Cerebrovascular Accident (CVA)

* Progressive CVA, or stroke - in - evolution ( thrombus - in - evolution ), begins
with slight neurologic deficit and worsens in a day or two.

* Complete CVA, the patient experiences maximal neurologic deficits at onset.

Most common cause of CVA is a result from thrombosis. Other causes include
embolism and hemorrhage. Risk factors increase the likelihood of CVA, such as
atherosclerosis, hypertension, dysrhythmias, rheumatic heart disease, diabetes mellitus,
gout, postural hypotension, and cardiac hypertrophy. Other risk factors include high
serum triglyceride levels, and sedentary life - style ( inactive habit ), the use of
contraceptives, cigarette smoking, and a family history of CVA.

CVA Symptoms:

Clinical features of CVA vary with the artery affected ( and , Consequently, the portion
of the brain it supplies ), the severity of damage, and the extent of collateral circulation
that develops to help the brain compensate for decreased blood supply. If CVA occurs
in the left hemisphere, it produces symptoms on the right side; if in the right hemisphere,
symptoms are on the left side. However, a CVA that causes cranial nerve damage
produces signs of cranial nerve dysfunction on the same side as the hemorrhage.
Usually the symptoms are classified according to the artery affected. It can also be
classified as premonitory, generalized, and focal.

Middle cerebral artery: This type of CVA may cause aphasia ( loss of the power of
expression of speech, writing, or signs or of comprehending spoken or written language)
, dysphasia ( impairment of speech), visual field cuts, and hemiparesis on the affected
side ( more severe in the face and arm than in the leg ).

Carotid artery: The patient may experience weakness, paralysis, numbness, sensory
changes, visual disturbances on the affected side, altered level of consciousness, bruits,
headaches, aphasia, and ptosis ( paralytic drooping of the upper eyelid ).

Vertebrobasilar artery: patients may experience weakness on the affected side,
numbness around the lips and mouth, visual field cuts, diplopia ( the preception of two
images of a single object ), poor coordination, dysphagia, slurred speech, dizziness,
amnesia, and failure of muscular coordination (ataxia).

Anterior cerebral artery: This type of stroke can cause confusion, weakness and
numbness on the affected side ( especially in the leg ), incontinence, loss of coordination,
impaired motor and sensory functions, and may have personality changes.

Posterior cerebral arteries: Paralysis usually doesn't occur. Patient may experience
visual field cuts, sensory impairment, dyslexia, coma, and cortical blindness.

Diagnostic tests: CT scan shows evidence of thrombotic or hemorrhagic stroke, tumor,
or hydrocephalus. Brain scan show ischemic areas but may not be positive for up to 2
weeks after the CVA. Other tests includes; lumbar puncture, ophthalmoscopy,
angiography, EEG, and lab studies.

Treatment:

Medication useful in CVA include: anticonvulsants to treat seizures, stool softeners, to
avoid straining, which increases ICP ( intracranial - pressure ), corticosteroids, to
minimize associated cerebral edema, analgesics to relieve headache that may follow
hemorrhagic CVA. Usually aspirin is contraindicated in hemorrhagic CVA because it
increases bleeding tendencies, but it may be useful in preventing TIAs.

Surgery to improve cerebral circulation for patients with thrombotic or embolic CVA
includes; endarterectomy ( removal of atherosclerotic plaques from inner arterial wall),
or microvascular bypass ( extracranial vessel is surgically anastomosed to an
intracranial vessel ).

For More On CVA, See Stroke: (click)

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