A.

Definition
Cerebrovascular accident (CVA) is the sudden death of some brain
cells due to lack of oxygen when the blood flow to the brain is impaired by
blockage or rupture of an artery to the brain. A CVA is also referred to as a
stroke. Symptoms of a stroke depend on the area of the brain affected.

B. Types
There are two main types of cerebrovascular accident, or stroke:
an ischemic stroke is caused by a blockage; a hemorrhagic stroke is
caused by the rupture of a blood vessel. Both types of stroke deprive part of
the brain of blood and oxygen, causing brain cells to die.
1. Ischemic Stroke
An ischemic stroke is the most common and occurs when a blood clot
blocks a blood vessel and prevents blood and oxygen from getting to a
part of the brain. There are two ways that this can happen. One way is
an embolic stroke, which occurs when a clot forms somewhere else in
your body and gets lodged in a blood vessel in the brain. The other way
is a thrombotic stroke, which is when the clot forms in a blood vessel
within the brain.
2. Hemorrhagic Stroke
A hemorrhagic stroke occurs when a blood vessel ruptures, or
hemorrhages, and then prevents blood from getting to part of the brain.
The hemorrhage may occur in any blood vessel in the brain, or it may
occur in the membrane surrounding the brain.

C. Symptoms
Symptoms of a stroke depend on the area of the brain affected. The most
common symptom is weakness or paralysis of one side of the body with
partial or complete loss of voluntary movement or sensation in a leg or arm.
There can be speech problems and weak face muscles, causing drooling.
Numbness or tingling is very common. A stroke involving the base of the
brain can affect balance, vision, swallowing, breathing and even
unconsciousness
Stroke symptoms include:
1. Difficult walking
2. Dizziness
3. Loss of balance and coordination
4. Difficulty speaking or understanding others who are speaking
 5. Numbness or paralysis in the face, leg, or arm, most likely on just one
side of the body
6. Blurred or darkened vision
7. A sudden headache, especially when accompanied by nausea, vomiting,
or dizziness

The symptoms of a stroke can vary depending on the individual and where in
the brain it has happened. Symptoms usually appear suddenly, even if
theyre not very severe, and they may become worse over time.

Remembering the acronym "FAST" helps people recognize the most

common symptoms of stroke:

1. Face: Does one side of the face droop?

2. Arm: If a person holds both arms out, does one drift downward?
3. Speech: Is their speech abnormal or slurred?
4. Time: Its time to call 911 and get to the hospital if any of these symptoms
are present.

D. Etiology
The causes of stroke: An artery to the brain may be blocked by a clot
(thrombosis) which typically occurs in a blood vessel that has previously
been narrowed due to atherosclerosis ("hardening of the artery"). When a
blood clot or a piece of an atherosclerotic plaque (a cholesterol and calcium
deposit on the wall of the artery) breaks loose, it can travel through the
circulation and lodge in an artery of the brain, plugging it up and stopping the
flow of blood; this is referred to as an embolic stroke. A blood clot can form in
a chamber of the heart when the heart beats irregularly, as in atrial
fibrillation; such clots usually stay attached to the inner lining of the heart but
they may break off, travel through the blood stream, form a plug (embolus) in
a brain artery and cause a stroke. A cerebral hemorrhage (bleeding in the
brain), as from ananeurysm (a widening and weakening) of a blood vessel in
the brain, also causes stroke.

E. Diagnosis
Healthcare providers have a number of tools to determine whether
youve had a stroke. Your healthcare provider will administer a full physical
examination, during which theyll check your strength, reflexes, vision,
speech, and senses. Theyll 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, they will check your blood pressure, which may be high if
youve had a stroke.
Your doctor may also perform diagnostic tests to discover the cause
of the stroke and pinpoint its location. These tests may include one or more
of the following:

1. Blood tests: Your healthcare provider 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.

2. Angiogram: An angiogram, which involves adding a dye to your blood and

taking an X-ray of your head, can help your doctor find the blocked or
hemorrhaged blood vessel.

3. Carotid ultrasound: This test uses sound waves to image the blood
vessels in your neck. This test can help your provider determine if theres
abnormal blood flow toward your brain.

4. Computed tomography (CT) scan: A CT scan is often performed soon

after symptoms of a stroke develop. The test can help your provider find
the problem area or other problems that might be associated with stroke.

5. Magnetic resonance imaging (MRI): An MRI can provide a more detailed

picture of the brain compared to CT scan

6. Echocardiogram: This imaging technique uses sound waves to create a

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

7. Electrocardiogram (EKG): This is an electrical tracing of your heart. This

will help your provider determine if an abnormal heart rhythm is the cause
of a stroke.

F. Treatment
Early use of anticoagulants to minimize blood clotting has value in some
patients. Treatment of blood pressure that is too high or too low may be
 necessary. The blood sugar (glucose) in diabetics is often quite high after a
stroke; controlling the glucose level may minimize the size of a stroke. Drugs
that can dissolve blood clots may be useful in stroke treatment. Clot
retrieving interventions can now be performed in some stroke centers.
Oxygen is given as needed. New medications that can help oxygen-starved
brain cells survive while circulation is reestablished are being developed.

References

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16-21.
"New Classification Scheme Helpful to Predict Risk of Stroke or Death." Heart Di
sease Weekly September 14, 2003: 3.
"New Drug Application Submitted to FDA for Exanta." Heart Disease Weekly Jan
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"New Stroke Prevention Drug." Chemist & Druggist September 13, 2003: 24.
"Poststroke Antidepressant Treatment Appears to Reduce Death Rate." Heart Di
sease Weekly October 26, 2003: 56.