Cerebrovascular Accident (CVA) or Stroke is a form of cardiovascular disease affecting the blood supply to the brain. It is damage to brain tissue either due to cerebral infarction or haemorrhage, characterized by focal neurological deficit. It is the third most common death the developed world after Cancer and Ischaemic Heart Disease (IHD).
Clinical Classification
1. Transient Stroke :-
The focal neurological deficit resolves completely within 24 hour.
2. Complete Stroke :-
The focal neurological deficit is persistent and not worsening.
3. Evolving Stroke :-
The focal neurological deficit continues to worsen after about 6 hours from onset.
4. Reversible Ischaemic Neurological Deficit (RIND) :-
The neurological deficit completely resolves within a period of 3 weeks.
Risk Factors
Characteristics and life-style
Definite
- Cigarette smoking
- Excessive alcohol consumption
- Drug use (cocaine, amphetamines)
- Age
- Sex
- Familial and genetic factors
Possible
- Oral contraceptive use
- Diet
- Personality type
- Geographic location
- Socioeconomic factors
- Physical inactivity
- Obesity
- Abnormal blood lipids
Disease or disease markers
- Hypertension
- Cardiac disease
- TIA
- Elevated hematocrit
- Diabetes mellitus
- Sickle cell disease
- Elevated fibrinogen concentration
- Migraine headaches and migraine equivalents
Clinical Features
1. Stroke due to infarction :-
Clinical features depend on the site and extent of infarction.
- Headache
- Vomiting
- Dysphasia (if dominant hemisphere is involved)
- Altered consciousness and papilloedema
- Facial numbness and weakness
- Diplopia
- Vertigo, ataxia
2. Stroke due to cerebral haemorrhage :-
- Headache, vomiting
- Convulsion
- Loss of consciousness
- Hemiplegia
- Facial nerve and other cranial nerve palsies.
On examination the following point should be noted :
• Glasgow coma scale
• Blood pressure
• Pulse rate & rhythm
• Pupil
• Respiration rate
• Planter response
• Facial palsy
Investigation
• Routine test :-
- Full Blood Count, ESR
- Blood glucose, urea, creatinine
- Chest X-ray
- ECG
• MRI/CT Scan of Head
• Echocardiography
• Doppler study of carotid
• Lipid profile
• Lupus anticoagulant
Treatment
General Measures :-
1. Care of airway
2. Regular change the position of patient to prevent bed sore
3. Fluid balance
4. Bladder catheterization if incontinent.
Specific Measures :-
1. Slow control of Blood Pressure
2. Anticoagulant if Atrial fibrillation or stroke are evolving.
3. Cerebral oedema reducing agent e.g. Mannintol, Dexamethasone.
4. Surgical treatment :-
- Cerebellar haemorrhage
- Intra cerebral haemorrhage extending to intra ventricales.
- A-V malformation haemorrhage
- Berry aneurysm haemorrhage
Complications
A stroke can sometimes cause temporary or permanent disabilities, depending on how long the brain suffers a lack of blood flow and which part was affected. Complications may include :
1. Paralysis or loss of muscle movement
2. Difficulty talking or swallowing
3. Memory loss or thinking difficulties
4. Emotional problems
5. Changes in behavior and self-care.
Clinical Classification
1. Transient Stroke :-
The focal neurological deficit resolves completely within 24 hour.
2. Complete Stroke :-
The focal neurological deficit is persistent and not worsening.
3. Evolving Stroke :-
The focal neurological deficit continues to worsen after about 6 hours from onset.
4. Reversible Ischaemic Neurological Deficit (RIND) :-
The neurological deficit completely resolves within a period of 3 weeks.
Risk Factors
Characteristics and life-style
Definite
- Cigarette smoking
- Excessive alcohol consumption
- Drug use (cocaine, amphetamines)
- Age
- Sex
- Familial and genetic factors
Possible
- Oral contraceptive use
- Diet
- Personality type
- Geographic location
- Socioeconomic factors
- Physical inactivity
- Obesity
- Abnormal blood lipids
Disease or disease markers
- Hypertension
- Cardiac disease
- TIA
- Elevated hematocrit
- Diabetes mellitus
- Sickle cell disease
- Elevated fibrinogen concentration
- Migraine headaches and migraine equivalents
Clinical Features
1. Stroke due to infarction :-
Clinical features depend on the site and extent of infarction.
- Headache
- Vomiting
- Dysphasia (if dominant hemisphere is involved)
- Altered consciousness and papilloedema
- Facial numbness and weakness
- Diplopia
- Vertigo, ataxia
2. Stroke due to cerebral haemorrhage :-
- Headache, vomiting
- Convulsion
- Loss of consciousness
- Hemiplegia
- Facial nerve and other cranial nerve palsies.
On examination the following point should be noted :
• Glasgow coma scale
• Blood pressure
• Pulse rate & rhythm
• Pupil
• Respiration rate
• Planter response
• Facial palsy
Investigation
• Routine test :-
- Full Blood Count, ESR
- Blood glucose, urea, creatinine
- Chest X-ray
- ECG
• MRI/CT Scan of Head
• Echocardiography
• Doppler study of carotid
• Lipid profile
• Lupus anticoagulant
Treatment
General Measures :-
1. Care of airway
2. Regular change the position of patient to prevent bed sore
3. Fluid balance
4. Bladder catheterization if incontinent.
Specific Measures :-
1. Slow control of Blood Pressure
2. Anticoagulant if Atrial fibrillation or stroke are evolving.
3. Cerebral oedema reducing agent e.g. Mannintol, Dexamethasone.
4. Surgical treatment :-
- Cerebellar haemorrhage
- Intra cerebral haemorrhage extending to intra ventricales.
- A-V malformation haemorrhage
- Berry aneurysm haemorrhage
Complications
A stroke can sometimes cause temporary or permanent disabilities, depending on how long the brain suffers a lack of blood flow and which part was affected. Complications may include :
1. Paralysis or loss of muscle movement
2. Difficulty talking or swallowing
3. Memory loss or thinking difficulties
4. Emotional problems
5. Changes in behavior and self-care.
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