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Cerebrovascular accident
• Intro

• Symptoms

• Types

• Causes

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Cerebrovascular accident:
1. Cerebrovascular accident: Introduction
2. Symptoms
3. Causes
4. Treatments
5. Misdiagnosis
6. Home Testing
7. Types
8. Complications
9. Videos
 10. Research
11. Book Excerpts
12. Stories from Users
13. Full Contents list
Related Cerebrovascular accident Info

Videos about Cerebrovascular accident

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Prevention & Treatment of StrokeWatch Video

Forum Discussions about Cerebrovascular accident

• Firefighter suffers CVA, misdiagnosed for a year...

News about Cerebrovascular accident

• Depression After Heart Attack Tied to Brain Changes

More information about Cerebrovascular accident

1. Cerebrovascular accident: Introduction
2. Symptoms
3. Causes
4. Treatments
5. Misdiagnosis
6. Home Testing
7. Types
8. Complications

Cerebrovascular accident: Introduction

Cerebrovascular accident is a very serious condition in which the brain is not receiving enough
oxygen to function properly. A cerebrovascular accident is also called CVA, brain attack, cerebral
infarction or stroke.

A cerebrovascular accident often results in permanent serious complications and disability and is a
common cause of death. Cerebrovascular accidents are the second leading cause of death
worldwide and the third leading cause of death in the U.S., according to the American Heart
Association.

The brain requires a steady supply of oxygen in order to pump blood effectively to all of the body.
Oxygen is supplied to the brain in the blood that flows through arteries. In a cerebrovascular
accident, one or more of these arteries becomes blocked or ruptures or begins to leak. This
deprives a portion of the brain of vital oxygen-rich blood. This damage can become permanent
within minutes and result in the death of the affected brain tissue. This is called cerebral necrosis.

There are two types of cerebrovascular accidents. An ischemic cerebrovascular accident occurs
when a brain artery has been blocked. A hemorrhagic cerebrovascular accident occurs when an
artery ruptures or leaks.

There are three primary causes of cerebrovascular accidents: cerebral thrombosis, cerebral
embolism and cerebral hemorrhage.

A cerebrovascular accident caused by a cerebral thrombosis is the result of a build-up of plaque

and inflammation in the arteries, called atherosclerosis. This process narrows the brain arteries and
lowers the amount of oxygen-rich blood that reaches the brain tissue. Arteries narrowed by
atherosclerosis are more likely to develop a blood clot that completely blocks blood flow to an area
of the brain. Risk factors for atherosclerosis include having high cholesterol, diabetes, and
hypertension.

Cerebrovascular accident cause by a cerebral embolism occurs when a clot forms in another part
of the body and travels in the bloodstream to a brain artery, blocking the flow of blood to the brain.
A cerebrovascular accident caused by cerebral hemorrhage occurs when a brain artery breaks or
leaks blood into the surrounding brain tissue.

The extent of the damage done to the brain and resulting symptoms of a cerebrovascular accident
vary depending on the type, the area or areas of the brain affected, and how much time passes
before the cerebrovascular accident is treated. Complications of cerebrovascular accident include
permanent neurological damage, disability and death. For more information on key hallmark
symptoms and other complications, refer to symptoms of cerebrovascular accident.

Risk factors for a cerebrovascular accident include a having hypertension, heart disease, diabetes,
high cholesterol and obesity. Other risk factors include being of African-American ancestry, being
male, drinking excessive amounts of alcohol, smoking and having a family history of heart disease
or cerebrovascular accident. Having a brain aneurysm puts a person at an extreme risk for a
hemorrhagic cerebrovascular accident.

Making a diagnosis of cerebrovascular accident includes completing a complete medical evaluation

and history and physical examination, including a neurological examination. This is often done in an
emergency room.

Diagnostic testing includes imaging tests, such as a CT or MRI and cerebral angiogram of the
brain. A cerebral angiogram is an imaging test that reveals obstructed or narrowed arteries in the
brain and can show blood flow or obstruction through the arteries of the brain.

A battery of other tests are also performed to evaluate for other conditions that commonly occur
with a cerebrovascular accident, such as heart disease and cardiac arrhythmia.

It is possible that a diagnosis of cerebrovascular accident can be missed or delayed because the
symptoms may be mild and be similar to symptoms of other conditions and diseases. For more
information about diseases and conditions that can mimic a cerebrovascular accident, refer to
misdiagnosis of cerebrovascular accident.
 If caught early, some cerebrovascular accidents can be successfully treated before the
development of permanent brain damage and complications. For more information on specific
treatment plans, refer to treatment of cerebrovascular accident. ...more »

Stroke symptoms: There are various causes of stroke-like symptoms including stroke, transient
ischemic attacks (mini-strokes) and several other serious conditions. Stroke is a form of ... more
about Stroke symptoms.

Cerebrovascular accident: Occurs when the blood supply to the brain is interrupted and results in
cell injury and death. More detailed information about the symptoms, causes, and treatments of
Cerebrovascular accident is available below.

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Cerebrovascular accident: Symptoms

Symptoms of a cerebrovascular accident differ depending on a variety of factors, including the

cause and the type and size of the area of the brain that is affected. In some cases, symptoms may
be mild and only include weakness, dizziness or headache. Symptoms such as these may also be
warning symptoms of an impending cerebrovascular accident. These symptoms can also be ...more
symptoms »

Cerebrovascular accident: Treatments

 The most effective cerebrovascular accident treatment plan uses a multifaceted approach. This
includes preventive care aimed at minimizing the risk factors for having a cerebrovascular accident
or a recurrent cerebrovascular accident. Preventive measures include regular medical care to
monitor and address such risk factors as high cholesterol, obesity, smoking, ...more treatments »

Cerebrovascular accident: Misdiagnosis

In some cases a diagnosis of cerebrovascular accident may be overlooked or delayed because

symptoms of cerebrovascular accident or of a transient ischemic attack may be mild or vague.
Symptoms may also be similar to symptoms of other less serious conditions, such as aging,
migraine headache, vertigo, orthostatic hypotension, acoustic neuroma, hypoglycemia, Bell's
palsy, ...more misdiagnosis »

Symptoms of Cerebrovascular accident

Click to Check

• Drooping of face

• Difficulty talking or swallowing

• Paralysis

• Paresthesia

• Personality change

• more symptoms...»

Read more about symptoms of Cerebrovascular accident

Treatments for Cerebrovascular accident

• Symptomatic support

• Physiotherapy

• Speech therapy

• Treatment of underlying medical conditions

• more treatments...»

Read more about treatments for Cerebrovascular accident

Home Diagnostic Testing

 Home medical testing related to Cerebrovascular accident:

• Nerve Neuropathy: Related Home Testing:

○ Home Diabetes Test Kits

○ Home Blood Glucose Testing Kits

• Brain & Neurological Disorders: Related Home Testing:

○ ADHD -- Home Tests

• more...»

Wrongly Diagnosed with Cerebrovascular accident?

• Misdiagnosis of Cerebrovascular accident

• Hidden causes of Cerebrovascular accident (possibly wrongly diagnosed)

Videos for Cerebrovascular accident

What is a Stroke?

Strokes are the number one cause of disability in the US, so it's critical to know the signs of
stroke and what to do immediately following a stroke...

Prevention & Treatment of Stroke

Dr. Paul explains the risk factors for stroke, what you can do to prevent a stroke, and the
treatment options following a stroke.

Money Stress at Holiday Time

 Don't give the gift of stress this year. Watch these tips on smart spending around the holidays.

Better You Tip: Set a Quit Day

Picking the right day to quit smoking is an important first step.

See full list of 4 related videos

Cerebrovascular accident: Related Patient Stories

• Firefighter suffers CVA, misdiagnosed for a year...

News Archives for Cerebrovascular accident

Medical news articles related to Cerebrovascular accident include:

• Depression After Heart Attack Tied to Brain Changes

• more health news...»

Source: HealthDay News

Cerebrovascular accident: Complications

Read more about complications of Cerebrovascular accident.

Causes of Cerebrovascular accident

• Hypertension, systemic

• Sneddon-Champion syndrome
 • Coronary angiography

• Haemophilia type A

• Vasculitis

• more causes...»

See full list of 41 causes of Cerebrovascular accident

Read more about causes of Cerebrovascular accident.

More information about causes of Cerebrovascular accident:

• Medical news summaries relating to Causes of Cerebrovascular accident

Disease Topics Related To Cerebrovascular accident

Research the causes of these diseases that are similar to, or related to, Cerebrovascular accident:

• Visual field deficits

• Diplopia

• Dysarthria

• Ataxia

• Vertigo

• more related diseases...»

Medical Textbooks Online about Cerebrovascular accident

Medical Books Excerpts Read excertps from published book sections related to Cerebrovascular
accident from the following published medical books for more detailed information about
Cerebrovascular accident. Free access (no registration): read all online book sections about
Cerebrovascular accident

Medical Books Excerpts

• Flank Pain/CVA Tenderness

• "In a Page: Signs and Symptoms" (2004)

 • [ read ]

• Cerebrovascular Disease

• "A Pocket Manual of Differential Diagnosis" (1999)

• [ read ]

• Stroke

• "Professional Guide to Diseases (Eighth Edition)" (2005)

• [ read ]

• Stroke

• "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)

• [ read ]

• Stroke Syndromes

• "Field Guide to Bedside Diagnosis" (2007)

• [ read ]

• Stroke

• "Handbook of Diseases" (2003)

• [ read ]

Book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.

Cerebrovascular accident: Undiagnosed Conditions

Commonly undiagnosed diseases in related medical categories:

• Brain & Neurological Disorders: Undiagnosed:

○ Adult ADHD -- Undiagnosed - ADHD can be undiagnosed in adults.

○ ADHD -- Undiagnosed

○ Alzheimer Disease -- Undiagnosed

○ Migraine -- Undiagnosed

○ Concentration Disorders -- Undiagnosed

○ Stroke -- Undiagnosed

○ Bipolar Disorder -- Undiagnosed

○ Schizophrenia -- Undiagnosed
 ○ Epilepsy -- Undiagnosed

• more undiagnosed conditions...»

Misdiagnosis and Cerebrovascular accident

Undiagnosed stroke leads to misdiagnosed aphasia: BBC News UK reported on a man who
had been institutionalized and treated for mental illness because he suffered from sudden inability
to speak. This was initially misdiagnosed as a ...read more »

Alzheimer's disease over-diagnosed: The well-known disease of Alzheimer's disease is often

over-diagnosed. Patients tend to assume that any memory loss or forgetulness symptom might be
Alzheimer's, whereas there are many...read more »

Dementia may be a drug interaction: A common scenario in aged care is for a patient to show
mental decline to dementia. Whereas this can, of course, occur due to various medical
conditions,...read more »

Tremor need not be Parkinson's disease: There is the tendency to believe that any tremor
symptom, or shakiness, means Parkinson's disease. The reality is that there are various
possibilities, such as benign essential tremor,...read more »

Mild traumatic brain injury often remains undiagnosed: Although the symptoms of severe brain
injury are hard to miss, it is less clear for milder...read more »

MTBI misdiagnosed as balance problem: When a person has symptoms such as vertigo or
dizziness, a diagnosis of brain injury may go overlooked. This...read more »

Rare diseases misdiagnosed as Parkinson's disease: A rare genetic disorder is often

misdiagnosed as Parkinson's disease for men in their 50's. The disease Fragile X disorder can
show only mild...read more »
 Brain pressure condition often misdiagnosed as dementia: A condition that results from an
excessive pressure of CSF within the brain is often misdiagnosed. It may be misdiagnosed...read
more »

Post-concussive brain injury often misdiagnosed: A study found that soldiers who had suffered
a concussive injury in battle often were misdiagnosed on their return. A variety of symptoms can
occur in post...read more »

Children with migraine often misdiagnosed: A migraine often fails to be correctly diagnosed in
pediatric patients. These patients are not the typical...read more »

Vitamin B12 deficiency under-diagnosed: The condition of Vitamin B12 deficiency is a possible
misdiagnosis of various conditions, such as multiple sclerosis (see symptoms of multiple
sclerosis)....read more »

Read more about Misdiagnosis and Cerebrovascular accident

Cerebrovascular accident: Research Doctors & Specialists

Research related physicians and medical specialists:

• Nerve Specialists:
○ Neuromusculoskeletal Medicine

○ Neurology (Brain/CNS Specialists)

○ Pediatric Neurology (Child Brain Specialist)

○ Spinal Cord Injury Medicine

• Neurology (Brain/CNS Specialists):

○ Pediatric Neurosurgery (Child Neurosurgeon)

○ Clinical Neurophysiology

○ Neurodevelopment Disabilities

○ Neurosurgery (Brain Surgery)

○ Neuromusculoskeletal Medicine (Nerve/Muscle/Bone Specialists)

 ○ Neuroradiology

○ Vascular Neurology

○ Neuropathology

○ Otology / Neurotology (Ear/Hearing Specialists)

• Stroke & Vascular Specialists:

○ Vascular Neurology (Brain Blood Vessels)

○ Vascular & Interventional Radiology

○ Vascular Surgery (Blood Vessel Surgeon)

○ Neuropathology (Brain Diagnostics)

• more specialists...»

Other doctor, physician and specialist research services:

• Rate Your Doctor Online

• Research Your Doctor Online

• Review Patient Surveys About Your Doctor

• Research local specialists including ratings, affiliations, and sanctions.

Hospitals & Clinics: Cerebrovascular accident

Research quality ratings and patient safety measures for medical facilities in specialties related to
Cerebrovascular accident:

• Senior Health -- Hospital Quality Ratings

• Nursing Homes & Aged Care Facilities -- Quality Ratings

• more hospital ratings...»

Hospital & Clinic quality ratings »

Choosing the Best Hospital: More general information, not necessarily in relation to
Cerebrovascular accident, on hospital performance and surgical care quality:

• 50 Best Hospitals Report

• Outstanding Patient Experience Award Winning Hospitals

 • Women's Health Best Hospitals

• Patient Safety

• Hospital Quality and Clinical Excellence Study (2009)

Cerebrovascular accident: Rare Types

Rare types of diseases and disorders in related medical categories:

• Brain & Neurological Disorders: Rare Types:

○ Adult ADHD -- Rare Types

○ ADHD -- Rare Types

○ Alzheimer Disease -- Rare Types

○ Migraine -- Rare Types

○ Concentration Disorders -- Rare Types

○ Stroke -- Rare Types

○ Bipolar Disorder -- Rare Types

○ Schizophrenia -- Rare Types

○ Epilepsy -- Rare Types

• more rare diseases...»

Evidence Based Medicine Research for Cerebrovascular accident

Medical research articles related to Cerebrovascular accident include:

• Do you start aspirin and dipyridamole straight after a TIA or should one wait for a CT scan?

• Anticoagulants for preventing recurrence following presumed non-cardioembolic ischaemic

stroke or transient ischaemic attack

• After a TIA or transient visual loss due to embolus for how long should the patient continue with
dipyridamole?

• Network meta-analysis: simultaneous meta-analysis of common antiplatelet regimens after

transient ischaemic attack or stroke

• Prognosis in patients with transient ischaemic attack (TIA) and minor stroke attending TIA
services in the North West of England: the NORTHSTAR Study

• more research...»
 Click here to find more evidence-based articles on the TRIP Database

Cerebrovascular accident: Animations

• Stroke

• Normal vs. Alzheimer's Brains

More Cerebrovascular accident animations & videos

Research about Cerebrovascular accident

Visit our research pages for current research about Cerebrovascular accident treatments.

Clinical Trials for Cerebrovascular accident

The US based website ClinicalTrials.gov lists information on both federally and privately supported
clinical trials using human volunteers.

Some of the clinical trials listed on ClinicalTrials.gov for Cerebrovascular accident include:
 • Safety and Effectiveness of NXY-059 for the Treatment of Patients Who Have Suffered From a
Stroke - This study is currently recruiting patients (Current: 23 Nov 2006) - NXY-059

• Acute Candesartan Cilexetil Outcomes Stroke Trial (ACCOST) - This study is currently
recruiting patients (Current: 23 Nov 2006) - Candesartan

• Evaluation of the STARFlex Septal Closure System in Patients With a Stroke or TIA Due to the
Possible Passage of Clot of Unknown Origin Through a Patent Foramen Ovale (PFO) - This
study is currently recruiting patients (Current: 23 Nov 2006)

• Brain and Coordination Changes Induced By Robotics and FES Treatment Following Stroke -
This study is currently recruiting patients (Current: 23 Nov 2006)

• Outcomes of Swallowing Rehabilitation After Stroke - This study has been completed (Current:
23 Nov 2006)

• more trials...»

See full list of 440 Clinical Trials for Cerebrovascular accident

Cerebrovascular accident: Broader Related Topics

• Circulatory system conditions

• Brain conditions

• Head conditions

• more types...»

Types of Cerebrovascular accident

Cerebrovascular accident Message Boards

Related forums and medical stories:

• Brain Conditions (288)

○ arachnoid cyst

○ Pain/Pressure in back of head when I laugh

○ "ice Pick" Headaches

○ Fluid running down back of my head feeling

○ vertigo + other symptoms

○ More user stories

User Interactive Forums

 Read about other experiences, ask a question about Cerebrovascular accident, or answer
someone else's question, on our message boards:

• I can not get a diagnosis. Please help.

• Tell us your medical story.

• Share your misdiagnosis story.

• What is the best treatment for this?

• See all the forums.

Definitions of Cerebrovascular accident:

A sudden, nonconvulsive loss of neurologic function due to an ischemic or hemorrhagic intracranial

vascular event. In general, cerebrovascular accidents are classified by anatomic location in the
brain, vascular distribution, etiology, age of the affected individual, and hemorrhagic vs.
nonhemorrhagic nature. (From Adams et al., Principles of Neurology, 6th ed, pp777-810) - (Source
- Diseases Database)

Contents for Cerebrovascular accident:

• Cerebrovascular accident

• What is Cerebrovascular accident?

• Online Medical Textbooks for Cerebrovascular accident

• Videos related to Cerebrovascular accident

• Types of Cerebrovascular accident

• Causes of Cerebrovascular accident

• Risk Factors for Cerebrovascular accident

• Symptoms of Cerebrovascular accident

• Diagnostic Tests for Cerebrovascular accident

• Home Testing and Cerebrovascular accident

• Diagnosis of Cerebrovascular accident

• Signs of Cerebrovascular accident

• Complications of Cerebrovascular accident

• Misdiagnosis of Cerebrovascular accident

• Misdiagnosis of Underlying Causes of Cerebrovascular accident

 • Treatments for Cerebrovascular accident

• Doctors and Medical Specialists for Cerebrovascular accident

• Cure Research for Cerebrovascular accident

• Medical News Summaries About Cerebrovascular accident

• Hospital Statistics for Cerebrovascular accident

• Articles about Cerebrovascular accident

• Glossary for Cerebrovascular accident

• Clinical Trials for Cerebrovascular accident

• External links relating to Cerebrovascular accident

• Flank Pain/CVA Tenderness (In a Page: Signs and Symptoms)

• Cerebrovascular Disease (A Pocket Manual of Differential Diagnosis)

• Stroke (Professional Guide to Diseases (Eighth Edition))

• Stroke (The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter)

• Stroke Syndromes (Field Guide to Bedside Diagnosis)

• Stroke (Handbook of Diseases)

What is a Stroke?

Strokes are the number one cause of disability in the US, so it's critical to know the signs of
stroke and what to do immediately following a stroke...

Prevention & Treatment of Stroke

Dr. Paul explains the risk factors for stroke, what you can do to prevent a stroke, and the
treatment options following a stroke.
Money Stress at Holiday Time

Don't give the gift of stress this year. Watch these tips on smart spending around the holidays.

Better You Tip: Set a Quit Day

Picking the right day to quit smoking is an important first step.

See full list of 4 related videos

» Next page: What is Cerebrovascular accident?

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• Cerebrovascular accident: Introduction

• Summary Overview: Cerebrovascular accident

• Types of Cerebrovascular accident

• Symptoms of Cerebrovascular accident

• Complications of Cerebrovascular accident

• Diagnosis for Cerebrovascular accident

• Diagnostic Tests for Cerebrovascular accident

• Home Diagnostic Testing for Cerebrovascular accident

• Signs of Cerebrovascular accident

• Misdiagnosis of Cerebrovascular accident

• Misdiagnosis of Underlying Causes of Cerebrovascular accident

• Causes of Cerebrovascular accident

• Risk Factors for Cerebrovascular accident

• All Online Books for Cerebrovascular accident

• Flank Pain/CVA Tenderness (In a Page: Signs and Symptoms)

• Cerebrovascular Disease (A Pocket Manual of Differential Diagnosis)

• Stroke (Professional Guide to Diseases (Eighth Edition))

• Stroke (The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter)

• Stroke Syndromes (Field Guide to Bedside Diagnosis)

• Treatments for Cerebrovascular accident

• Doctors and Medical Specialists for Cerebrovascular accident

• Cure Research for Cerebrovascular accident

• Clinical Trials for Cerebrovascular accident

• Medical News Summaries About Cerebrovascular accident

• Videos related to Cerebrovascular accident

• Hospital Statistics for Cerebrovascular accident

• Articles about Cerebrovascular accident

• Glossary for Cerebrovascular accident

• External links relating to Cerebrovascular accident

Read more at http://www.wrongdiagnosis.com/c/cerebrovascular_accident/intro.htm?ktrack=kcplink

A stroke or cerebrovascular accident (CVA) occurs when the blood supply to a part of
the brain is suddenly interrupted by occlusion (called an ischemic stroke -- approximately 90%
of strokes), by hemorrhage (called a hemorrhagic stroke -- about 10% of strokes) or other
causes. Ischemia is a reduction of blood flow most commonly due to occlusion (an
obstruction). On the other hand, hemorrhagic stroke (or intracranial hemorrhage), occurs
when a blood vessel in the brain bursts, spilling blood into the spaces surrounding the brain
cells or when a cerebral aneurysm ruptures. The mortality and long-term morbidity prognosis
is generally worse for hemorrhagic strokes than for ischemic strokes. A small proportion of
strokes are watershed strokes caused by hypoperfusion (usually due to hypotension) or other
vascular problems including vasculitis.
Pathophysiology
Neurons and glia die when they no longer receive oxygen and nutrients from the blood or
when they are damaged by sudden bleeding into or around the brain. These damaged cells can
linger in a compromised state for several hours. With timely treatment, these cells can be saved.
Intriguingly, when the brain cells suffer the ischemia, they begin to fill up with free zinc ions
which are released from some of their proteins, especially metallothionein, which can release 7
zinc ions per molecule. This released zinc is a major player in the ensuing death of the brain
cells. Drugs that buffer the zinc and reduce the level of free zinc are already being tested to
reduce brain cell death after stroke.
The following are the symptoms of Cerebrovascular accident:
• Headache
• Dizziness and confusion
• Visual disturbance
• Slurred speech or loss of speech
• Difficulty of swallowing
Risk factors:
• Age
• High blood pressure – weakens the walls of arteries
• Atherosclerosis – narrowed artery channels
• Heart disease – cause blot clot in the heart that may break off and migrate to the brain.
• Diabetes mellitus – accelerated degeneration of small blood vessel
• Smoking – increase the risk ofhypertension
• Polycythemia – a raised level of red cells in the blood.
• Hyperlipidemia – high level of fatty substances in the blood
• A cerebrovascular accident (CVA) or stroke is caused by an acute lack of blood
supply to part of the brain. There are two major types of stroke: ischemic, in
which a blockage (usually a blood clot) reduces or halts blood flow, and
hemorrhagic, in which bleeding in the brain triggers a response that restricts
blood supply elsewhere. The pathophysiology of cerebrovascular accident is
different for these two types of stroke.
• Pathophysiology of Ischemic Stroke
 • An ischemic stroke may be caused by a blood clot that occurs in the affected
artery (thrombosis), a blood clot that traveled from another part of the body
(embolism), or a blockage due to damage to the arterial wall (lacunar infarct).
Blockage of a single artery can often be compensated for by other arteries in the
blood vessel network, call collaterals. Artherosclerosis (hardening of the arteries),
other damage to arteries, and natural variations in the collateral network can
prevent the collateral system from compensating fully. The result is a loss of
perfusion, or blood supply, to an area of the brain (ischemia).
• Arteriovenous malformations (AVMs), abnormal tangles of blood vessels in which
arteries flow directly into veins, are another possible cause of ischemic stroke.
AVMs can press directly on brain tissue, blocking blood flow.
• Pathophysiology of Hemorrhagic Stroke
• The main type of hemorrhage that can lead to stroke is subarachnoid
hemorrhage. In this type of bleed, which usually results from head trauma or a
ruptured aneurysm, there is uncontrolled bleeding between the innermost two of
the three meninges (membranes lining the brain), the pia mater and the
arachnoid mater.
• The blood that pools or collects in a subarachnoid bleed is called a hematoma.
Ischemia (lack of blood flow) from the hematoma is a secondary problem. It is
caused by constriction of the arteries (vasospasm) as a protective response to
reduce bleeding. About 25% of patients with subarachnoid hemorrhages will
experience stroke symptoms resulting from secondary ischemia.
• Another common type of brain hemorrhage is an intracerebral hemorrhage, in
which an artery inside the brain tissue fails due to high blood pressure and
begins to bleed. It usually results from hypertension, but other causes of burst
intracerebral arteries include various types of aneurysm, brain tumors, and blood
clotting disorders. Symptoms of intracerebral hemorrhages can mimic symptoms
of ischemic stroke, especially for smaller bleeds, but the two problems have
different etiologies and treatments.
•

Read more: http://www.brighthub.com/health/conditions-

treatments/articles/57961.aspx#ixzz1I6wo9qkR

Cerebrovascular accident - Definition

This article is about stroke as medical term. For other uses of stroke, see stroke (disambiguation)
A stroke or cerebrovascular accident (CVA) occurs when the blood supply to a part of the brain is suddenly interrupted by
occlusion (an ischemic stroke) or by hemorrhage (a hemorrhagic stroke). The former, ischemia, is a reduction of blood flow due to
occlusion (an obstruction). The latter, hemorrhagic stroke (or intracranial hemorrhage), occurs when a blood vessel in the brain
bursts, spilling blood into the spaces surrounding the brain cells or when a cerebral aneurysm ruptures.
A stroke is a medical emergency. It generally presents with loss of function of the area of the body controlled by the affected part
of the brain, e.g. hemiplegia, loss of speech or vision, impaired swallowing reflex or altered sensation. The immediate and long-
 term results lead to marked morbitity and mortality.
Contents [showhide]

1 Causes

1.1 Ischemic stroke

1.2 Hemorrhagic stroke

2 Signs and symptoms

3 Diagnosis

4 Pathophysiology

5 Prevention

6 Treatment

6.1 Immediate
6.2 Care and rehabilitation

7 Prognosis

8 See also

9 External link

10 References

Causes
Ischemic stroke
Ischemic stroke is usually caused by atherosclerosis (fatty lumps in the artery wall), embolism (obstruction of blood vessels by
blood clots from elsewhere in the body), or microangiopathy (small artery disease, the occlusion of small cerebral vessels).
Risk factors (for atherosclerosis and small vessel disease) are hypertension (high blood pressure), diabetes mellitus, elevated
cholesterol levels and cigarette smoking. High blood pressure is the main cause of stroke. Atrial fibrillation and other arrhythmias
can lead to clot formation in the heart, which embolize to the brain. Some forms of thrombophilia (increased coagulation
tendency) have a predilection for arterial thrombosis and stroke; these include polycythemia vera and the rare paroxysmal
nocturnal hemoglobinuria. Sickle cell anemia predisposes to strokes.
Hemorrhagic stroke
High blood pressure also predisposes to cerebral bleeding. Other causes include arteriovenous malformation (cerebral AVM),
cerebral aneurysms, trauma and prematurity.

Signs and symptoms

The symptoms of stroke are usually easy to spot:

1. sudden numbness or weakness, especially on one side of the body;

1. reflexes can initially be decreased on the affected side, but are often livelier than on the other side
2. the face is normally spared (as this is served by both hemispheres), but the corner of the mouth can be affected on the
same side as the limb symptoms

2. sudden confusion or aphasia (trouble speaking) or understanding speech;

3. sudden trouble seeing in one eye (or rarely both);

4. sudden trouble walking, dizziness, or loss of balance or coordination.

A subgroup loses conciousness as part of the initial presentation. This occurs more often in bleeding than in thrombosis.
A sudden-onset severe headache can denote subarachnoid hemorrhage, which is a stroke-like clinical entity. Some other forms
of stroke can feature headaches.
If the symptoms resolve within an hour, or maximum 24 hours, the diagnosis is transient ischemic attack (TIA), and not stroke.
This syndrome may be a warning sign, and a proportion of patients develop strokes in the future. Treatment is with aspirin.

Diagnosis
Stroke is diagnosed through several techniques: a neurological examination, blood tests, CT scans (without contrast
enhancements) or MRI scans, Doppler ultrasound, and arteriography. The most important risk factors for stroke are hypertension,
heart disease, diabetes, and cigarette smoking. Other risks include heavy alcohol consumption, high blood cholesterol levels, illicit
drug use, and genetic or congenital conditions. Some risk factors for stroke apply only to women. Primary among these are
pregnancy, childbirth, and the menopause and treatment thereof (HRT). Stroke seems to run in some families. Family members
may have a genetic tendency for stroke or share a lifestyle that contributes to stroke.

Pathophysiology
Neurons and glia die when they no longer receive oxygen and nutrients from the blood or when they are damaged by sudden
bleeding into or around the brain. These damaged cells can linger in a compromised state for several hours. With timely
treatment, these cells can be saved.

Prevention
Prevention is an important public health concern. Identification of patients with treatable risk factors for stroke is paramount.
Treatment of risk factors in patients who have already had strokes (secondary prevention) is also very important as they are at
high risk of subsequent events compared with those who have never had a stroke. Medication or drug therapy is the most
common method of stroke prevention. Surgery such as Carotid endarterectomy can be used to remove significant narrowing of
the neck (internal) carotid artery which supplies blood to the brain and this operation has been shown to be an effective way to
prevent stroke in particular groups of patients.
Some brain damage that results from stroke may be secondary to the initial death of brain cells caused by the lack of blood flow
to the brain tissue. This brain damage is a result of a toxic reaction to the primary damage. Researchers are studying the
mechanisms of this toxic reaction and ways to prevent this secondary injury to the brain. Scientists hope to develop
neuroprotective agents to prevent this damage. Another area of research involves experiments with vasodilators, medications that
expand or dilate blood vessels and thus increase the blood flow to the brain. Basic research has also focused on the genetics of
stroke and stroke risk factors. One area of research involving genetics is gene therapy. One promising area of stroke animal
research involves hibernation. The dramatic decrease of blood flow to the brain in hibernating animals is extensive enough that it
would kill a non-hibernating animal. If scientists can discover how animals hibernate without experiencing brain damage, then
maybe they can discover ways to stop the brain damage associated with decreased blood flow in stroke patients. Other studies
are looking at the role of hypothermia, or decreased body temperature, on metabolism and neuroprotection. Scientists are
working to develop new and better ways to help the brain repair itself and restore important functions to the stroke patients. Some
evidence suggests that transcranial magnetic stimulation (TMS), in which a small magnetic current is delivered to an area of the
brain, may possibly increase brain plasticity and speed up recovery of function after stroke.

Treatment
Immediate
It is important to identify that a patient is having a stroke as early as possible. Some suggest that we should rename stroke as a
"brain attack" to underline the urgency of early assessment and treatment. Emergency services should be contacted so that the
patient can be assessed by medical staff as quickly as possible. If the patient has had the stroke symptoms for less than 3 hours
then they may need further assessment as they may be suitable for thrombolysis. This is "clot busting" treatment, useful only in
those with ischemic stroke. The aim of the therapy is to minimise the size of the stroke and therefore minimise subsequent
disability by restoring blood flow to the area of the brain affected as quickly as possible. It can however only be used in selected
patients. The patient will need blood tests to be performed urgently as well as a CT scan of the head. If the scan shows no signs
of bleeding (haemorrhage) then clot-busting therapy may be given depending on the judgment of the physician involved. Surgery
may also be indicated in very selected cases to treat acute stroke.
If the CT scan shows the stroke to be ischaemic then Aspirin 75 mg to 300 mg is given. It is common for the blood pressure to be
elevated following a stroke but many clinicians feel this is beneficial allowing better cerebral blood flow, though there is little hard
evidence for this. Many clinicians do not treat mildly elevated blood pressures for the first few days at least. In the long term
evidence has shown that particular antihypertensive medications reduce the long term risk of stroke.
Care and rehabilitation
Good nursing care is fundamental in maintaining skin care, feeding and hydration and positioning as well as the monitoring of vital
signs such as temperature, pulse and blood pressure. Stroke rehabilitation begins almost immediately.
Stroke rehabilitation is the process by which patients with disabling strokes undergo treatment to help them return to normal life
as much as possible by regaining and relearning the skills of everyday living. It is multidisciplinary in the fact that it involves a
team with different skills working together to help the patient. These include nursing staff, physiotherapy, occupational therapy,
speech and language therapy and usually a physician trained in rehabiliation medicine. Some teams may also include
psychologists and social workers and pharmacists.
For most stroke patients, physical therapy is the cornerstone of the rehabilitation process. Another type of therapy involving
relearning daily activities is occupational therapy (OT). OT involves exercise and training to help the stroke patient relearn
everyday activities sometimes called the Activities of daily living (ADLs) such as eating, drinking and swallowing, dressing,
bathing, cooking, reading and writing, and toileting. Speech and language therapy is appropriate for patients who have have
problems understanding speech or written words, or problems forming speech.
Patients may have particular problems such as an inability to swallow or a swallow that is not safe such that swallowed material
may pass into the lungs and cause an aspiration pneumonia. The swallow may improve with time but in the interim a nasogastric
tube may be passed which enables liquid food to be given directly into the stomach. If after a week the swallow is still not safe
then a PEG tube is passed and this can remain indefinitely.
The team have regular meetings at which the patient and family may be present to discuss the current situation and to set goals
and to ensure effective communication. In most cases the desired goal is to enable the patient to return home to independent
living though this is not always possible.
Stroke rehabilitation can last anything from a few days up to several months. Most return of function is seen in the first few days
and weeks and then falls off. It is unusual that there is complete recovery but not impossible. Most patients will improve to some
extent.

Prognosis
Although stroke is a disease of the brain, it can affect the entire body. Some of the disabilities that can result from stroke include
paralysis, cognitive deficits, speech problems, emotional difficulties, pressure sores, pneumonia, continence problems and daily
living problems, and pain. If the stroke is severe enough, coma or death can result. Depression is a common and understandable
response but responds well to antidepressants.

Cerebrovascular disease
From Wikipedia, the free encyclopedia
Jump to: navigation, search

Cerebrovascular disease

Classification and external resources

Cerebrovascular disease is a group of brain dysfunctions related to disease of the blood vessels
supplying the brain. Hypertension is the most important cause; it damages the blood vessel
lining, endothelium, exposing the underlying collagen where platelets aggregate to initiate a
repairing process which is not always complete and perfect. Sustained hypertension permanently
changes the architecture of the blood vessels making them narrow, stiff, deformed, uneven and
more vulnerable to fluctuations in blood pressure.
A fall in blood pressure during sleep can then lead to a marked reduction in blood flow in the
narrowed blood vessels causing ischemic stroke in the morning. Conversely, a sudden rise in
blood pressure due to excitation during the daytime can cause tearing of the blood vessels
resulting in intracranial hemorrhage. Cerebrovascular disease primarily affects people who are
elderly or have a history of diabetes, smoking, or ischemic heart disease. The results of
cerebrovascular disease can include a stroke, or occasionally a hemorrhagic stroke. Ischemia or
other blood vessel dysfunctions can affect the person during a cerebrovascular accident.

Contents
[hide]
• 1 Classification
• 2 Stroke
• 3 Causes
• 4 Pathophysiology
• 5 Epidemiology
• 6 References

Classification
A transient ischemic attack (TIA) leaves little to no permanent damage within the brain. The
symptoms of this include facial weakness, visual impairment, loss of coordination, or balance
and a sudden headache. Severe blockage of the arteries to the brain is known as carotid stenosis.
This generally results from high head trauma.
Stroke
Main article: Stroke

Carotid artery effects retina, cerebral hemisphere, or both. Retinal Transient blackouts; the sense
of a shade pulled over the eyes. Cerebral Contralateral (opposite sided) paralysis of a single body
part; paralysis of one side of the body; localized tingling, numbness; hemianopic visual loss;
aphasia (loss of speech); rare loss of consciousness. Vertebrobasilar Bilateral visual disturbance
including dim, gray, or blurred vision or temporary total blindness; diplopia (double vision).
Labyrinth/medulla Vertigo; unsteadiness; nausea; vomiting. Brainstem Slurring dysarthria
(tongue weakness causing impaired speech); dysphagia (difficulty swallowing); numbness,
weakness; all four limb paresthesia; drop attacks from sudden loss of postural tone are basilar in
origin; a vertebrobasilar artery occlusion episode causes symptoms to be induced by abrupt
position changes.
Causes
Cerebrovascular disease can be divided in to embolism, aneurysms, and low flow states
depending on its cause. Major modifiable risk factors include hypertension, smoking, obesity,
and diabetes.
Pathophysiology

Disability-adjusted life year for cerebrovascular disease per 100,000 inhabitants in

2004.[1]

no data

less than 250

250-425

425-600

600-775

775-950

950-1125

1125-1300

1300-1475

1475-1650

1650-1825

1825-2000

more than 2000

In a healthy, anatomical structure of the body, the carotid arteries form the main blood supply to
the brain. Following a stroke, voluntary control of the muscles may be lost, depending on the
type of stroke the victim is encountering. Strokes can also result from embolism or due to a
ruptured blood vessel. Embolism blocks small arteries within the brain, causing dysfunction to
occur. Spontaneous rupture of a blood vessel in the brain causes a hemorrhagic stroke.
Another form of cerebrovascular disease includes aneurysms. In females with defective collagen,
the weak branching points of arteries give rise to protrusions with a very thin covering of
endothelium that can tear to bleed easily with minimal rise of blood pressure. This can also occur
with defective capillaries caused by tissue cholesterol deposition especially in hypertensive
subjects with or without dyslipidemia. If bleeding occurs in this process, the resulting effect is a
hemorrhagic stroke in the form of subarachnoid hemorrhage, intracerebral hemorrhage or both.
In the main structure, the carotid arteries overspread the majority of the cerebrum. The common
carotid artery divides into the internal and the external cartoid arteries. The internal carotid artery
becomes the anterior cerebral artery and the middle central artery. The ACA transmits blood to
the frontal parietal and a small part of the occipital lobe. The MCA is the largest branch of the
internal carotid artery. From the Basillar artery are two posterior cerebral arteries. Branches of
the Basillar and PCA supply the occipital lobe, brain stem, and the cerebellum.
Ischemia is the loss of blood flow to the focal region of the brain. The beginning process of this
is quite rapid. The duration of a stroke is usually two to fifteen minutes. One side of the face,
hand, or arm may swell up. During this time, the person may lose conscious control and faint.
Brain deficits may improve over a maximum of 72 hours. Deficits do not resolve in all cases.
The neurological recovery period includes stable, to improving, brain function. Stable is the
period by which neither nutrient supply is regained, nor is it lost. Improving, depending on a
hospital code, generally means that the arteries gain control and blood flow functions
consistently within the brain. The carotid arteries connect to the vertebral arteries. These branch
off into the cerebellar and posterior meningenial arteries, which supply the back of the brain.
Also, during ischemia, interneurons weaken, causing an insufficient amount to perform vital
functions to be present. The neuroglis become congested or maintain loss during a
cerebrovascular accident. If impulse amount ceases, then life itself will cease and the victim may
enter the stage of clinical death. Neural pathways weaken, therefore decreasing action potential.
The neural arc, which in general consists of sensory and motor neurons, weaken as well. The
muscles become paralyzed, in some cases for life. Paralysis also includes the weakening of the
receptors in the body, unless improvement is made. Cerebrovascular damage to the brain is what
makes it difficult for receptors to receive the impulse and transmit it of a neuron. This chemical
reaction is then transmitted creating a poor reflex to the body. The meninges that also protect the
brain and spinal cord are deeply weakened, allowing the victim to suffer vast transmission of
diseases or unstable growth or maintenance if the victim is not in resting position.
During the stage of paralysis, the spinal tracts do not have much to do with the enduring
condition of cerebrovascular disease, either, in time may shorten the life of a victim who is
suffering because the nutrient supply is weakened in transmission during cerebrovascular
disease. Descending and ascending tracts will generally be cut off during cerebrovascular
disease, which conduct impulses down from the cord of the brain. This is known as anesthesia in
a minor case.
In a healthy body, the cerebrospinal fluid (also known as CSF) may also weaken the choroid
plexus, into a network of brain capillaries. Certain types of hydrocephalus ("water" or CSF on
the brain) may be treated by using a shunt (medical) or a cerebral shunt, which involves inserting
a hollow tube (or the shunt) through a blocked channel so the CSF can be used to be drained to
another portion of the body. The dermatomes are a skin surface area which is regulated by the
spinal cord. During a stroke, these may be damaged.
Epidemiology