This document discusses cerebrovascular accidents (strokes). It defines strokes as occurring when blood flow to the brain is interrupted, and describes the two main types: ischemic (caused by blockage) and hemorrhagic (caused by ruptured blood vessel). Risk factors include conditions like high blood pressure, smoking, obesity, and older age. Symptoms appear suddenly and may include weakness, trouble speaking, or vision issues. Diagnosis involves tests like CT/MRI scans and angiograms. Treatment depends on stroke type but aims to restore blood flow or control bleeding. Prevention focuses on controlling risk factors like blood pressure and diabetes.

1. JOHNY WILBERT, M.SC[N]
LECTURER,
APOLLO INSTITUTE OF HOSPITAL
MANAGEMENT AND ALLIED SCIENCE

2. Cerebrovascular accident (CVA) 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 the
rupture of a blood vessel.

3. Types of cerebrovascular accident
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.
Transient ischemic attack, TIA, or ministroke
(The stroke symptoms resolve within minutes, but
may take up to 24 hours on their own without
treatment. This is a warning sign that a stroke may
occur in the near future

4. Etiology
Ischemic stroke
Modifiable risk factor
Lifestyle risk factors
Being overweight or obese
Cigarette smoking or exposure to second hand
smoke
Physical inactivity
Heavy or binge drinking
Use of illicit drugs such as cocaine and
methamphetamines

5. Medical risk factors
Blood pressure readings higher than 120/80
millimeters of mercury (mm Hg)
High cholesterol
Diabetes
Cardiovascular disease, including heart failure,
heart defects, heart infection or abnormal heart
rhythm
Personal or family history of stroke, heart
attack or transient ischemic attack.

6. Non-modifiable risk factor
Age —People age 55 or older have a higher risk
of stroke than do younger people.
Race — African-Americans have a higher risk of
stroke than do people of other races.
Sex — 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.
Hormones — use of birth control pills or hormone
therapies that include estrogen, as well as
increased estrogen levels from pregnancy and
childbirth.

7. Risk factors for haemorrhagic stroke
include:
high blood pressure;
smoking;
taking anticoagulant medicines;
having a bleeding disorder (such as
thrombocytopenia or haemophilia); and
a previous brain/head injury.

8. Symptoms of a cerebrovascular accident
The quicker you can get a diagnosis and treatment for a
stroke, the better your prognosis will be.
Stroke symptoms include:
 difficulty walking
 dizziness
 loss of balance and coordination
 difficulty speaking or understanding others who are
speaking
 numbness or paralysis in the face, leg, or arm, most
likely on just one side of the body
 blurred or darkened vision
 a sudden headache, especially when accompanied by
nausea, vomiting, or dizziness

9. 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 they’re not very severe, and they may
become worse over time.
Remembering the acronym “FAST” helps people
recognize the most common symptoms of stroke:
Face: Does one side of the face droop?
Arm: If a person holds both arms out, does one
drift downward?
Speech: Is their speech abnormal or slurred?
Time: It’s time to call 911 and get to the hospital
if any of these symptoms are present.

10. Diagnosis of a cerebrovascular accident
Healthcare providers have a number of tools to
determine whether you’ve had a stroke. Your
healthcare provider will administer a full
physical examination, during which they’ll
check your strength, reflexes, vision, speech,
and senses.
They’ll 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 you’ve had a stroke.

11.  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:
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.
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.
Carotid ultrasound: This test uses sound waves to
create images of the blood vessels in your neck.
This test can help your provider determine if
there’s abnormal blood flow toward your brain.

12.  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.
 MRI scan: An MRI can provide a more detailed picture of
the brain compared to CT scan. It’s more sensitive than a
CT scan in being able to detect a stroke.
 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.
 Electrocardiogram (EKG): This is an electrical tracing of
your heart. This will help your healthcare provider
determine if an abnormal heart rhythm is the cause of a
stroke.

13. Treatment for a cerebrovascular accident
 Treatment for stroke depends on the type of stroke
you’ve had. The goal of treatment for ischemic stroke,
for instance, is to restore the blood flow. Treatments for
hemorrhagic stroke are aimed at controlling the
bleeding.
Ischemic stroke treatment
 Thrombolysis
 Intravenous recombinant tissue plasminogen activator)
in a dose of 0.9 mg/kg (maximum 90 mg) given over
one hour within three hours of onset of ischaemic
stroke. showed a highly significant increase in the
proportion of patients making full neurological recovery
from stroke.

14. Antiplatelet treatment—There is substantial
evidence supporting the value of aspirin 75–
300 mg. Aspirin plus modified release
dipyridamole (200 mg twice daily) or
clopidogrel monotherapy (75 mg daily) are
more effective,
▸ Anticoagulation—Warfarin significantly
reduces risk of recurrent stroke, myocardial
infarction, and systemic embolism in patients
in atrial fibrillation after minor stroke.

15. Antihypertensive treatment—Reduction in
stroke risk with antihypertensive treatment is
probably similar to the relative risk reduction
achievable with this therapy in the primary
prevention setting
Smoking cessation—Stopping smoking has not
been subjected to clinical trials but should be
beneficial.

16. Surgical treatment
Endovascular procedures.
Endovascular procedures may be used to treat
certain hemorrhagic strokes. The doctor inserts
a long tube through a major artery in the leg or
arm and then guides the tube to the site of the
weak spot or break in a blood vessel. The tube
is then used to install a device, such as a coil,
to repair the damage or prevent bleeding.

17. angioplasty
Some patients can be helped by a procedure
called angioplasty, During the procedure, a tiny
balloon at the end of a long, thin tube is pushed
through the artery to the blockage. When the
balloon is inflated, it opens the artery. In
addition, a mesh tube may be placed inside the
artery to help hold it open. The tube is called a
stent.

18. carotid endarterectomy
The operation is called a carotid
endarterectomy This procedure cleans out and
opens up the narrowed artery. During the
operation, the surgeon scrapes away plaque
from the wall of the artery. Blood can then flow
freely through the artery to the brain
clipping
A clip may be placed across the
neck of the aneurysm (like a clip at the end of a
balloon) to stop the bleeding.

19. Bypass surgery
Bypass surgery may be advised for some
patients who continue to have TIAs. During the
operation, an artery on the outside of the scalp
is re-routed to the part of the brain that is not
getting enough blood flow.
craniotomy
 It is a surgical operation in which a bone flap is
temporarily removed from the skull to access
the brain, cariotomy is one to remove the clot
and relive pressure in the cranial cavity

20. Decompressive craniectomy is
a neurosurgical procedure in which part of
the skull is removed to allow a
swelling brain room to expand without being
squeezed.

21. Prevention of a cerebrovascular accident
There are many risk factors for having a stroke,
including diabetes, atrial fibrillation,
and hypertension
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.