at risk of having one, there are some heart-healthy lifestyle changes you can make to prevent future strokes. These changes include smoking cessation and blood pressure and cholesterol control.

Ways to treat cerebrovascular accidents

Treatment for stroke includes drug therapy, surgery, and rehabilitation. The treatment you receive depends on the type of stroke and the stage of treatment.

Acute treatment is to try to stop a stroke while it is occurring and usually involves drugs, while post-stroke rehabilitation is to overcome disability caused by a stroke. tPA (Tissue Plasminogen Activator) is a drug that may be given to help break up blood clots. This medicine can only be received within 4 hours of the onset of symptoms. The sooner it is administered, the better your chances of recovery. If you cannot take this medicine, your doctor may prescribe a medicine that prevents platelets from sticking together and forming a blood clot. 

Acute treatment of haemorrhagic stroke focuses on haemostasis, and it is crucial to find the cause.

Prophylaxis is aimed at preventing the first stroke or re-occurrence of another stroke. Blood thinners can be obtained to prevent existing blood clots from growing. Blood pressure medication may be prescribed if high blood pressure is causing the bleeding.

If the cause is an aneurysm, aneurysm clipping or coil embolisation may be necessary. These are surgeries to prevent the aneurysm from leaking more blood, and helps prevent it from re-rupturing. Surgery is also used to open a blocked carotid artery, which may be necessary if you have carotid artery disease. 

If an arteriovenous malformation (AVM) is the cause of your stroke, you may need to repair the AVM. AVM is a tangle of damaged arteries and veins that can rupture in the brain

FAQs

What causes a cerebrovascular accident?

Many factors can increase the risk of stroke.

Lifestyle risk factors such as:

• Overweight or Obesity
• Lack of Exercise
• Heavy or Binge Drinking
• Use of illicit drugs Such as cocaine and methamphetamines

Medical risk factors such as:

• Hypertension
• Tobacco or passive Smoking
• High cholesterol
• Obstructive diabetes 

Other non-modifiable factors are:

• Age – People over the age of 55 have a higher risk of stroke than younger people
• Race or Ethnicity – African Americans and Hispanics have a higher risk of stroke than people of other races or ethnicities
• Gender – Men have a higher risk of stroke than women - however, women are usually more likely than men to die from a stroke
• Hormones – Use of oral contraceptives and hormone therapy containing oestrogen increases risk

What type of CVA is most common? 

About 87% of all strokes are ischaemic, while about 13% are haemorrhagic.

What is the difference between a stroke and a cerebrovascular accident?

An acute stroke is also commonly called a cerebrovascular accident, but this is not the term of choice for most stroke neurologists. A stroke is not an accident. A more appropriate and descriptive term would be 'brain attack', which is similar to 'heart attack'.

Can you survive a cerebrovascular accident?

Possibly, if a quick and appropriate response is done, it can increase the chances of survival. 

Your brain cells can't get the oxygen and nutrients they need from the blood and begin to die within minutes. This can lead to permanent brain damage, long-term disability, and even death. 

Summary

Stroke or cerebrovascular accident (CVA) is an acute injury of cerebral perfusion or vasculature. About 85% of strokes are ischaemic and the rest are haemorrhagic, and  though the incidence of stroke and mortality has declined, it is still the leading cause of disability in adults worldwide. Therefore, early detection and prompt treatment of stroke are critical to prevent or minimise morbidity and mortality. Treatments for acute stroke are evolving rapidly, so patients should consider intravenous tissue plasminogen activation (IV tPA) for up to 4.5 hours and mechanical thrombectomy for up to 6 hours.