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Tuesday, March 18, 2014

Cerebrovascular Accident







Stroke, CVA, or brain attack

  • Stroke occurs when an infarct (damage) to the brain occurs, either because there is not enough blood or oxygen (nonhemorrhagic Stroke) going to the brain, or due to bleeding into the brain (hemorrhagic Stroke). A Non-hemorrhagic Stroke is more common than a hemorrhagic StrokeStrokes cause symptoms and physical findings depending on the area injured in the injured brain.

  • Arm or leg weakness and paralysis
  • Speech difficulties
  • Balance problems when walking
  • Numbness or lack of sensation
  • Hand clumsiness
  • Sudden vision loss
  • Confusion
  • Nausea
  • Room spinning
  • Seizure
  • Coma

  • Certain irregularities such as atrial fibrillation to the brain, cause the blood clot to move from the valve of the heart
  • The blood clot moves from the carotid arteries to the brain
  • Blood vessels to the brain become narrow due to cholesterol blockage
  • Severely Low Blood Sugar
  • Decreased oxygen in the blood due to lung problems
  • Myocardial Infarction (heart attack), in which the heart does not pump enough blood to the brain
  • A heart arrythmia does not allow the heart to pump enough blood to the brain
  • Very High Blood Pressure

  • Neurological examination
  • A CT scan can make an immediate diagnosis especially of hemorrhagic Strokes
  • A MRI may be performed, but usually is done for 2-3 days
  • Laboratory:
  1. Complete blood count, Blood glucose, sedimentation rate, PT, PTT, Lipid (cholesterol) profile.
  2. If a hypercoaguable (blood clots too easily) is suspected, then the lupus anticoagulant, and anticardiolipin antibodies are examined. Blood cultures are checked if endocarditis (heart infection) is suspected.
  • An EKG can rule out a cardiac problem
  • Pulse oximetry to check blood oxygenation
  • Cardiac monitoring to rule out an arrythmia
  • Echocardiogram (or Transesophageal echo) to check for blood clots on the heart valve

  • High Blood Pressure
  • Cigarette smoking
  • Diabetes
  • High cholesterol
  • Heart disease
  • Alcohol Abuse
  • Family history of Strokes

  • Nonhemorrhagic Stroke:
    1. If treatment can be started within 3 hours of the first symptom, then thrombolytic therapy ("clot breaking drug") with Altepase may be considered as an option
    2. Low doses of intravenous heparin is sometimes an option
    3. Supportive measures may be considered as an option
    4. Blood pressure is cautiously controlled (Lowering blood pressure too much may cause another Stroke to occur)
  • Hemorrhagic Stroke:
  1. Supportive measures only. All blood thinning medications will make a Stroke worse, and therefore need to be avoided.
  2. Correct any bleeding problems. Again, blood pressure is controlled very cautiously (we do not want to lower blood pressure too much or a another Stroke may occur)

  • You need immediate emergency medical treatment.

  • If the patient has atrial fibrillation (a heart irregularity), Coumadin (Warfarin) is recommended. A secondary option here is aspirin.
  • If there is Carotid Stenosis (blockage or narrowing), then surgery is often recommended to open blockages -- the decision on when and on whom to do this on, is made by your doctor.
  • Cholesterol lowering medications such as Pravachol have been shown to lower the risk of a Stroke.
  • Cholesterol levels should be brought to a normal level.
  • Diabetes should be controlled
  • You should stop smoking cigarettes. Discuss with your doctors methods to Quit Smoking (e.g., Zyban, Nicotine patches, hypnosis, etc.)

  • Transient Ischemic Attack
  • Intracerebral Hemorrhage
  • Subarachnoid Hemorrhage

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