Cerebrovascular Accident (CVA)

Cerebrovascular Accident (CVA), also referred to as a stroke, is the sudden death of brain cells due to lack of oxygen and nutrients. It occurs when blood flow to part of the brain gets impaired by blockage or rupture of blood vessels in the brain. CVA can cause long-lasting brain damage, long-term disability, and even death.

If you think you or your loved one is having a CVA, it’s wise to seek medical help right away. Immediate treatment can save someone’s life. Also, it can boost the chances for successful rehabilitation and recovery.

Types of Cerebrovascular Accident

There are two types of CVA or stroke:

Ischemic Stroke

About 80% of strokes are ischemic. It occurs when a blood clot (thrombosis) blocks a blood vessel in the brain, stopping blood flow. Therefore, preventing oxygen and nutrients from reaching the brain.

Besides blood clots, fat, cholesterol, and other substances can collect on the walls of blood vessels and harden. Thus, forming structures called plaque. The buildup of plaque clogs arteries, narrowing the passage of blood to the brain. As such, the brain cells fail to receive enough oxygen and nutrients, resulting in an ischemic stroke.

Ischemic stroke can occur in two ways. One is thrombotic stroke, which results from a clot forming in a blood vessel within the brain, hence cutting the supply of oxygen and blood to the brain. As a result, the brain cells of that part of the brain die. And the part of the body that the cells controlled will stop working.

The other way is embolic stroke. It occurs when a blood clot forms somewhere else in the body, breaks loose and travels through the bloodstream. It then gets lodged in a blood vessel in the brain.

Hemorrhagic Stroke

A hemorrhagic stroke happens when blood vessels in the brain rupture or hemorrhage. The blood vessels then bleed into the surrounding brain tissues.

The hemorrhage causes stroke by preventing the flow of blood and oxygen to other parts of the brain. Furthermore, blood flow is very irritating and result in swelling of brain tissues or cerebral edema.

The hemorrhage may occur in the membrane surrounding the brain or in any blood vessels in the brain.

Another condition that’s worth mentioning because of its similarity to stroke is transient ischemic attack or TIA. It’s usually referred to as a min-stroke. It happens when the blood supply to the brain gets blocked for a short period. Although the damage to the brain isn’t permanent, TIA places you at a higher risk of having a stroke.

Symptoms of Cerebrovascular Accident

The symptoms of CVA often happen quickly. If not diagnosed and treated, they can become worse over time. For this reason, it is crucial to identify and understand the common symptoms of a stroke. The symptoms include:

  • Sudden numbness or weakness of the arm, leg, or face, especially on one side of the body
  • Loss of balance and coordination
  • Sudden trouble speaking, confusion, or understanding speech
  • Difficulty walking
  • Dizziness
  • Blurred or darkened vision

Ischemic and hemorrhagic strokes have the same signs and symptoms. But patients with hemorrhagic stroke may also complain of severe headaches, nausea, and vomiting.

Symptoms of stroke depend on the individual and the area of the brain affected. From the onset of symptoms, there is only a 3 to 4-hour window to use thrombolytic (clot-busting drugs) to restore blood supply to the affected brain cells.

If you think someone is having a stroke, remember the acronym FAST to identify the most common symptoms.

  • Face drooping
  • Arm weakness
  • Speech difficulty
  • Time to call the hospital

Who is at Risk of Stroke?

Certain risk factors can increase an individual’s risk of a stroke. The main risk factors include:

  • High blood pressure
  • High cholesterol levels
  • Diabetes
  • Smoking- It raises your blood pressure and damages your blood vessels
  • People with heart diseases, especially atrial fibrillation
  • A family or personal history of TIA or stroke
  • Age- older people are at high risk of stroke
  • Race and ethnicity- Certain races like African American have a high risk of stroke
  • Other factors that can increase the risk of stroke include:
  • Unhealthy diet
  • Obesity
  • Not getting enough physical activity
  • Alcohol and illegal drug use

Diagnosis of Cerebrovascular Accident

Neurosurgeons can identify cerebrovascular problems by conducting diagnostic imaging tests. The tests allow them to view and examine the blood vessels in and around the brain and the brain tissue itself. This way, they can determine the cause of the stroke and pinpoint its location.

The diagnostic imaging test may include:

Cerebral Angiography: It’s also known as a carotid angiogram or vertebral angiogram. The test involves adding a dye to your blood and then taking x-ray pictures of your head. This allows the doctor to find the blocked or hemorrhages blood vessels.

Carotid duplex or carotid ultrasound: In this procedure, the doctor uses ultrasound to create images of the blood vessels in your neck. The images help the doctor detect plaque, blood clots, or other problems with the blood flow in the carotid arteries. Besides that, it helps the health provider identify abnormal blood flow toward your brain.

Computed Tomography (CT Scan): A CT scan is a useful diagnostic test for hemorrhagic strokes since examiners can easily see the blood. However, the scan might fail to reveal damage from ischemic stroke for several hours or days. Also, the individual blood vessels in the brain won’t be visible.

Magnetic Resonance Imaging (MRI): An MRI test can produce three-dimensional images of the brain. The test can help determine whether there are signs of prior mini-strokes. An MRI is more sensitive than a CT scan in detecting a stroke.

Echocardiogram: This test uses sound waves to develop detailed images of your heart. An echocardiogram can determine the source of clots in your heart that might have traveled from your heart to the brain, causing the stroke.

Electrocardiogram (ECG, EKG): An electrocardiogram is a test that checks the heart’s electrical activity. It can help the examiner determine whether heart problems caused the stroke.

Besides the imaging tests, a doctor will conduct physical exams such as listening to your heart and checking blood pressure. Also, he or she might conduct several blood tests to determine how fast your blood clots, levels of blood sugar, and whether you have an infection.

Treatment of Cerebrovascular Accident

Treatment of CVA depends on the type of stroke you’re having. Ischemic stroke treatment aims to restore blood flow, while hemorrhagic stroke treatment aims to control the bleeding.

Treatment of Ischemic Stroke

Doctors treat ischemic stroke by quickly removing the obstruction and restoring blood flow to the brain. They can achieve these through:

Emergency IV medication: The doctor can administer an FDA-approved drug–tissue plasminogen activator(tPA)- within 3 to 4.5 hours from the onset of the symptoms. The sooner they administer the drug, the better the chances of the patient’s survival. It also may reduce stroke-related complications.

tPA restores blood flow by dissolving the blood clot causing your stroke. By quickly removing the cause of the stroke, it can assist patients in recovering from a stroke.

However, this medication carries a risk for increased intracranial hemorrhage. That’s why it’s not used for hemorrhagic stroke.

Doctors can also administer blood-thinning drugs such as warfarin and aspirin, and clopidogrel or heparin.

Emergency endovascular procedure: Sometimes, doctors treat ischemic strokes directly inside the blocked artery. They can use the following procedures:

Removing the clot with a stent retriever: The retriever device helps to remove clots from the arteries of stroke patients. Patients with large blood clots will benefit from this procedure since tPA can’t dissolve all the clots.

Delivering medication directly to the brain: The doctors make a small incision in the patient’s groin, into which they insert a small catheter until it reaches your brain to deliver tPA directly where the stroke is happening. The time frame for this medication is longer than that for injected tPA but still limited.

Other Treatment Procedures

To prevent the occurrence of a stroke or transient ischemic attack again. Your doctor might recommend an invasive procedure to open up the artery narrowed by plaque. Procedures your doctor might suggest include:

  • Carotid Endarterectomy: The surgery involves the removal of plaque, blocking the blood vessels running along each side of your neck, supplying your brain with blood. But this procedure involves risks, particularly for individuals with heart disease or other medical conditions.
  • Angioplasty and stents: During an angioplasty, a doctor inserts a catheter through an artery in your groin and threads it to your carotid arteries. Next, he or she inflates a balloon to expand the narrow artery and inserts a stent to keep the artery open. This procedure will help to improve blood flow in the brain’s arteries and veins.

Treatment of Hemorrhagic Stroke

Hemorrhagic stroke treatment involves administering drugs to ease pressure caused by the bleeding. But if the bleeding is severe, the doctor might have to perform intracranial surgery to reduce the pressure and remove excess blood.

Doctors can also do surgery to repair or seal defective blood vessels and redirect blood flow to other vessels that supply blood to the damaged region of the brain.

Endovascular treatment will involve threading a catheter to the defective blood vessels through a major artery, usually in the thigh, then inserting stents (tiny platinum coils) into the blood vessels through the catheter. The stents will not only support the blood vessels but also prevent further damage and extra strokes.

Doctors can also perform stereotactic radiosurgery. The surgery involves using many beams of focused radiation to repair blood vessel malformations.

Cerebrovascular Accident Recovery and Rehabilitation

After cerebrovascular accident treatment, many patients receive post-stroke rehabilitation from recovering as much function as possible and returning to independent living.

The impact of your CVA depends on the brain area involved and the amount of tissue damaged. If It’s the left side of the brain, the movement and sensation of the left part of your body might get affected and vice versa.

Rehabilitation will help the undamaged area of the brain may learn how to perform the functions that were lost when the stroke happened. The rehabilitation program will include physical therapy, occupational therapy, and speech therapy.

Rehabilitation will also prevent another stroke from happening by eliminating risk factors such as high cholesterol, high blood pressure, and diabetes.

Prevention of Cerebrovascular Accident

If you have already suffered from stroke or possess the risk factors of stroke, you should make some lifestyle changes to prevent a future stroke. Here are ways you can do to reduce the risk:

  • Eat a heart-healthy diet
  • Maintain normal blood pressure
  • Reduce saturated fat and cholesterol intake
  • Manage stress
  • Getting regular physical activity
  • Eat a diet rich in vegetables and fruits
  • Quit smoking
  • Aim for a healthy weight

If these lifestyle changes are not enough, your healthcare provider may prescribe medications for preventing stroke.

Final Note

Cerebrovascular Accident (CVA) is a severe medical condition that requires immediate medical attention once it occurs. The quickly the patient receives diagnosis and treatment, the better the prognosis and the higher the chances of preventing permanent brain damages.

If you or someone around you has stroke risk factors, it’s wise to adopt life changes that can prevent the condition from happening. Also, we suggest you contact your health care provider to receive the needed help and recommendations.