02/06/2025
๐๐ฉ๐ง๐ค๐ ๐/๐พ๐๐ง๐๐๐ง๐ค๐ซ๐๐จ๐๐ช๐ก๐๐ง ๐ผ๐๐๐๐๐๐ฃ๐ฉ (CVA)
A Cerebrovascular Accident (CVA) or stroke is a sudden loss of brain function due to a disturbance in the blood supply to the brain. This can be caused by ischemia (lack of blood flow) due to a blockage or by hemorrhage (bleeding). The resulting lack of oxygen and nutrients can lead to the death of brain cells.
๐๐ฎ๐ฅ๐๐จ ๐ค๐ ๐๐ฉ๐ง๐ค๐ ๐
1. Ischemic Stroke (โ 85% of cases)
Caused by an obstruction in a blood vessel supplying blood to the brain.
Subtypes:
-Thrombotic stroke: Caused by a blood clot (thrombus) forming in an artery in the brain.
-Embolic stroke: Caused by a clot or debris that forms elsewhere in the body (commonly the heart) and travels to the brain.
2. Hemorrhagic Stroke (โ 15% of cases)
Caused by the rupture of a blood vessel in the brain.
Subtypes:
-Intracerebral hemorrhage: Bleeding within the brain tissue itself.
-Subarachnoid hemorrhage: Bleeding into the subarachnoid space (often from a ruptured aneurysm).
3. Transient Ischemic Attack (TIA)
Often called a "mini-stroke."
Temporary blockage of blood flow to the brain.
Symptoms resolve within 24 hours without permanent damage.
A major warning sign for future strokes.
๐๐ฉ๐๐ค๐ก๐ค๐๐ฎ / ๐๐๐จ๐ ๐๐๐๐ฉ๐ค๐ง๐จ
โขModifiable:
-Hypertension (most significant risk factor)
-Diabetes mellitus
-Smoking
-Hyperlipidemia
-Obesity
-Sedentary lifestyle
-Atrial fibrillation and other cardiac diseases
-Excessive alcohol intake
โขNon-modifiable:
-Age (risk increases with age)
-Gender (males > females)
-Family history
-Previous stroke or TIA
๐๐๐ฉ๐๐ค๐ฅ๐๐ฎ๐จ๐๐ค๐ก๐ค๐๐ฎ
โขIn ischemic stroke, a blockage (thrombus or embolus) leads to decreased cerebral blood flow. This causes an ischemic cascade leading to:
-Energy failure
-Loss of ionic gradients
-Excitotoxicity (glutamate release)
-Calcium influx
-Cell death
โขIn hemorrhagic stroke, vessel rupture causes bleeding into brain tissue, increasing intracranial pressure and damaging nearby cells.
๐พ๐ก๐๐ฃ๐๐๐๐ก ๐๐๐๐ฉ๐ช๐ง๐๐จ
Symptoms depend on the area of the brain affected but may include:
Sudden onset of:
-Weakness or numbness of face, arm, or leg (especially on one side)
-Difficulty speaking or understanding speech (aphasia)
-Visual disturbances (e.g., blurred vision, loss of vision)
-Loss of coordination or balance
-Severe headache (especially in hemorrhagic stroke)
-Altered level of consciousness or confusion
๐๐ผ๐๐ Mnemonic for Recognition:
>Face drooping
>Arm weakness
>Speech difficulty
>Time to call emergency services
๐ฟ๐๐๐๐ฃ๐ค๐จ๐๐จ
1. Clinical evaluation
History and neurological examination
2. Imaging
-CT scan (non-contrast): First line to differentiate ischemic vs. hemorrhagic stroke
-MRI brain: More sensitive, especially in early ischemia
3. Other investigations:
-ECG (to check for atrial fibrillation)
-Echocardiography (to look for cardiac emboli)
-Carotid Doppler
-Blood tests (glucose, CBC, lipid profile, clotting profile)
๐๐๐ฃ๐๐๐๐ข๐๐ฃ๐ฉ
Acute Management:
1. Ischemic Stroke:
-Thrombolysis: IV alteplase (tPA) within 4.5 hours of symptom onset if no contraindications
-Mechanical thrombectomy: For large vessel occlusions within 6โ24 hours
-Antiplatelet therapy: Aspirin after 24 hours (if tPA not given or after thrombolysis)
2. Hemorrhagic Stroke:
-Control of blood pressure
-Reversal of anticoagulation if applicable
-Surgical intervention (e.g., hematoma evacuation, aneurysm clipping/coiling)
-Management of increased intracranial pressure
๐๐ช๐ฅ๐ฅ๐ค๐ง๐ฉ๐๐ซ๐ ๐พ๐๐ง๐:
-Airway management
-Monitoring vital signs
-Control of glucose and temperature
-Prevention of complications (DVT, infections, pressure sores)
๐๐๐๐๐๐๐ก๐๐ฉ๐๐ฉ๐๐ค!
Begins as early as possible and includes:
โขPhysical therapy: Strengthening, mobility, and coordination
โขOccupational therapy: Activities of daily living (ADLs)
โขSpeech therapy: For aphasia or dysphagia
โขPsychological support: For depression or cognitive deficits
๐พ๐ค๐ข๐ฅ๐ก๐๐๐๐ฉ๐๐ค๐ฃ๐จ
-Increased intracranial pressure
-Seizures
-Pneumonia (aspiration)
-Deep vein thrombosis (DVT)
-Long-term disability
-Cognitive impairment or dementia
-Depression
๐๐ง๐ค๐๐ฃ๐ค๐จ๐๐จ
Depends on:
-Type, size, and location of the stroke
-Time to treatment
-Patient's age and overall health
-Early intervention and rehabilitation significantly improve outcomes
๐๐ง๐๐ซ๐๐ฃ๐ฉ๐๐ค๐ฃ
-Control of risk factors (blood pressure, diabetes, cholesterol)
-Lifestyle changes (diet, exercise, no smoking or excessive alcohol)
-Antiplatelet or anticoagulant therapy in high-risk patients
-Carotid endarterectomy or stenting in select cases
