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Cerebrovascular Accident

A cerebrovascular accident is the medical term for a stroke. A stroke is when


blood flow to a part of your brain is stopped either by a blockage or a rupture
of a blood vessel. There are important signs of a stroke that you should be
aware of and watch out for. If you think that you or someone around you
might be having a stroke, it is important to seek medical attention
immediately. The more quickly you get treatment, the better the prognosis.
When a stroke goes untreated for too long, there can be permanent brain
damage.
A stroke occurs when the blood supply to your brain is interrupted or
reduced. This deprives your brain of oxygen and nutrients, which can cause
your brain cells to die.
A stroke may be caused by a blocked artery (ischemic stroke) or the leaking
or bursting of a blood vessel (hemorrhagic stroke). Some people may
experience only a temporary disruption of blood flow to their brain (transient
ischemic attack, or TIA).
Types of CVA
1. Ischemic stroke
About 85 percent of strokes are ischemic strokes. Ischemic strokes occur
when the arteries to your brain become narrowed or blocked, causing
severely reduced blood flow (ischemia). The most common ischemic strokes
include:

Thrombotic stroke. A thrombotic stroke occurs when a blood clot


(thrombus) forms in one of the arteries that supply blood to your brain. A clot
may be caused by fatty deposits (plaque) that build up in arteries and cause
reduced blood flow (atherosclerosis) or other artery conditions.

Embolic stroke. An embolic stroke occurs when a blood clot or other


debris forms away from your brain commonly in your heart and is swept
through your bloodstream to lodge in narrower brain arteries. This type of
blood clot is called an embolus.

2. Hemorrhagic stroke
Hemorrhagic stroke occurs when a blood vessel in your brain leaks or
ruptures. Brain hemorrhages can result from many conditions that affect
your blood vessels, including uncontrolled high blood pressure
(hypertension), overtreatment with anticoagulants and weak spots in your
blood vessel walls (aneurysms).
A less common cause of hemorrhage is the rupture of an abnormal tangle of
thin-walled blood vessels (arteriovenous malformation) present at birth.
Types of hemorrhagic stroke include:

Intracerebral hemorrhage. In an intracerebral hemorrhage, a blood


vessel in the brain bursts and spills into the surrounding brain tissue,
damaging brain cells. Brain cells beyond the leak are deprived of blood and
also damaged.
High blood pressure, trauma, vascular malformations, use of blood-thinning
medications and other conditions may cause an intracerebral hemorrhage.

Subarachnoid hemorrhage. In a subarachnoid hemorrhage, an


artery on or near the surface of your brain bursts and spills into the space
between the surface of your brain and your skull. This bleeding is often
signaled by a sudden, severe headache.
A subarachnoid hemorrhage is commonly caused by the bursting of a small
sack-shaped or berry-shaped outpouching on an artery known as an
aneurysm. After the hemorrhage, the blood vessels in your brain may widen
and narrow erratically (vasospasm), causing brain cell damage by further
limiting blood flow
3. Transient ischemic attack (TIA)

A transient ischemic attack (TIA) also known as a ministroke is a


brief period of symptoms similar to those you'd have in a stroke. A
temporary decrease in blood supply to part of your brain causes TIAs,
which often last less than five minutes.

Like an ischemic stroke, a TIA occurs when a clot or debris blocks blood
flow to part of your brain. A TIA doesn't leave lasting symptoms
because the blockage is temporary.
Seek emergency care even if your symptoms seem to clear up. Having
a TIA puts you at greater risk of having a full-blown stroke, causing
permanent damage later. If you've had a TIA, it means there's likely a
partially blocked or narrowed artery leading to your brain or a clot
source in the heart.
It's not possible to tell if you're having a stroke or a TIA based only on
your symptoms. Up to half of people whose symptoms appear to go
away actually have had a stroke causing brain damage.

Risk factors
Many factors can increase your risk of a stroke. Some factors can also
increase your chances of having a heart attack. Potentially treatable
stroke risk factors include:
Lifestyle risk factors

Being overweight or obese

Physical inactivity

Heavy or binge drinking

Use of illicit drugs such as cocaine and methamphetamines


Medical risk factors

High blood pressure the risk of stroke begins to increase at blood


pressure readings higher than 120/80 millimeters of mercury (mm Hg). Your
doctor will help you decide on a target blood pressure based on your age,
whether you have diabetes and other factors.
Cigarette smoking or exposure to secondhand smoke.

High cholesterol.

Diabetes.

Obstructive sleep apnea a sleep disorder in which the oxygen level


intermittently drops during the night.

Cardiovascular disease, including heart failure, heart defects, heart


infection or abnormal heart rhythm.
Other factors associated with a higher risk of stroke include:

Personal or family history of stroke, heart attack or transient ischemic


attack.
Being age 55 or older.

Race African-Americans have a higher risk of stroke than do people


of other races.

Gender Men have a higher risk of stroke than women. Women are
usually older when they have strokes, and they're more likely to die of
strokes than are men. Also, they may have some risk from some birth control
pills or hormone therapies that include estrogen, as well as from pregnancy
and childbirth.
Diagnosis of a Cerebrovascular Accident
Your doctor can tell if you have had a stroke in a number of ways. First,
you will be examined. Your doctor will check your reflexes, vision,
speaking, and senses. He or she will also check for a particular sound
in the blood vessels of your neck. This sound, which is called a bruit,
indicates abnormal blood flow. Finally, your doctor will check your
blood pressure, which may be high if you have had a stroke.

Your doctor may also perform diagnostic tests to confirm a stroke and
to pinpoint its location:

Blood tests: Your doctor may want to test your blood for clotting time,
blood sugar levels, or infection. These can all affect the likelihood and
progression of a stroke.

Angiogram: By adding a dye to your blood and then taking an X-ray of


your head, your doctor can find the blocked or hemorrhaged blood vessel.

Carotid ultrasound: Using sound waves to image the blood vessels in


your neck helps to determine if there is abnormal blood flow towards your
brain.

Computed tomography (CT) scan: A CT scan is often performed


soon after symptoms of a stroke develop to find the problem area or other
problems that might rule out a stroke.

Magnetic resonance imaging (MRI): MRIs can also be used to


check for damaged blood vessels.

Echocardiogram: This imaging technique uses sound waves to create


a picture of your heart. It can help to find the source of blood clots.

Treatment for a Cerebrovascular Accident

Treatment for a stroke depends on the type. In the case of an ischemic


stroke, the goal is to remove the blockage. In the case of a
hemorrhagic stroke, treatments are aimed at controlling the bleeding.
To treat an ischemic stroke, you may be given a clot-dissolving drug or
a blood thinner. You may also be given aspirin to prevent a second
stroke. In some cases, emergency treatment may include injecting
medicine into the brain or removing a blockage with surgery.

For a hemorrhagic stroke, you may be given a drug that lowers the
pressure in your brain caused by the bleeding. You may also need
surgery, if the bleeding is severe, to remove excess blood. You may
also need surgery to repair the ruptured blood vessel.
After any type of stroke, there is a recovery period that varies
depending on how severe the stroke was. You may need to participate
in rehabilitation because of the effects of the stroke. This can include
speech therapy, occupational therapy, or work with a psychiatrist,
neurologist, or other professionals.

Prevention of a Cerebrovascular Accident


There are many risk factors for having a stroke. Correspondingly, there
are many measures that can be taken to help prevent them. These
preventive measures are similar to the actions that you would take to
help prevent heart disease, and include the following:

maintain normal blood pressure

limit saturated fat and cholesterol intake

refrain from smoking and drink alcohol in moderation

control diabetes

maintain a healthy weight

get regular exercise

eat a diet rich in vegetables and fruits


If your doctor knows that you are at risk for a stroke, you may be
prescribed medications to prevent one. These include drugs that thin
the blood and prevent clot formation.

Prognosis for a Cerebrovascular Accident

If you suffer from a stroke, your prognosis depends on the type of


stroke, how much damage it causes to your brain, and how quickly you
are able to receive treatment. The prognosis after an ischemic stroke is
better than after a hemorrhagic stroke.
Common complications resulting from a stroke include difficulty
speaking, moving, or thinking. These can improve over the weeks,
months, and even years after a stroke. Approximately half of all stroke
patients are able to go home and function without help, while the other
half requires care