cerebrovascular accident article
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ar_accident/articles.htm
Cerebrovascular accident: Introduction
Cerebrovascular accident is a very serious condition in which the brain is not
receiving enough oxygen to function properly. A cerebrovascular accident is
also called CVA, brain attack, cerebral infarction or stroke.
A cerebrovascular accident often results in permanent serious complications
and disability and is a common cause
of death.Cerebrovascular accidents are the second leading cause
of death worldwide and the third leading cause of death in the U.S.,
according to theAmerican Heart Association.
The brain requires a steady supply of oxygen in order to pump blood
effectively to all of the body. Oxygen is supplied to the brain in the blood that
flows through arteries. In a cerebrovascular accident, one or more of these
arteries becomes blocked or ruptures or begins to leak. This deprives a
portion of the brain of vital oxygen-rich blood. This damage can become
permanent within minutes and result in the death of the affected brain tissue.
This is called cerebral necrosis.
There are two types of cerebrovascular accidents. An ischemic
cerebrovascular accident occurs when a brain artery has been blocked. A
hemorrhagic cerebrovascular accident occurs when an artery ruptures or
leaks.
There are three primary causes of cerebrovascular accidents: cerebral
thrombosis, cerebral embolism and cerebral hemorrhage.
A cerebrovascular accident caused by a cerebral thrombosis is the result of a
build-up of plaque and inflammation in the arteries, called atherosclerosis.
This process narrows the brain arteries and lowers the amount of oxygen-
rich blood that reaches the brain tissue. Arteries narrowed
by atherosclerosisare more likely to develop a blood clot that completely
blocks blood flow to an area of the brain. Risk factors
for atherosclerosis include having high cholesterol, diabetes,
and hypertension.
Cerebrovascular accident cause by a cerebral embolism occurs when a clot
forms in another part of the body and travels in the bloodstream to a brain
artery, blocking the flow of blood to the brain. A cerebrovascular accident
caused by cerebral hemorrhage occurs when a brain artery breaks or leaks
blood into the surrounding brain tissue.
The extent of the damage done to the brain and resulting symptoms of a
cerebrovascular accident vary depending on the type, the area or areas of
the brain affected, and how much time passes before the cerebrovascular
accident is treated. Complications of cerebrovascular accident include
permanent neurological damage, disability and death. For more information
on key hallmark symptoms and other complications, refer to symptoms of
cerebrovascular accident.
Risk factors for a cerebrovascular accident include a
having hypertension, heart disease, diabetes, high cholesterol and obesity.
Other risk factors include being of African-American ancestry, being male,
drinking excessive amounts of alcohol, smoking and having a family history
of heart disease or cerebrovascular accident. Having a brain aneurysm puts
a person at an extreme risk for a hemorrhagic cerebrovascular accident.
Making a diagnosis of cerebrovascular accident includes completing a
complete medical evaluation and history and physical examination, including
a neurological examination. This is often done in an emergency room.
Diagnostic testing includes imaging tests, such as a CT or MRI and cerebral
angiogram of the brain. A cerebral angiogram is an imaging test that reveals
obstructed or narrowed arteries in the brain and can show blood flow or
obstruction through the arteries of the brain.
A battery of other tests are also performed to evaluate for other conditions
that commonly occur with a cerebrovascular accident, such as heart
diseaseand cardiac arrhythmia.
It is possible that a diagnosis of cerebrovascular accident can be missed or
delayed because the symptoms may be mild and be similar to symptoms of
other conditions and diseases. For more information about diseases and
conditions that can mimic a cerebrovascular accident, refer to misdiagnosis
of cerebrovascular accident.
If caught early, some cerebrovascular accidents can be successfully treated
before the development of permanent brain damage and complications. For
more information on specific treatment plans, refer to treatment of
cerebrovascular accident. ...more »
Stroke symptoms: There are various causes of stroke-like symptoms
including stroke, transient ischemic attacks (mini-strokes) and several other
serious conditions ... more about Stroke symptoms.
Cerebrovascular accident: Occurs when the blood supply to the brain is
interrupted and results in cell injury and death. More detailed information
about the symptoms, causes, and treatments of Cerebrovascular accident is
available below.
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• supply to a part of the brain. As opposed to lacunar strokes, larger parts of
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Symptoms of Cerebrovascular accident: Introduction
Symptoms of a cerebrovascular accident differ depending on a variety of
factors, including the cause and the type and size of the area of the brain
that is affected. In some cases, symptoms may be mild and only
include weakness, dizziness or headache. Symptoms such as these may
also be warning symptoms of an impending cerebrovascular accident. These
symptoms can also be symptoms of a "small stroke", more accurately called
a transient ischemic attack.
Related Cerebrovascular accident Info
Videos about Cerebrovascular accident
What is a Stroke?
Watch Video
Related Pages
1. Cerebrovascular accident: Introduction
2. Symptoms Overview
3. List of Symptoms of Cerebrovascular accident
4. Tests to Confirm Diagnosis
5. Home Diagnostic Testing
6. Alternative Diagnoses
7. Misdiagnosis information
8. Complications
9. More about Symptoms
10. Medical articles
Cerebrovascular accidents often do occur suddenly with dramatic symptoms,
such as numbness,weakness, and paralysis of the face, leg or arm, or entire
side of the body. There may also be a loss of consciousness, facial
drooping, slurred speech, aphasia, confusion, blurred vision, and impaired
breathing or swallowing. There may also be difficulty understanding
speech, change in vision, and incoordination. Nausea and vomiting may
also occur.
Serious complications of cerebrovascular accident include long-term
difficulties with such activities as walking, talking, movement of the limbs and
permanent disability. Coma and death may also occur...
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at http://www.wrongdiagnosis.com/c/cerebrovascular_accident/symptoms.ht
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http://www.medicinenet.com/stroke/article.htm
What is a stroke?
Brain cell function requires a constant delivery of oxygen and glucose from
the bloodstream. A stroke, or cerebrovascular accident (CVA), occurs when
blood supply to part of the brain is disrupted, causing brain cells to die. Blood
flow can be compromised by a variety of mechanisms.
Blockage of an artery
• Narrowing of the small arteries within the brain can cause a lacunar
stroke, (lacune means "empty space"). Blockage of a single arteriole can
affect a tiny area of brain causing that tissue to die (infarct).
• Hardening of the arteries (atherosclerosis) leading to the brain. There
are four major blood vessels that supply the brain with blood. The
anterior circulation of the brain that controls most motor activity,
sensation, thought, speech, and emotion is supplied by the carotid
arteries.The posterior circulation, which supplies the brainstem and the
cerebellum, controlling the automatic parts of brain function and
coordination, is supplied by the vertebrobasilar arteries.
If these arteries become narrow as a result of atherosclerosis, plaque
orcholesterol, debris can break off and float downstream, clogging the blood
 the brain can lose blood supply, and this may produce more symptoms than
a lacunar stroke.
• Embolism to the brain from the heart. In some instances blood
clots can form within the heart and the potential exists for them to break
off and travel (embolize) to the arteries in the brain and cause a stroke.
Rupture of an artery (hemorrhage)
• Cerebral hemorrhage (bleeding within the brain substance). The most
common reason to have bleeding within the brain is uncontrolled high
blood pressure. Other situations include aneurysms that leak or rupture or
arteriovenous malformations (AVM) in which there is an abnormal
collection of blood vessels that are fragile and can bleed.
What causes a stroke?
Blockage of an artery
The blockage of an artery in the brain by a clot (thrombosis) is the most
common cause of a stroke. The part of the brain that is supplied by the
clotted blood vessel is then deprived of blood and oxygen. As a result of the
deprived blood and oxygen, the cells of that part of the brain die and the part
of the body that it controls stops working. Typically, a cholesterol plaque in a
small blood vessel within the brain that has gradually caused blood vessel
narrowing ruptures and starts the process of forming a small blood clot.
Risk factors for narrowed blood vessels in the brain are the same as those
that cause narrowing blood vessels in the heart and heart attack (myocardial
infarction). These risk factors include:
• high blood pressure (hypertension),
• high cholesterol,
• diabetes, and
• smoking.
Embolic stroke
Another type of stroke may occur when a blood clot or a piece of
atherosclerotic plaque (cholesterol and calcium deposits on the wall of the
inside of the heart or artery) breaks loose, travels through the bloodstream
and lodges in an artery in the brain. When blood flow stops, brain cells do not
receive the oxygen and glucose they require to function and a stroke occurs.
This type of stroke is referred to as an embolic stroke. For example, a blood
clot might originally form in the heart chamber as a result of an irregular heart
rhythm, such as occurs in atrial fibrillation. Usually, these clots remain
attached to the inner lining of the heart, but occasionally they can break off,
travel through the blood stream, form a plug (embolism) in a brain artery, and
cause a stroke. An embolism can also originate in a large artery (for
example, the carotid artery, a major artery in the neck that supplies blood to
the brain) and then travel downstream to clog a small artery within the brain.
Cerebral hemorrhage
A cerebral hemorrhage occurs when a blood vessel in the brain ruptures and
bleeds into the surrounding brain tissue. A cerebral hemorrhage (bleeding in
the brain) causes stroke symptoms by depriving blood and oxygen to parts of
the brain in a variety of ways. Blood flow is lost to some cells. As well, blood
is very irritating and can cause swelling of brain tissue (cerebral
edema). Edema and the accumulation of blood from a cerebral hemorrhage
increases pressure within the skull and causes further damage by squeezing
the brain against the bony skull further decreasing blood flow to brain tissue
and cells.
Subarachnoid hemorrhage
In a subarachnoid hemorrhage, blood accumulates in the space beneath the
arachnoid membrane that lines the brain. The blood originates from an
abnormal blood vessel that leaks or ruptures. Often this is from an aneurysm
(an abnormal ballooning out of the wall of the vessel). Subarachnoid
hemorrhages usually cause a sudden, severeheadache, nausea, vomiting,
light intolerance, and a stiff neck. If not recognized and treated, major
neurological consequences, such as coma, and brain death may occur.
Vasculitis
Another rare cause of stroke is vasculitis, a condition in which the blood
vessels become inflamed causing decreased blood flow to brain tissue.
Migraine headache
There appears to be a very slight increased occurrence of stroke in people
with migraine headache. The mechanism for migraine or vascular headaches
includes narrowing of the brain blood vessels. Some migraine headache
episodes can even mimic stroke with loss of function of one side of the body
or vision or speech problems. Usually, the symptoms resolve as the
headache resolves.
What are the risk factors for stroke?
Overall, the most common risk factors for stroke are:
• high blood pressure,
• high cholesterol,
• smoking,
• diabetes and
• increasing age.
Heart rhythm disturbances like atrial fibrillation, patent foramen ovale,
and heart valve disease can also be the cause.
When strokes occur in younger individuals (less than 50 years old), less
common risk factors to be considered include illicit drugs, such as cocaine or
amphetamines, ruptured aneurysms, and inherited (genetic) predispositions
to abnormal blood clotting.
An example of a genetic predisposition to stroke occurs in a rare condition
called homocystinuria, in which there are excessive levels of the chemical
homocystine in the body. Scientists are trying to determine whether the non-
hereditary occurrence of high levels of homocystine at any age can
predispose to stroke.
What is a transient ischemic attack (TIA)?
A transient ischemic attack (TIA, mini-stroke) is a short-lived stroke that gets
better and resolves. It is a short-lived episode (less than 24 hours) of
temporary impairment if brain function that is caused by a loss of blood
supply. A TIA causes a loss of function in the area of the body that is
controlled by the portion of the brain affected. The loss of blood supply to the
brain is most often caused by a clot that spontaneously forms in a blood
vessel within the brain (thrombosis). However, it can also result from a clot
that forms elsewhere in the body, dislodges from that location, and travels to
lodge in an artery of the brain (emboli). A spasm and, rarely, a bleed are
other causes of a TIA. Many people refer to a TIA as a "mini-stroke."
Some TIAs develop slowly, while others develop rapidly. By definition, all
TIAs resolve within 24 hours. Strokes take longer to resolve than TIAs, and
with strokes, complete function may never return and reflect a more
permanent and serious problem. Although most TIAs often last only a few
minutes, all TIAs should be evaluated with the same urgency as a stroke in
an effort to prevent recurrences and/or strokes. TIAs can occur once,
multiple times, or precede a permanent stroke. A transient ischemic attack
should be considered an emergency because there is no guarantee that
the situation will resolve and function will return.
A TIA from a clot in the blood vessel that supplies the retina of the eye can
cause temporary visual loss (amaurosis fugax), which is often described as
the sensation of a curtain coming down. A TIA that involves the carotid artery
(the largest blood vessel supplying the brain) can produce problems with
movement or sensation on one side of the body, which is the side opposite to
the actual blockage. An affected patient may experience temporary double
vision, dizziness (vertigo), loss of balance, one sidedweakness or
complete paralysis of the arm, leg, face, or one whole side of the body or be
unable to speak or understand commands.
What is the impact of strokes?
In the United States, stroke is the third largest cause of death (behind heart
diseaseand all forms of cancer). The cost of strokes is not just measured in
the billions of dollars lost in work, hospitalization, and the care of survivors in
nursing homes. The major cost or impact of a stroke is the loss of
independence that occurs in 30% of the survivors. For some individuals,
what was a self-sustaining and an enjoyable lifestyle prior to the stroke,
many may lose most of their quality of life after a stroke. Family members
and friends may have their lives altered as they find themselves in the new
role as caregivers.
What are stroke symptoms?
When brain cells are deprived of oxygen, they cease to perform their usual
tasks. The symptoms that follow a stroke depend on the area of the brain
that has been affected and the amount of brain tissue damage.
Small strokes may not cause any symptoms, but can still damage brain
tissue. These strokes that do not cause symptoms are referred to as silent
strokes. According to The U.S. National Institute of Neurological Disorders
and Stroke (NINDS), these are the five major signs of stroke:
1. Sudden numbness or weakness of the face, arm or leg, especially
on one side of the body. The loss of voluntary movement and/or
sensation may be complete or partial. There may an associated
tingling sensation in the affected area.
2. Sudden confusion or trouble speaking or understanding.
Sometimes weakness in the muscles of the face can
cause drooling.
3. Sudden trouble seeing in one or both eyes
4. Sudden trouble walking, dizziness, loss of balance or coordination
5. Sudden, severe headache with no known cause
What should be done if you suspect you or someone else is
having a stroke?
If any of the symptoms mentioned above suddenly appear, immediate
emergency medical attention should be sought. The first action should be to
activate the emergency medical system in your area (call 911 if it is
available). The goal is to get the stroke victim to a hospital as quickly as
possible to confirm the diagnosis. An urgent medical decision is necessary in
the emergency room to determine whether thrombolytic or clot busting drugs
can potentially reverse the stroke situation. There is a very limited window of
opportunity from the onset of symptoms to when this therapy can be used. If
delays occur, the opportunity to intervene is lost.
The first priority is ensuring that the ambulance arrives as soon as possible
since first responders, EMTs and paramedics may be able to help make the
diagnosis and alert the hospital about the stoke victim's situation.
While waiting for the ambulance, the following first aid suggestions may be
helpful:
• The affected person should lie flat to promote an optimal blood flow to the
brain.
• If drowsiness, unresponsiveness, or nausea are present, the person
should be placed in the rescue position on their side to prevent choking
should vomiting occur.
• Although aspirin plays a major role in stroke prevention (see below), once
the symptoms of a stroke begin, it is generally recommended that
additional aspirin not be taken until the patient receives medical attention.
If stroke is of the bleeding type, aspirin could theoretically make matters
worse. Moreover, patients with stroke may have swallowing difficulties and
may choke on the pill.
Three commands, known as the Cincinnati Prehospital Stroke Scale (CPSS),
may help to determine if the potential for stroke exists. Ask the patient to do
the following:
1. Smile: the face should move symmetrically
2. Raise both arms: looking for weakness on one side of the body
3. Speak a simple sentence
If a potential stroke victim cannot perform these tasks, 911 should be called
to activated the emergency medical system.
How is a stroke diagnosed?
A stroke is a medical emergency. Anyone suspected of having a stroke
should be taken to a medical facility immediately for evaluation and
treatment. Initially, the doctor takes a medical history from the patient if
possible or from others familiar with the patient if they are available.
Important questions include what the symptoms were, when they began, if
they were getting better, worse or staying the same. Past medical history
adds important information looking for risk factors for stroke and for
medications that can cause bleeding (for
example,warfarin [Coumadin], clopidogrel [Plavix], prasugrel [Effient]).
Physical examination is key in confirming the parts of the body that have
stopped functioning and may help determine what part of the brain has lost
its blood supply. If available, a neurologist, a doctor specializing in disorders
of the nervous system and diseases of the brain, can assist in the diagnosis
and management of stroke patients.
Just because a person has slurred speech or weakness on one side of the
body does not necessarily signal the occurrence of a stroke. There are many
other possibilities that can be responsible for these symptoms. Other
conditions that can mimic a stroke include:
• brain tumors,
• brain abscess (a collection of pus in the brain caused by bacteria or a
fungus),
• migraine headache,
• bleeding in the brain either spontaneously or from trauma,
• meningitis or encephalitis,
• an overdose of certain medications, or
• an electrolyte imbalance in the body. Abnormal concentrations (too high or
too low) of sodium, calcium, or glucose in the body may also cause
changes in the nervous system that can mimic a stroke.
In the acute stroke evaluation, many things will occur at the same time. As
the physician is taking the history and performing the physical examination,
nursing staff will begin monitoring the patient's vital signs, performing blood
tests, and performing anelectrocardiogram (EKG or ECG).
Part of the physical examination that is becoming standardized is the use of
a stroke scale. The American Heart Association has published a guide to the
examination of the nervous system to help health care practitioners
determine the severity of a stroke and whether aggressive intervention may
be warranted.
There is a narrow time frame to intervene in an acute stroke with medications
to reverse the loss of blood supply to part of the brain (please see TPA
below). The patient needs to be appropriately evaluated and stabilized before
any clot-busting drugs can be potentially utilized.
Computerized tomography: In order to help determine the cause of a
suspected stroke, a special X-ray test called a CT scan of the brain is often
performed. A CT scan is used to look for bleeding or masses within the brain
that may cause symptoms that mimic a stroke, but are not treated with
thrombolytic therapy with TPA.
MRI scan: Magnetic resonance imaging (MRI) uses magnetic waves rather
than X-rays to image the brain. The MRI images are much more detailed
than those from CT, but due to the length of time to do the test and lack of
availability of the machines in many hospitals, is not a first line test in stroke.
While a CT scan may be completed within a few minutes, an MRI may take
more than an hour to complete. An MRI may be performed later in the course
of patient care if finer details are required for further medical decision
making. People with certain medical devices (for example, pacemakers) or
other metals within their body, cannot be subjected to the powerful magnetic
field of an MRI.
Other methods of MRI technology: An MRI scan can also be used to
specifically view the blood vessels non-invasively (without using tubes or
injections), a procedure called an MRA (magnetic resonance angiogram).
Another MRI method called diffusion weighted imaging (DWI) is being
offered in some medical centers. This technique can detect the area of
abnormality minutes after the blood flow to a part of the brain has ceased,
whereas a conventional MRI may not detect a stroke until up to six hours
after it has started, and a CT scan sometimes cannot detect it until it is 12 to
24 hours old. Again, this is not a first line test in the evaluation of a stroke
patient, when time is of the essence.
Computerized tomography with angiography: Using dye that is injected
into a vein in the arm, images of the blood vessels in the brain can give
information regardinganeurysms or arteriovenous malformations. Moreover,
other abnormalities of brain blood flow may be evaluated. With faster
machines and better technology, CT angiography may be done at the same
time as the initial CT scan to look for a blood clot within an artery in the brain.
CT and MRI images often require a radiologist to interpret their results.
Conventional angiogram: An angiogram is another test that is sometimes
used to view the blood vessels. A long catheter tube is inserted into an artery
in the groin or arm and threaded into the arteries of the brain. Dye is injected
while X-rays are taken and information can be obtained about blood flow in
the brain. The decision to perform CT angiography versus conventional
angiography depends upon a patient's specific situation and the technical
capabilities of the hospital.
Carotid Doppler ultrasound: A carotid Doppler ultrasound is a non-invasive
test that uses sound waves to look for narrowing or stenosis and decreased
blood flow in the carotid arteries (the major arteries in the front of the neck
that supply blood to the brain).
Heart tests: Certain tests to evaluate heart function are often performed in
stroke patients to search for the source of an
embolism. Electrocardiograms (EKG or ECG) may be used to
detect abnormal heart rhythms like atrial fibrillation that are associated with
embolic stroke.
Ambulatory rhythm monitoring may be considered if the patient complains
of palpitationsor passing out episodes (syncope) and the doctor cannot find
reason for it on the EKG. The patient can wear a Holter monitor for 1-2 days
and sometimes longer looking fro a potential electrical conduction problem
with the heart.
Echocardiograms or ultrasounds of the heart can help evaluate the structure
and function of the heart including the heart muscle, valves and the motion of
the heart chamber when the heart beats. As well, specifically for stroke
patients, this test may be able to find blood clots within the heart and the
presence of a patent foramen ovale, both potential causes of stroke.
Blood tests: In the acute situation, when the patient is in the midst of a
stroke, blood tests are done to check for anemia, kidney and liver function,
electrolyte abnormalities and blood clotting function.
In other situations, when time is not of the essence, similar blood tests may
be done. In addition, screening test for inflammation may be considered
including an ESR (erythrocyte sedimentation rate) and CRP (C-reactive
protein). These are non specific tests that may give direction to medical care.
What is the treatment of a stroke?
Tissue plasminogen activator (TPA)
There is opportunity to use alteplase (TPA) as a clot-buster drug to dissolve
the blood clot that is causing the stroke. There is a narrow window of
opportunity to use this drug. The earlier that it is given, the better the result
and the less potential for the complication of bleeding into the brain.
Present American Heart Association guidelines recommend that if used, TPA
must be given within 4 1/2 hours after the onset of symptoms. for patients
who waken from sleep with symptoms of stroke, the clock starts when they
were last seen in a normal state.
TPA is injected into a vein in the arm but, the time frame for its use may be
extended to six hours if it is dripped directly into the blood vessel that is
blocked requiring angiography, which is performed by an interventional
radiologist. Not all hospitals have access to this technology.
TPA may reverse stroke symptoms in more than one-third of patients, but
may also cause bleeding in 6% patients, potentially making the stroke worse.
For posterior circulation strokes that involve the vertebrobasilar system, the
time frame for treatment with TPA may be extended even further to 18 hours.
Heparin and aspirin
Drugs to thin the blood (anticoagulation; for example, heparin) are also
sometimes used in treating stroke patients in the hopes of improving the
patient's recovery. It is unclear, however, whether the use of anticoagulation
improves the outcome from the current stroke or simply helps to prevent
subsequent strokes (see below). In certain patients,aspirin given after the
onset of a stroke does have a small, but measurable effect on recovery. The
treating doctor will determine the medications to be used based upon a
patient's specific needs.
Managing other Medical Problems
Blood pressure will be tightly controlled often using intravenous medication to
prevent stroke symptoms from progressing. This is true whether the stroke is
ischemic or hemorrhagic.
Supplemental oxygen is often provided.
In patients with diabetes, the blood sugar (glucose) level is often elevated
after a stroke. Controlling the glucose level in these patients may minimize
the size of a stroke.
Patients who have suffered a transient ischemic attacks, the patient may be
discharged with blood pressure and cholesterol medications even if the blood
pressure and cholesterol levels are within acceptable levels. Smoking
cessation is mandatory.
Rehabilitation
When a patient is no longer acutely ill after a stroke, the health care staff
focuses on maximizing the individuals functional abilities. This is most often
done in an inpatient rehabilitation hospital or in a special area of a general
hospital. Rehabilitation can also take place at a nursing facility.
The rehabilitation process can include some or all of the following:
1. speech therapy to relearn talking and swallowing;
2. occupational therapy to regain as much function dexterity in the
arms and hands as possible;
3. physical therapy to improve strength and walking; and
4. family education to orient them in caring for their loved one at
home and the challenges they will face.
The goal is for the patient to resume as many, if not all, of their pre-stroke
activities and functions. Since a stroke involves the permanent loss of brain
cells, a total return to the patient's pre-stroke status is not necessarily a
realistic goal in many cases. However, many stroke patients can return to
vibrant independent lives.
Depending upon the severity of the stroke, some patients are transferred
from the acute care hospital setting to a skilled nursing facility to be
monitored and continue physical and occupational therapy.
Many times, home health providers can assess the home living situation and
make recommendations to ease the transition home. Unfortunately, some
stroke patients have such significant nursing needs that they cannot be met
by relatives and friends and long-term nursing home care may be required.
What complications can occur after a stroke?
A stroke can become worse despite an early arrival at the hospital and
appropriate medical treatment. Progression of symptoms may be due to
brain swelling or bleeding into the brain tissue.
It is not unusual for a stroke and a heart attack to occur at the same time or
in very close proximity to each other.
During the acute illness, swallowing may be affected. The weakness that
affects the arm, leg, and side of the face can also impact the muscles of
swallowing. A stroke that causes slurred speech seems to predispose the
patient to abnormal swallowing mechanics. Should food and saliva enter the
trachea instead of the esophagus when eating or swallowing, pneumonia or
a lung infection can occur. Abnormal swallowing can also occur
independently of slurred speech.
Because a stroke often results in immobility, blood clots can develop in a leg
vein (deep vein thrombosis). This poses a risk for a clot to travel upwards to
and lodge in the lungs - a potentially life-threatening situation (pulmonary
embolism). There are a number of ways in which the treating physician can
help prevent these leg vein clots. Prolonged immobility can also lead to
pressure sores (a breakdown of the skin, called decubitus ulcers), which can
be prevented by frequent repositioning of the patient by the nurse or other
caretakers.
Stroke patients often have some problem with depression as part of the
recovery process, which needs to be recognized and treated.
The prognosis following a stroke is related to the severity of the stroke and
how much of the brain has been damaged. Some patients return to a near-
normal condition with minimal awkwardness or speech defects. Many stroke
patients are left with permanent problems such as hemiplegia (weakness on
one side of the body), aphasia (difficulty or the inability to speak),
or incontinence of the bowel and/or bladder. A significant number of persons
become unconscious and die following a major stroke.
If a stroke has been massive or devastating to a person's ability to think or
function, the family is left with some very difficult decisions. In these cases, it
is sometimes advisable to limit further medical intervention. It is often
appropriate for the doctor and the patient's family to discuss and implement
orders to not resuscitate the patient in the case of a cardiac arrest, since the
quality of life for the patient would be so poor. In many cases, this decision is
made somewhat easier if the patient has had a discussion with family or
loved ones before an illness has occurred.
What can be done to prevent a stroke?
Risk factor reduction
High blood pressure: The possibility of suffering a stroke can be markedly
decreased by controlling the risk factors. The most important risk factor for
stroke is high blood pressure. When a person's blood pressure is persistently
too high, roughly greater than 130/85, the risk of a stroke increases in
proportion to the degree by which the blood pressure is elevated. Managing
high blood pressure so that it is well controlled and in the normal range
decreases the chances of a stroke.
Smoking: An important stroke risk factor is cigarette smoking or other
tobacco use. Chemicals in cigarettes are associated with developing
atherosclerosis or narrowing of the arteries in the body. This narrowing can
involve the large carotid arteries as well as smaller arteries within the brain.
Smoking is also a major risk factor in heart disease and artery disease.
Diabetes: Diabetes causes the small vessels to close prematurely. When
these blood vessels close in the brain, small (lacunar) strokes may occur.
Good control of blood sugar is important in decreasing the risk of stroke in
people with diabetes.
High cholesterol: Elevated cholesterol and/or triglycerides in the
bloodstream are risk factors for a stroke due to the eventual blockage of
blood vessels (atherosclerosis) and plaque formation. A healthy
diet and medications can help normalize an elevated blood cholesterol level.
Blood thinner/warfarin: An irregular heart beat called atrial fibrillation
whereby the upper chambers of the heart do not beat in a coordinated
fashion can cause blood clots to form inside the heart. These can break off
and travel or embolize to blood vessels in the brain blocking blood flow and
causing a stroke. Warfarin (Coumadin) is a blood "thinner" that prevents the
blood from clotting. This medication is often used in patients with atrial
fibrillation to decrease this risk. Warfarin is also sometimes used to prevent
the recurrence of a stroke in other situations, such as with certain other heart
conditions and conditions in which the blood has a tendency to clot on its
own (hypercoagulable states). Warfarin dosing is monitored by periodic blood
tests to measure INR (international normalized ration) which assess how
quickly the patient's blood clots. Aspirin may also be considered for
anticoagulation in atrial fibrillation.
Antiplatelet therapy: Many TIA and stroke patients may benefit from
"antiplatelet" drugs that can decrease clotting risk and potentially reduce their
risk of suffering another cerebrovascular event. These medicines act on
platelets to decrease their stickiness and reduce the tendency to clot blood.
The side effect is an increased risk of bleeding. Aspirin is the most commonly
prescribed medication in this group. If the patient develops TIA or stroke
symptoms while taking aspirin, other anti-platelet medicationsmay be
considered including clopidogrel (Plavix), prasugrel (Effient), and
dipyridamole (Persantine).
Carotid endarterectomy: In many cases, a person may suffer a TIA or a
stroke that is caused by the narrowing or of the carotid arteries (the major
arteries in the neck that supply blood to the brain). If left untreated, patients
with these conditions have a higher risk of experiencing a major stroke in the
future. An operation that cleans out the carotid artery and restores normal
blood flow is known as a carotid endarterectomy. This procedure has been
shown to markedly reduce the incidence of a subsequent stroke. In patients
who have a narrowed carotid artery, but no symptoms, this operation may be
indicated in order to prevent the occurrence of a first stroke.
What is in the future for stroke treatment?
New medications are also being tested that help slow the degeneration of the
nerve cells that are deprived of oxygen during a stroke. These drugs are
referred to as "neuroprotective" agents, an example of which is sipatrigine.
Another example is chlormethiazole, which works by modifying the
expression of genes within the brain. (Genes produce proteins that determine
an individual's makeup.)
Finally, stem cells, which have the potential to develop into a variety of
different organs, are being used to try to replace brain cells damaged by a
previous stroke. In many academic medical centers, some of these
experimental agents may be offered in the setting of a clinical trial. While new
therapies for the treatment of patients after a stroke are on the horizon, they
are not yet perfect and may not restore complete function to a person who
has had a stroke.
Stroke At A Glance
• Stroke is the sudden death of brain cells due to lack of oxygen.
• Stroke is caused by the blockage of blood flow or rupture of an artery to
the brain.
• Sudden tingling, weakness, or paralysis on one side of the body or
difficulty with balance, speaking, swallowing, or vision can be a symptom
of a stroke.
• Any person suspected of having a stroke or TIA should present for
emergency care immediately
• Clot-busting drugs like TPA can be used to reverse a stroke, but the time
frame for their use is very narrow. Patients need to present for care as
soon as possible so that TPA therapy can be considered.
• Stroke prevention involves minimizing risk factors, such as controlling high
blood pressure, elevated cholesterol, tobacco abuse, and diabetes.
REFERENCES:
del Zoppo GJ, et al. Expansion of the Time Window for Treatment of Acute Ischemic
Stroke with Intravenous Tisse Plasminogen Activator: A Science Advisory from the
AMerican Heart Association/American Stroke Association. Stroke 2009;40;2945-2948.
Goldtein, Larry. B. et al. Primary prevention of ischemic stroke: a guideline from the
American Heart Association/American Stroke Association Stroke Council: cosponsored
by the Atherosclerotic Peripheral Vascular Disease Interdisciplinary Working Group;
Cardiovascular Nursing Council; Clinical Cardiology Council; Nutrition, Physical Activity,
and Metabolism Council; and the Quality of Care and Outcomes Research
Interdisciplinary Working Group: the American Academy of Neurology affirms the value
of this guideline. Stroke. 2006 Jun;37(6):1583-633. Epub 2006 May 4.
Johnston SC. et al. National Stroke Association guidelines for the management of
transient ischemic attacks. Ann Neurol. 2006 Sep;60(3):301-13.
Liferidge AT. et al. Ability of laypersons to use the Cincinnati Prehospital Stroke
Scale. Prehosp Emerg Care. 2004 Oct-Dec:8(4):384-7.
===============================
v http://www.articlesbase.com/health-articles/icd-
9-updated-cva-diagnosis-guidelines-
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ICD 9: Updated CVA Diagnosis Guidelines
ICD 9: Updated CVA Diagnosis
Guidelines
Posted: Oct 29, 2010 |Comments: 0 |
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Training.
With the ICD 9 codes 2011 going into effect on October 1, 2010,
as a neurology coder, you too can expect some changes likely to
affect your practice. Here are some guidelines that will stand you in
good stead:
Check your terminology
Patients and practitioners sometimes use the terms 'stroke' and
'CVA' interchangeably to refer to a cerebral infarction. The terms
'stroke', 'CVA and 'cerebral infarction NOS' each fall under
diagnosis 434.91. The updated guidelines add, 'additional codes
should be assigned for any neurological deficits with the acute CVA,
irrespective of whether or not the neurologic defect resolves before
discharge'.
Do not mix late effects with neurological deficits
Diagnoses under ICD-9's category 438 deal with late effects of
cardiovascular disease. A late effect is the residual effect post the
acute phase of an illness or injury has terminated. There is in fact,
no time limit on when you can use a late effect code.
According to ICD 9 2010 guidelines, you needed to turn to 438.xx
when indicating conditions in categories 430-437 as the cases of
late effects. These late effects include neurological deficits that
persist after the initial onset of conditions in categories 430-437,
like speech and language deficits (438.1x), dysphagia (438.82), or
vertigo (438.85).
With effect from October 1, 2010, guidelines specify to use codes
in category 438 only for late effects of cerebrovascular disease, not
for neurological deficits associated with an acute CVA.
Diagnosis signals disease
Guidelines under Section 1 C.18.d.3 differentiate status and history
diagnosis codes. The guideline update clarifies what status codes
represent. These codes indicate that a patient is a carrier of a
disease, has the sequelae or residual of a past disease or condition,
or has another factor influencing a person's health status.
A status code (such as V58.61, Long-term use of anticoagulants)
informs healthcare providers and insurers of the patient's condition
and might affect the course of treatment and its outcome. Using a
personal history code (like V12.41, Personal history of benign
neoplasm of the brain) explains a patient's medical condition that
no longer exists and is not receiving any treatment. The code also
indicates that the patient has the potential for recurrence, and
therefore might need constant monitoring.
Since all ICD-9-CM 2011 books will not include the updated
guidelines as the books went to printers before the updated
guidelines became available, you'll stand in good stead to sign up
for a medical coding guide like Supercoder!
(ArticlesBase SC #3568722)
Read more: http://www.articlesbase.com/health-articles/icd-9-
updated-cva-diagnosis-guidelines-3568722.html#ixzz187EUuxAf
Under Creative Commons License: Attribution
===============
http://www.articlesbase.com/health-
articles/duck-cva-diagnosis-coding-pitfalls-with-
43813-43814-2576610.html
Duck CVA diagnosis coding pitfalls with 438.13, 438.14
Posted: Jun 08, 2010 |Comments: 0 | Views: 151 |
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CPC classes, outsource coding, HCC Audit, training and placement
However, you will turn to a V code when your neurologist reports.
When your neurologist tends to a patient who had a stroke, either
now or in the distant past, he may record a number of different
conditions, which makes your job tougher. If you remember a few
guidelines, you will choose the right ICD-9 codes for every
cerebrovascular accident (CVA) case your neurologist tends to.
Get specific with two CVA diagnosis codes
When your neurologist tends to a patient who has had a stroke, or
CVA, he may document multiple deficiencies, both new as well as
lingering. When the patient presents with speech and language
deficits, you have two diagnosis codes to select from.
To aid both differentiate the etiology of speech and language
deficits, and to add specificity to those deficits, ICD-9 2010 covers
two cerebrovascular disease late effects codes 438.13 (Late effects
of cerebrovascular disease, speech and language deficits,
dysarthria) and 438.14 (…, fluency disorder [stuttering]).
If you're not aware of the "combined" ICD-9 late effects codes
often you might misreport the ICD-9 code(s) indicating that the
patient has the active or ongoing condition; in this case a CVA
rather than going for the compliant late effect code.
Here's an example: Your neurologist tends to a patient who
suffered a stroke three years ago and has subsequent hemiplegia
on her right (dominant) side. Here, you may go for 434.91
(Cerebral artery occlusion, unspecified, with cerebral infarction)
and 342.91 (Hemiplegia, unspecified, affecting dominant side) in
error as if the patient is dynamically being treated for a current
occlusion and hemiplegia rather than going for the correct
combined late effects code, 438.21 (Late effect of cerebrovascular
disease; Hemiplegia affecting dominant side), according to Marvel
J. Hammer, RN, CPC, CCS-P, PCS, ACSPM, CHCO, owner of MJH
Consulting in Denver.
Alter your late effects code thinking for CVA
Coding for CVA patients is done a bit differently than coding late
effects from other conditions like spinal cord injury from an
accident.
Important: When reporting late effects of a stroke, you only
require to use a single ICD-9 code to describe the late effects or
manifestations of the CVA, rather than go for two ICD-9 codes –
one for the residual effect while one for the condition's cause or as
sometimes referenced as the etiology of the manifestation.
Codes recounting late effects of stroke appear in a different section
of the ICD-9 manual (438). These codes, like 438.11 (Late effects
of cerebrovascular disease; aphasia) and 438.21 (… hemiplegia
affecting dominant side), explain both the manifestation as well as
the etiology of the condition.
Let documentation show you the way on active versus late effects
"A late effect is any residual effect that results from the original
injury and/or condition and can be coded as such at any time after
the onset of the condition," Claudia Kernaghan, CPC, coder for
Nevada Imaging Centers in Las Vegas says.
Here's an example: A patient may have a vertebral fracture and
continue to suffer from pain years after the fracture heals. While
some late effects present early, others might become obvious
months or years later.
 Watch out: Do not confuse late effects with complications. A
complication is normally associated with a difficulty or problem that
takes place with a specific procedure (996.xx) and not a condition
owing to the original disease or injury.
To find out if a condition is a late effect, you should look in your
neurologist's documentation for keywords like:
• Since all ICD-9-CM 2011 books will not include the updated guidelines as the
Due to – like "pain in right hip due to fracture last year" • Following
- like "personality changes following a brain injury in 1996" • As a
consequence of – such as "hemiplegia as a result of CVA" •
Residual effect — like "arthritis that's a residual effect of previous
hip fracture." Capture ‘No Effects' with the help of V12.54 There
can be examples where a patient who suffered a CVA doesn't have
any neurologic deficits present.
(ArticlesBase SC #2576610)
Read more: http://www.articlesbase.com/health-articles/duck-cva-
diagnosis-coding-pitfalls-with-43813-43814-
2576610.html#ixzz187HtYB7V
Under Creative Commons License: Attribution
============
http://health.ezinemark.com/icd-9-updated-cva-
diagnosis-guidelines-16c78ca6527.html
James Smith
2010/10/29 |302 views|0
ICD 9: Updated CVA Diagnosis Guidelines
With the ICD 9 codes 2011 going into effect on October 1, 2010, as a
neurology coder, you too can expect some changes likely to affect your
practice. Here are some guidelines that will stand you in good stead:
Check your terminology
Patients and practitioners sometimes use the terms 'stroke' and 'CVA'
interchangeably to refer to a cerebral infarction. The terms 'stroke', 'CVA and
'cerebral infarction NOS' each fall under diagnosis 434.91. The updated
guidelines add, 'additional codes should be assigned for any neurological
deficits with the acute CVA, irrespective of whether or not the neurologic
defect resolves before discharge'.
Do not mix late effects with neurological deficits
Diagnoses under ICD-9's category 438 deal with late effects of
cardiovascular disease.
Related Coverage
• Get ICD-9 2011 updates in an audio conference
• Medical coding & billing: Know the ICD-9 2011 changes
• Specificity matters in Diagnosis Coding
• Make Smooth Transition from ICD 9 to ICD 10
A late effect is the residual effect post the acute phase of an illness or injury
has terminated. There is in fact, no time limit on when you can use a late
effect code.
According to ICD 9 2010 guidelines, you needed to turn to 438.xx when
indicating conditions in categories 430-437 as the cases of late effects.
These late effects include neurological deficits that persist after the initial
onset of conditions in categories 430-437, like speech and language deficits
(438.1x), dysphagia (438.82), or vertigo (438.85).
With effect from October 1, 2010, guidelines specify to use codes in category
438 only for late effects of cerebrovascular disease, not for neurological
deficits associated with an acute CVA.
Diagnosis signals disease
Guidelines under Section 1 C.18.d.3 differentiate status and history diagnosis
codes.
The guideline update clarifies what status codes represent. These codes
indicate that a patient is a carrier of a disease, has the sequelae or residual
of a past disease or condition, or has another factor influencing a person's
health status.
A status code (such as V58.61, Long-term use of anticoagulants) informs
healthcare providers and insurers of the patient's condition and might affect
the course of treatment and its outcome. Using a personal history code (like
V12.41, Personal history of benign neoplasm of the brain) explains a
patient's medical condition that no longer exists and is not receiving any
treatment. The code also indicates that the patient has the potential for
recurrence, and therefore might need constant monitoring.
books went to printers before the updated guidelines became available, you'll
stand in good stead to sign up for a medical coding guide like Supercoder!
Article Source: http://health.ezinemark.com/icd-9-updated-cva-diagnosis-
guidelines-16c78ca6527.html
Read more: http://health.ezinemark.com/icd-9-updated-cva-diagnosis-
guidelines-16c78ca6527.html#ixzz187IVak9T
Under Creative Commons License: Attribution No Derivatives
============
http://www.articlealley.com/article_1834126_17.
html
ICD 9: Updated CVA Diagnosis
Guidelines
Date Published: 11th November 2010
Author: James Smith
RSS
Views: 46
PRINT
ASK ABOUT THIS ARTICLE
With the ICD 9 codes 2011 going into effect on October 1, 2010,
as a neurology coder, you too can expect some changes likely to
affect your practice. Here are some guidelines that will stand you
in good stead:
Check your terminology
Patients and practitioners sometimes use the terms 'stroke' and
'CVA' interchangeably to refer to a cerebral infarction. The terms
'stroke', 'CVA and 'cerebral infarction NOS' each fall under diagnosis
434.91. The updated guidelines add, 'additional codes should be
assigned for any neurological deficits with the acute CVA,
irrespective of whether or not the neurologic defect resolves
before discharge'.
Do not mix late effects with neurological deficits
Diagnoses under ICD-9's category 438 deal with late effects of
cardiovascular disease. A late effect is the residual effect post the
acute phase of an illness or injury has terminated. There is in fact,
no time limit on when you can use a late effect code.
According to ICD 9 2010 guidelines, you needed to turn to 438.xx
when indicating conditions in categories 430-437 as the cases of
late effects. These late effects include neurological deficits that
persist after the initial onset of conditions in categories 430-437,
like speech and language deficits (438.1x), dysphagia (438.82), or
vertigo (438.85).
With effect from October 1, 2010, guidelines specify to use codes
in category 438 only for late effects of cerebrovascular disease,
not for neurological deficits associated with an acute CVA.
Diagnosis signals disease
Guidelines under Section 1 C.18.d.3 differentiate status and
history diagnosis codes. The guideline update clarifies what status
codes represent. These codes indicate that a patient is a carrier of
a disease, has the sequelae or residual of a past disease or
condition, or has another factor influencing a person's health
status.
A status code (such as V58.61, Long-term use of anticoagulants)
informs healthcare providers and insurers of the patient's condition
and might affect the course of treatment and its outcome. Using a
personal history code (like V12.41, Personal history of benign
neoplasm of the brain) explains a patient's medical condition that
no longer exists and is not receiving any treatment. The code also
indicates that the patient has the potential for recurrence, and
therefore might need constant monitoring.
Since all ICD-9-CM 2011 books will not include the updated
guidelines as the books went to printers before the updated
guidelines became available, you'll stand in good stead to sign up
for a medical coding guide like Supercoder!
Read more
at http://www.articlealley.com/article_1834126_17.html?
ktrack=kcplink
==============
http://www.suite101.com/content/stroke-like-
symptoms-and-conditions-that-mimic-a-cva-
a252961
Stroke Like Symptoms and
Conditions that Mimic a CVA
Jun 25, 2010 Katrena Wells
Stroke is also Known as Brain Attack or CVA - Bobjgalindo
Learn about signs of a stroke and health conditions that have symptoms
similar to a stroke, brain attack, or cerebrovascular accident (CVA).
According to the American Heart Association’s article “Heart Disease &
Stroke Statistics: 2010 Update at a Glance,” stroke is the third leading cause
of death and is the number one cause of serious, long-term disability in the
United States. Each year, approximately 795,000 people experience a stroke
while about 137,000 people die from a stroke, also called a “brain attack.”
A serious medical emergency affecting blood flow to the brain, anyone who is
experiencing stroke-like symptoms should seek immediate emergency care
in order to rule out a stroke or “brain attack.” Other conditions may have
similar symptoms, and not everyone who is having a stroke has all of the
symptoms listed below. Symptoms tend to vary depending on the part of the
brain involved.
Symptoms of a Stroke
According to the National Stroke Association, an easy way to remember a
quick and simple test to help someone determine if a person is having stroke
like symptoms is to “Act F.A.S.T.”:
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• Face – Ask the person to smile and look for facial droop on one
side.
• Arms – Ask the person to raise his or her arms and look to see if
one arm is lower or begins to sink down.
• Speech – Ask the person to say something simple and listen for
slurred speech or the inability to say the words correctly.
• Time – Delays in seeking emergency medical care can result in
lost brain cells. If the person is having the above symptoms, it is
important to call 911 or the equivalent in areas without 911
immediately, noting the time the symptoms began. People who
seek care earlier may have more options for treatment than
someone who waits to seek care.
Stroke symptoms always appear suddenly, are often accompanied by
hypertension (high blood pressure), particularly of the diastolic or bottom
number, and may include any or all of the following per the above National
Stroke Association article:
• weakness on one side of the body, which might include the face,
arm, and/or leg
• confusion
• difficulty speaking, including understanding speech, making
statements that are inappropriate, or the inability to properly say
words – the speech patterns vary from the person’s normal speech
patterns
• changes in sight in one or both eyes
• problems walking, maintaining balance, or a loss of coordination
• severe headache without an obvious cause
According to the National Stroke Association article “Women and Stroke:
Unique Symptoms in Women,” adult women who are experiencing a stroke
may have sudden symptoms that might be unusual or not typical, such as:
• hiccups
• nausea
• weakness
• pain in the chest
• problems breathing
• palpitations
Conditions That Can Mimic a Stroke
According to The Internet Stroke Center: Stroke Education for Clients and
Students article entitled “Emergency Stroke Evaluation & Diagnosis,”
approximately 81% of people who present to the Emergency Department
with stroke-like symptoms are experiencing a stroke. However, a healthcare
provider may look for other conditions that can also cause some of the same
or similar symptoms.
Read on
• A Stroke Should be Considered a Brain Attack
• Understanding Canine Stroke Syndrome
• Acute Management of Stroke
A few examples of health conditions that can cause some symptoms similar
to a stroke include, but are not limited to:
• TIA (Transient Ischemic Attack or Mini Stroke) – stroke symptoms
resolve on their own without any intervention
• certain infections, particularly in seniors
• tumors
• migraine headache
• Bell’s palsy
• metabolic disturbances
• seizure
• low blood sugar, including hypoglycemia due to diabetes
• delirium or dementia, including Alzheimer’s disease
• heart attack, particularly if someone is experiencing atypical
symptoms of a stroke
Stroke Symptoms Require Immediate Medical Evaluation
Seeking immediate emergency care can give a person who is having stroke-
like symptoms the best chance for survival and may increase the likelihood of
effective rehabilitation and lessen the severity of stroke symptoms. Even if
the symptoms resolve on their own, it is important to be evaluated by a
healthcare professional because aTIA is a major risk factor for stroke.
Some health conditions may mimic symptoms of a stroke, and a healthcare
profession can help determine if symptoms are due to a stroke or some other
condition.
=+++++++++++++++++++++++++++=
http://factoidz.com/what-we-must-better-know-
about-cerebrovascular-accident/
 http://www.imedix.com/stroke_(cva)/articles

http://www.merckmanuals.com/home/sec06/ch0
86/ch086c.html

Ischemic Stroke
What We Must Better Know
About Cerebrovascular
Accident
by Dania Dery, Member

Buy the Book

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What is a stroke? Description, Symptoms, Injuries caused and
Prevention after !!
A stroke, or also known as a cerebrovascularaccident, is occurring
when the blood supply and oxygen of an area of the brain is
stopping for a certain period of time. This traumatic "shock" results in
the death of the cells implicated due to lack of oxygen and essential
nutrients needed for the good functioning of the brain. The blood Pronunciations
vessels can be blocked by arteriosclerosis, clotting, or hemorrhagia.
The cerebrovascular accident is in a way similar to an heart attack,
but at the difference during a stroke the brain cells are dying or more
damaged.
Symptoms of a Cerebrovascuslar accident
The most common symptoms are: impaired memory, lost of
attention and concentration, tingling, lack of feeling in limbs, feeling
heaviness in limbs, lost of movement, dizziness, pressure on the 1
or 2 sides of the head, etc… Symptoms are often restricted only on
one side of the body. It is the reason sometimes paralysis following
a stroke is frequently right-sided or left-sided.
Injuries caused by a Cerebrovascular accident
Strokes can be so small that they are not feel or noticed by the
person or they can be so severe they are fatal. Medically, it is
sometimes difficult to evaluate the extent of the injury at the moment
of the stroke occurred. It is more following a long term then the
specialist like a neurologist will be able to analyze the damage of the
brain resulting of the stroke. Depending of the brain areas damaged
by the stroke, a rehabilitation plan will be suggested to the patient
and will be helpful specially if the person is needing physical or
speech therapies.
Preventive Measures after a Cerebrovascular accident
Changing the diet and some habits of the person is often
recommended. Like the management of main risk factors: high
blood pressure, obesity, diabetes, arteriosclerosis, cholesterol level,
reducing sodium intake, to stop cigarettes smoking.
The diet must be well equilibrated, specially with more intakes of B
vitamins and vitamin C, because they are very important for the
health of the blood vessels particularly. Vitamin E is an antioxidant
preventing clots, by its specific action making the blood thinner and
also in reducing the need in oxygen.
The choice of food must be done in function to reduce the
overweight, the cholesterol level and the high blood pressure. Best
choices can be: whole grains products, soya products less fat, fruits,
vegetables and complete proteins.
If you wish to take some Nutritional Supplements:
- Vitamin B Complex, Choline, Inositol, Vitamin C, Vitamin E,
Bioflavonoids, Potassium, Selenium, Zinc, Soya Protein, Lecithin
and Omega-3.

++++++++++++++++++++++
acetaminophen
pulmonary embolism

amphetamines
sclerosis

aneurysm
subarachnoid

angiography
subarachnoid hemorrhage

anticoagulants
thrombolytic

aorta
thrombosis

arrhythmia
ultrasonography

atheroma
vasculitis

atherosclerosis
warfarin

atrial

atrial fibrillation

An ischemic stroke is death of an area of brain tissue (cerebral

carotid arteries
infarction) resulting from an inadequate supply of blood and
oxygen to the brain due to blockage of an artery.
computed tomography • Ischemic stroke usually results when an artery to the
brain is blocked, often by a blood clot or a fatty
deposit due to atherosclerosis.
deep vein thrombosis • Symptoms occur suddenly and may include muscle
weakness, paralysis, lost or abnormal sensation on
echocardiography
one side of the body, difficulty speaking, confusion,
problems with vision, dizziness, and loss of balance
and coordination.
edema • Diagnosis is usually based on symptoms and results
of a physical examination, imaging tests, and blood
tests.
electrocardiography
• Treatment may include drugs to break up blood clots
or to make blood less likely to clot and surgery,
embolism followed by rehabilitation.
• About one third of people recover all or most of
normal function after an ischemic stroke.
esophagus
Causes
An ischemic stroke typically results from blockage of an artery
fibrillation that supplies the brain, most commonly a branch of one of the
internal carotid arteries.
Commonly, blockages are blood clots (thrombi) or pieces of fatty
fibrin deposits (atheromas, or plaques) due to atherosclerosis. Such
blockages often occur in the following ways:
• By forming in and blocking an artery: An atheroma
fibrinolytic drugs
in the wall of an artery may accumulate more fatty
material and become large enough to block the
gastrointestinal artery. Or a blood clot can form and block the artery
when an atheroma ruptures (Atherosclerosis: How
hemorrhage Atherosclerosis Develops ). Clots tend to form on a
ruptured atheroma because the atheroma narrows
infarction the artery and slows blood flow through it, like a
clogged pipe slows the flow of water. Slow-moving
blood is more likely to clot. A large clot can block
ischemic enough blood flowing through the narrowed artery
that brain cells supplied by that artery die.
pneumonia
• By traveling to another artery: A blood clot in the
heart, a piece of an atheroma, or a blood clot in the
wall of an artery can break off and travel through the
polycythemia bloodstream (becoming an embolus). The embolus
 may then lodge in an artery that supplies the brain
and block blood flow there. (Embolism refers to
blockage of arteries by materials that travel through
the bloodstream to another part of the body.) Such
blockages are more likely to occur where arteries are
already narrowed by fatty deposits.
Several conditions besides rupture of an atheroma can trigger or
promote the formation of blood clots, increasing the risk of
blockage by a blood clot, such as the following:
• Heart-related problems: Blood clots may form in the
heart or on a heart valve (including artificial valves).
Strokes due to such blood clots are most common
among people who have recently had heart surgery
and people who have a heart valve disorder or an
abnormal heart rhythm (arrhythmia), especially a fast,
irregular heart rhythm called atrial fibrillation.
• Blood disorders: Some disorders, such as an
excess of red blood cells (polycythemia), make blood
thick, increasing the risk of blood clots. Some
disorders, such as antiphospholipid syndrome and a
high homocysteine level in the blood
(hyperhomocysteinemia), make blood more likely to
clot.
• Oral contraceptives: Taking oral contraceptives,
particularly those with a high estrogen dose,
increases the risk of blood clots.
Another common cause of ischemic strokes is a lacunar
infarction. In lacunar infarction, one of the small arteries deep in
the brain becomes blocked by a mixture of fat and connective
tissue—a blood clot is not the cause. This disorder is called
lipohyalinosis and tends to occur in older people with diabetes or
poorly controlled high blood pressure. Lipohyalinosis is different
from atherosclerosis, but both disorders can cause blockage of
arteries. Only a small part of the brain is damaged in lacunar
infarction.
Rarely, small pieces of fat from the marrow of a broken long
bone, such as a leg bone, are released into the bloodstream.
These pieces can clump together and block an artery. The
resulting disorder, called fat embolism syndrome, may resemble
a stroke.
An ischemic stroke can also result from any disorder that reduces
the amount of blood or oxygen supplied to the brain, such as
severe blood loss or very low blood pressure. Occasionally, an
ischemic stroke occurs when blood flow to the brain is normal but
the blood does not contain enough oxygen. Disorders that reduce
the oxygen content of blood include a severe deficiency of red
blood cells (anemia), suffocation, and carbon monoxide
poisoning. Usually, brain damage in such cases is widespread
(diffuse), and coma results.
An ischemic stroke can occur if inflammation of blood vessels
(vasculitis) or infection (such as herpes simplex) narrows blood
vessels that supply the brain. Migraine headaches or drugs such
as cocaine and amphetamines can cause spasm of the arteries,
which can narrow the arteries supplying the brain and cause a
stroke.
Clogs and Clots: Causes of Ischemic Stroke
When an artery that carries blood to the brain becomes clogge
ischemic stroke can occur. Arteries may be blocked by fatty de
plaques) due to atherosclerosis. Arteries in the neck, particula
arteries, are a common site for atheromas. Arteries may also b
clot (thrombus). Blood clots may form on an atheroma in an ar
form in the heart of people with a heart disorder. Part of a clot
travel through the bloodstream (becoming an embolus). It may
that supplies blood to the brain, such as one of the cerebral ar
Symptoms
Usually, symptoms occur suddenly and are often most severe a
few minutes after they start because most ischemic strokes begin
suddenly, develop rapidly, and cause death of brain tissue within
minutes to hours. Then, most strokes become stable, causing
little or no further damage. Strokes that remain stable for 2 to 3
days are called completed strokes. Sudden blockage by an
embolus is most likely to cause this kind of stroke.
Less commonly, symptoms develop slowly. They result from
strokes that continue to worsen for several hours to a day or two,
as a steadily enlarging area of brain tissue dies. Such strokes are
called evolving strokes. The progression of symptoms and
damage is usually interrupted by somewhat stable periods, during
which the area temporarily stops enlarging or some improvement
occurs. Such strokes are usually due to the formation of clots in a
narrowed artery.
Many different symptoms can occur, depending on which artery is
blocked and thus which part of the brain is deprived of blood and
oxygen Brain Dysfunction: Dysfunction by Location). When the
arteries that branch from the internal carotid artery (which carry
blood along the front of the neck to the brain) are affected, the
following are most common:
• Blindness in one eye
• Inability to see out of the same side in both eyes
• Abnormal sensations, weakness, or paralysis in one
arm or leg or on one side of the body
When the arteries that branch from the vertebral arteries (which
carry blood along the back of the neck to the brain) are affected,
the following are most common:
• Dizziness and vertigo
• Double vision
• Generalized weakness on both sides of the body
Many other symptoms, such as difficulty speaking (for example,
slurred speech), impaired consciousness (such as confusion),
loss of coordination, and urinary incontinence, can occur.
Severe strokes may lead to stupor or coma. In addition, strokes,
even milder ones, can cause depression or an inability to control
emotions. For example, people may cry or laugh inappropriately.
If symptoms, particularly impaired consciousness, worsen during
the first 2 to 3 days, the cause is often swelling due to excess
fluid (edema) in the brain. Symptoms usually lessen within a few
days, as the fluid is absorbed. Nonetheless, the swelling is
particularly dangerous because the skull does not expand. The
resulting increase in pressure can cause the brain to shift, further
impairing brain function, even if the area directly damaged by the
stroke does not enlarge. If the pressure becomes very high, the
brain may be forced downward in the skull, through the rigid
structures that separate the brain into compartments. The
resulting disorder is called herniation (see Head
Injuries:Introduction ).
Strokes can lead to other problems. If swallowing is difficult,
people may not eat enough and become malnourished. Food,
saliva, or vomit may be inhaled (aspirated) into the lungs,
resulting in aspiration pneumonia. Being in one position too long
can result in pressure sores and lead to muscle loss. Not being
able to move the legs can result in the formation of blood clots in
deep veins of the legs and groin (deep vein thrombosis). Clots
can break off, travel through the bloodstream, and block an artery
to a lung (a disorder called pulmonary embolism). People may
have difficulty sleeping. The losses and problems resulting from
the stroke may make people depressed.
Diagnosis
Turbulent Blood Flow
Doctors can usually diagnose an ischemic stroke based on the
history of events and results of a physical examination. Doctors
can usually identify which artery in the brain is blocked based on
symptoms (see Brain Dysfunction:Introduction ). For example,
weakness or paralysis of the left leg suggests blockage of the
artery supplying the area on the right side of the brain that
controls the left leg's muscle movements.
Computed tomography (CT) is usually done first. CT helps
distinguish an ischemic stroke from a hemorrhagic stroke, a brain
tumor, an abscess, and other structural abnormalities. Doctors
also measure the blood sugar level to rule out a low blood sugar
level (hypoglycemia), which can cause similar symptoms. If
available, diffusion magnetic resonance imaging (MRI), which can
detect ischemic strokes within minutes of their start, may be done
next.
Identifying the precise cause of the stroke is important. If the
blockage is a blood clot, another stroke is very likely unless the
underlying disorder is corrected. For example, if blood clots result
from an abnormal heart rhythm, treating that disorder can prevent
new clots from forming and causing another stroke. Tests for
causes may include the following:
• Electrocardiography (ECG) to look for abnormal heart
rhythms
• Continuous ECG monitoring (done at home or in the
hospital—see Symptoms and Diagnosis of Heart and
Blood Vessel Disorders: Continuous Ambulatory
Electrocardiography) to record the heart rate and
rhythm continuously for 24 hours (or more), which
may detect abnormal heart rhythms that occur
unpredictably or briefly
• Echocardiography to check the heart for blood clots,
pumping or structural abnormalities, and valve
disorders
• Imaging tests—color Doppler ultrasonography,
magnetic resonance angiography, CT angiography,
or cerebral (standard) angiography—to determine
whether arteries, especially the internal carotid
arteries, are blocked or narrowed
• Blood tests to check for anemia, polycythemia, blood
clotting disorders, vasculitis, and some infections
(such as heart valve infections and syphilis) and for
risk factors such as high cholesterol levels or
diabetes
Imaging tests enable doctors to determine how narrowed the
carotid arteries are and thus to estimate the risk of a subsequent
stroke or TIA. Such information helps determine which treatments
are needed.
For cerebral angiography, a thin, flexible tube (catheter) is
inserted into an artery, usually in the groin, and threaded through
the aorta to an artery in the neck. Then, a dye is injected to
outline the artery. Thus, this test is more invasive than other tests
that provide images of the brain's blood supply. However, it
provides more information (see Common Imaging Tests:
Angiography). Cerebral angiography may be done before
atheromas are removed surgically or when vasculitis is
suspected.
Rarely, a spinal tap (lumbar puncture) is done—for example, after
CT, when doctors still need to determine whether strokelike
symptoms are due to an infection or whether a subarachnoid
hemorrhage is present (see Stroke (CVA): Subarachnoid
Hemorrhage). This procedure is done only if doctors are sure that
the brain is not under excess pressure (usually determined by CT
or MRI).
Prognosis
About 10% of people who have an ischemic stroke recover
almost all normal function, and about 25% recover most of it.
About 40% of people have moderate to severe impairments
requiring special care, and about 10% require care in a nursing
home or other long-term care facility. Some people are physically
and mentally devastated and unable to move, speak, or eat
normally. About 20% of people who have a stroke die in the
hospital. The proportion is higher among older people. About
25% of people who recover from a stroke have another stroke
within 5 years. Subsequent strokes impair function further.
During the first few days after an ischemic stroke, doctors usually
cannot predict whether a person will improve or worsen. Younger
people and people who start improving quickly are likely to
recover more fully. About 50% of people with one-sided paralysis
and most of those with less severe symptoms recover some
function by the time they leave the hospital, and they can
eventually take care of their basic needs. They can think clearly
and walk adequately, although use of the affected arm or leg may
be limited. Use of an arm is more often limited than use of a leg.
Most impairments still present after 12 months are permanent.
Treatment
People who have any symptom suggesting an ischemic stroke
should go to an emergency department immediately. The earlier
the treatment, the better are the chances for recovery.
The first priority is to restore the person's breathing, heart rate,
blood pressure (if low), and temperature to normal. An
intravenous line is inserted to provide drugs and fluids when
needed. If the person has a fever, it may be lowered
using acetaminophen
, ibuprofen
, or a cooling blanket. An increase in body temperature by even a
few degrees can dramatically worsen brain damage due to an
ischemic stroke. Generally, doctors do not immediately treat high
blood pressure unless it is very high (over 220/120 mm Hg)
because, when arteries are narrowed, blood pressure must be
higher than normal to push enough blood through them to the
brain. However, very high blood pressure can injure the heart,
kidneys, and eyes and must be lowered.
If a stroke is very severe, drugs such as mannitol may be given to
reduce swelling and the increased pressure in the brain. Some
people need a ventilator to breathe adequately.
Specific treatment of stroke may include drugs to break up blood
clots (thrombolytic drugs), drugs to make blood less likely to clot
(antiplatelet drugs and anticoagulants), and surgery, followed by
rehabilitation.
Thrombolytic (Fibrinolytic) Drugs: In certain circumstances, a
drug called tissue plasminogen activator (tPA) is given
intravenously to break up clots and help restore blood flow to the
brain. Because tPA can cause bleeding in the brain and
elsewhere, it should not be given to people with certain
conditions, such as the following:
• A past occurrence of a hemorrhagic stroke, a bulge
 (aneurysm) in an artery to the brain, other structural
abnormalities in the brain, or a brain tumor
• A seizure when the stroke began
• A tendency to bleed
• Recent major surgery
• Recent bleeding (hemorrhage) in the gastrointestinal
or urinary tract
• A recent head injury or other serious trauma
• A very high or very low blood sugar level
• A heart infection
• Current use of an anticoagulant ( warfarin
)
• A large ischemic stroke
• Blood pressure that remains high after treatment with
an antihypertensive drug
• Symptoms that are resolving quickly
Before tPA is given, CT is done to rule out bleeding in the brain.
To be effective and safe, tPA, given intravenously, must be
started within 3 hours of the beginning of an ischemic stroke.
After 3 hours, most of the damage to the brain cannot be
reversed, and the risk of bleeding outweighs the possible benefit
of the drug. However, pinpointing when the stroke began may be
difficult. So doctors assume that the stroke began the last time a
person was known to be well. For example, if a person awakens
with symptoms of a stroke, doctors assume the stroke began
when the person was last seen awake and well. Thus, tPA can be
used in only a few people who have had a stroke.
If people arrive at the hospital 3 to 6 hours (occasionally, up to 18
hours) after the stroke began, they may be given tPA or another
thrombolytic drug. But the drug must be given through a catheter
instead. For this treatment, doctors make an incision in the skin,
usually in the groin, and insert a catheter into an artery. The
catheter is then threaded through the aorta and other arteries, to
the clot. The clot is partly broken up with the catheter wire and
then injected with tPA. This treatment is usually available only at
specialized stroke centers.
Antiplatelet Drugs and Anticoagulants: If a thrombolytic drug
cannot be used, most people are given aspirin
(an antiplatelet drug) as soon as they get to the hospital. If
symptoms seem to be worsening, anticoagulants such as heparin
are occasionally used, but their effectiveness has not been
proved. Antiplatelet drugs make platelets less likely to clump and
form clots. Anticoagulants inhibit proteins in blood that help it to
clot (clotting factors).
Regardless of the initial treatment, long-term treatment usually
consists of aspirin
or another antiplatelet drug to reduce the risk of blood clots and
thus of subsequent strokes (see Stroke (CVA): Prevention).
People who have atrial fibrillation or a heart valve disorder are
given anticoagulants (such as warfarin
) instead of antiplatelet drugs, which do not seem to prevent
blood clots from forming in the heart. Occasionally, people at high
risk of another stroke are given both aspirin
and warfarin
.
If people have been given a thrombolytic drug, doctors usually
wait at least 24 hours before antiplatelet drugs or anticoagulants
are started because these drugs add to the already increased risk
of bleeding in the brain. Anticoagulants are not given to people
who have uncontrolled high blood pressure or who have had a
hemorrhagic stroke.
Surgery: Once an ischemic stroke is completed, surgical removal
of atheromas or clots (endarterectomy) in an internal carotid
artery may be done. Carotid endarterectomy can help if all of the
following are present:
• The stroke resulted from narrowing of a carotid artery
by more than 70%.
• Some brain tissue supplied by the affected artery still
functions after the stroke.
• The person's life expectancy is at least 5 years.
In such people, carotid endarterectomy may reduce the risk of
subsequent strokes. It also reestablishes the blood supply to the
affected area, but it cannot restore lost function because some
brain tissue is dead.
For carotid endarterectomy, a general anesthetic or a local
anesthetic (to numb the neck area) may be used. If people
remain awake during the operation, the surgeon can better
evaluate how the brain is functioning. The surgeon makes an
incision in the neck over the area of the artery that contains the
blockage and an incision in the artery. The blockage is removed,
and the incisions are closed. For a few days afterwards, the neck
may hurt, and swallowing may be difficult. Most people can stay
in the hospital 1 or 2 days. Heavy lifting should be avoided for
about 3 weeks. After several weeks, people can resume their
usual activities.
Carotid endarterectomy can trigger a stroke because the
operation may dislodge clots or other material that can then travel
through the bloodstream and block an artery. However, after the
operation, the risk of stroke is lower for several years than it is
when drugs are used.
In other narrowed arteries, such as the vertebral arteries,
endarterectomy may not be possible because the operation is
riskier to perform in these arteries than in the internal carotid
arteries.
People should find a surgeon who is experienced doing this
operation and who has a low rate of serious complications (such
as heart attack, stroke, and death) after the operation. If people
cannot find such a surgeon, the risks of endarterectomy outweigh
its expected benefits.
Stents: If endarterectomy is too risky, a less invasive procedure
can be done: A wire mesh tube (stent) with an umbrella filter may
be placed in the carotid artery. The stent helps keep the artery
open, and the filter catches blood clots and prevents them from
reaching the brain and causing a stroke. The filter is similar to
one used to prevent pulmonary embolism (see Venous Disorders:
Umbrellas: One Way to Prevent Pulmonary Embolism ). After a
local anesthetic is given, a catheter is inserted through a small
incision into a large artery near the groin or in the arm and is
threaded to the internal carotid artery in the neck. A dye that can
be seen on x-rays (radiopaque dye) is injected, and x-rays are
taken so that the narrowed area can be located. After the stent
and filter are placed, the catheter is removed. People remain
awake for the procedure, which usually takes 1 to 2 hours. The
procedure appears to be as safe as endarterectomy and is
almost as effective in preventing strokes and death.
Other Treatments: Another option being studied is a tiny
corkscrew-shaped device that is attached to a catheter, threaded
to the clot, and used to snag the clot. The clot is then drawn out
through the catheter. This treatment may be useful for people
who cannot be given tPA.
Treatment of Problems Due to Strokes: Measures to prevent
aspiration pneumonia (seePneumonia: Aspiration Pneumonia)
and pressure sores (see Pressure Sores: Prevention) are started
early. Heparin, injected under the skin, may be given to help
prevent deep vein thrombosis (see Venous Disorders: Deep Vein
Thrombosis (DVT)). People are closely monitored to determine
whether the esophagus, bladder, and intestines are functioning.
Often, other disorders such as heart failure, abnormal heart
rhythms, and lung infections must be treated. High blood
pressure is often treated after the stroke has been stabilized.
Because a stroke often causes mood changes, especially
depression, family members or friends should inform the doctor if
the person seems depressed. Depression can be treated with
drug therapy and psychotherapy (see Mood Disorders: Prognosis
and Treatment).
Last full review/revision November 2007 by Elias A. Giraldo, MD
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http://www.medicineonline.com/articles/C/2/CVA/
Stroke.html
Medical References
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Overview, Causes, & Risk Factors
Diseases & Conditions A stroke is the death of brain tissue that occurs when the brain does not
• Allergy get enough blood and oxygen.
• Arthritis What is going on in the body?
• Alzheimer's Strokes are classified as ischemic strokes or hemorrhagic
• Cancer strokes. Ischemic strokes happen when the blood supply to the brain is
interrupted. The brain cells then die from lack of
• Cardiovascular Disorders
oxygen. Hemorrhagic strokes occur when blood vessels in the brain
• Cholesterol burst and release blood into the area around the brain cells. The blood
• Constipation then damages the brain cells. The products released when cells die
cause swelling in the brain. Since the skull doesn't allow much room for
• Diabetes
expansion, this swelling can damage the brain tissue even further.
• Eczema
Examples of ischemic strokes are:
• AIDS / HIV  stroke from atherosclerosis, which occurs when the arteries
• More Topics... supplying the brain are narrowed by plaque formation on the vessel
walls
Women's Health  stroke from carotid stenosis, which is a blockage in one of the
• Breast Cancer
carotid arteries in the neck
• Ovarian Cancer  arteritis, or artery inflammation, in an artery that supplies the brain.
• Bladder Control This may be due to a condition called temporal arteritis, for example.
 stroke from carotid dissection. A carotid dissection occurs when one
• Migraines
of the carotid arteries in the neck is torn by an injury and blood flow to
• Pregnancy
the brain is blocked.
• Weight management  polycythemia vera, a blood cancer that causes blood cells to multiply
• More Topics ... and the blood to thicken. The thickened blood prevents normal
oxygenation of brain cells.
• Duzoxin Weight loss European Diet
 stroke from cardiogenic embolism, a condition in which blood clots
• Sexual and Active - Sex Toys travel from the heart. Blood clots from the heart may be caused by an
• Health & Beauty Blog irregular heartbeat called atrial fibrillation, severe congestive heart
Mental Health failure, and heart attack.
 stroke caused by cholesterol or plaque from an artery in the neck.
• ADD/ADHD Child Behavior
When the cholesterol or plaque travels and blocks an artery supplying
• Alzheimer’s disease
the brain, a stroke occurs.
• Anxiety Disorder  severe migraine headaches, which cause constriction of the blood
• Bipolar Disorder vessels within the brain and deprive brain cells of oxygen
Hemorrhagic strokes occur when there is bleeding into the brain
• Depression
caused by damage to the blood vessels. A hemorrhagic stroke may be
• Schizophrenia caused by:
• More Topics...  high blood pressure
Men's Health  abnormal bleeding from blood-thinning medications, such as
warfarin or heparin
• Cholesterol
 hemophilia A or hemophilia B, which are blood disorders that
• Erectile Dysfunction prevent normal blood clotting
• Hair Loss  low numbers of platelets, a type of blood cell involved in blood
• Heart Disease clotting. Low platelet counts are seen in a number of diseases and
conditions, including acute infections and a severe allergic reaction
• Prostate Disorders
known as anaphylactic shock.
• More Topics...  rupture of a cerebral aneurysm, or weakened blood vessel wall
• Sexual Health within the brain
Healthy Choice News  sickle cell disease, an inherited condition that results in abnormal
red blood cells
• Fat Burners
 a group of abnormal blood vessels within the brain known as an
• Medical Information arteriovenous malformation, or AVM
• Medical Battery  head injuries
• Health Food News  eclampsia, a complication of pregnancy that causes high blood
pressure in the mother
MOL Site Map Stroke is the third leading cause of death in the US and many other
• Laptop Battery
countries, right after heart disease and cancer.
• Rhinoplasty Orange County
What are the causes and risks of the condition?
• Medical Battery Strokes are caused by an interruption of the blood flow to brain cells or
• HIPAA Security by damage to brain cells.
• Battery Onsale The American Heart Association has recently issued guidelines for
stroke prevention. The guidelines discuss risk factors for stroke in 3
• Battery News
categories: nonmodifiable, well-documented modifiable, and less well-
• Digital Camera Battery documented or potentially modifiable.
• Cell Phone Battery The nonmodifiable factors are ones that cannot be changed by the
individual and include:
 increasing age. A person's risk of stroke doubles each year after age
55.
 race. Strokes occur approximately twice as often in blacks and
Attention, chocolate lovers: You may not be able to help yourselves. Hispanics as they do in whites.
Swiss and British scientists have linked the widespread love of  gender. Men have a 50% higher chance of stroke than women do.
chocolate to a chemical "signature" that may be programmed into our  family history of stroke or transient ischemic attack (TIA). A TIA is a
metabolic systems. short, reversible form of stroke that may serve as an early warning sign
Read more health news of stroke.

CVA - Stroke Well-documented modifiable risk factors are those that can be changed
by the individual in conjunction with his or her healthcare provider.
• Overview, Causes, & Risk Factors These factors are linked to stroke by strong research findings, and there
is documented proof that changing the risk factor lowers a person's risk
of stroke. These factors include:
 high blood pressure
 smoking
 diabetes
 asymptomatic carotid stenosis, or narrowing of one of the arteries in
the neck
 sickle cell anemia, a blood disorder that forms abnormal red blood
cells
 high cholesterol levels in the blood, including total cholesterol and
LDL or "bad cholesterol." Low levels of HDL or "good cholesterol" are
also cause for concern.
 atrial fibrillation, an abnormal heart rhythm
Less well-documented or potentially modifiable risk factors for stroke
are those that have less proof of either a link to stroke or the impact of
modifying the risk factor. These factors include:
 obesity
 sedentary lifestyle
 alcohol abuse
 high blood levels of homocysteine, a blood component sometimes
associated with a higher risk of stroke
 drug abuse
 blood disorders, such as blood that clots easily or deficiencies of
various blood components
 hormone replacement therapy (HRT). The AHA currently states that
the risk of stroke associated with HRT appears low but needs further
study.
 use of birth control pills, or oral contraceptives
 inflammatory processes, such as a chronic infection with chlamydia
Several recent studies have identified factors that seem to increase or
decrease the risk of stroke in particular groups of people. These studies,
which warrant further investigation, include these findings:
 People who were treated for high blood pressure with thiazide
diuretics, such as hydrochlorothiazide, had a significantly lower stroke
risk than people on ACE inhibitors or calcium channel blockers.
 Women ages 39 to 50 who ate more fish and omega-3
polyunsaturated fatty acids had a reduced risk of ischemic stroke. This
was particularly true in women who did not take aspirin regularly.
 Women ages 15 to 44 who had 2 drinks of wine a day had a 40% to
60% lower risk of stroke than women who did not drink alcohol.
 Phenylpropanolamine, a compound contained in appetite
suppressants and cold remedies, significantly increased the risk of
hemorrhagic stroke in women 18 to 49 years of age. The Food and Drug
Administration (FDA) has since asked manufacturers to remove
phenylpropanolamine from their products.
 In one study, people who were treated in emergency departments
for transient ischemic attacks (TIA) had a 25% chance of having a
stroke or other serious health event within the next 90 days.
Symptoms & Signs
What are the signs and symptoms of the
condition?
Strokes can cause many different signs and symptoms, depending on
the area of the brain that is damaged. Some people have multiple areas
of damage. Most strokes begin suddenly, develop rapidly, and cause
brain damage within minutes. Signs or symptoms may include:
 problems with movement, such as weakness, clumsiness, or
paralysis. These are often on only one side of the body. In some cases,
people may only have weakness or clumsiness in their hand. In other
cases, one entire half of the body becomes paralyzed.
 headache
 numbness or a lack of feeling, which is also often on only one side of
the body
 speech impairments, including slurred speech or difficulty finding the
correct word
 difficulty doing math or writing
 difficulty understanding speech or writing
 inability to recognize family members or common objects
 dementia, a condition that affects memory, understanding, and the
ability to carry out the normal activities of daily life
 visual impairment, including blurred vision or total vision loss
 hearing impairment
 personality changes
 difficulty swallowing
 balance problems, known as ataxia
 coma
 the inability to breathe on one's own. This may require a person to
be put on an artificial breathing machine, or ventilator.
Diagnosis & Tests
How is the condition diagnosed?
The first step in diagnosis of stroke is a medical history and physical
exam. This may be all that is needed to make the diagnosis. In other
cases, further tests may be needed.
Cranial MRIs and cranial CT scans may be ordered to show the type,
size, and location of the stroke. They can also show whether or not
there is bleeding in the brain, which can help with some treatment
decisions.
Other tests may be ordered to help determine the cause of the stroke.
For instance, a special X-ray test of the neck arteries can detect
blockage. Certain X-ray tests of the heart can show heart failure or
changes from a heart attack. A heart tracing, or ECG, can show
abnormal heartbeats, such as atrial fibrillation, or certain changes from
a heart attack.
Prevention & Expectations
What can be done to prevent the condition?
The American Heart Association guidelines for stroke prevention
address both modifiable and less well-documented or potentially
modifiable risk factors.
Measures to reduce the modifiable risk of high blood pressure, a major
cause of stroke, include:
 measurement of blood pressure in adults at least every 2 years to
screen for high blood pressure
 weight control
 physical activity
 moderation in alcohol intake
 moderate sodium intake
 for those who smoke, quitting smoking
 medications to treat high blood pressure if the person's blood
pressure is over 140/90 after 3 months of these lifestyle modifications,
or if the initial blood pressure is over 180/100
Other measures to reduce an individual's modifiable risk factors for
stroke may include:
 smoking cessation using nicotine patches, counseling, and formal
smoking programs
 control of blood sugar levels in a person with diabetes through
medication, diet, and exercise
 the use of ramipril in people with diabetes. A recent study showed
that people with diabetes have a 33% lower risk of ischemic stroke if
they take ramipril.
 careful evaluation of asymptomatic carotid stenosis to determine the
need for surgery. Coronary artery surgery, such as an endarterectomy,
may be indicated. An endarterectomy opens the narrow portion of the
artery and increases the blood flow to the brain. People with carotid
stenosis should also work closely with their healthcare providers to
control other risk factors for stroke.
 semiannual screening of children with sickle cell anemia, using
ultrasound to determine the child's risk of stroke
 treatment of atrial fibrillation with blood thinners such as aspirin or
warfarin, depending on the person's age and other risk factors
 monitoring of high levels of total cholesterol or LDL, as well as low
levels of HDL. Depending on the blood levels and the person's other risk
factors, medications to lower cholesterol may be given.
Measures to reduce less well-documented or potentially modifiable risks
for stroke may include:
 weight reduction in overweight persons
 30 or more minutes of moderate exercise a day for most individuals.
People with heart disease or disabilities should be in a medically
supervised exercise program.
 a healthy diet for preventing heart disease, containing at least 5
fruits and vegetables a day
 for those who drink alcohol, drinking in moderation. The AHA defines
moderate drinking as no more than 2 drinks a day for men and 1 drink a
day for women.
 seeking treatment for drug abuse
 monitoring of blood levels of homocysteine. For most individuals, a
well-balanced diet following the food guide pyramid will provide enough
folic acid and B vitamins to maintain a healthy homocysteine level. For
people with elevated homocysteine levels, supplements containing folic
acid and B vitamins may be recommended.
 avoiding the use of oral contraceptives in women with other stroke
risk factors
Some people have early warning signs that they are at risk for strokes.
The most common warning sign is what is known as a transient
ischemic attack, or TIA. This is a type of reversible stroke that often
goes away after a few minutes. These people can often get treatment
that will prevent a stroke in the future. For instance, they may be
advised to take aspirin or have carotid artery surgery to correct a
blockage in a neck artery.
What are the long-term effects of the condition?
Strokes can cause death or permanent disability. Though many people
recover some function in the first several months after a stroke, others
show no improvement. Some people have several small strokes over
time and slowly get worse with each one.
What are the risks to others?
Strokes are not contagious and pose no risk to others.
Treatment & Monitoring
What are the treatments for the condition?
Most people with strokes are treated right away with only aspirin if they
do not have bleeding into the brain. This only serves to help prevent
further strokes. In cases when a stroke is caught in the first few hours, a
clot-busting medication may be used to reverse a stroke. This is why
early recognition of a stroke can be important.
If someone has the early warning signs of stroke, the emergency
1.
medical system should be contacted immediately.
These signs include a sudden onset of:
 severe headache
 weakness or numbness of the face, arm, or leg, especially on one
side of the body
 dizziness
 trouble walking or loss of balance, known as ataxia
 confusion
 speech impairments, including trouble speaking or understanding
speech
 visual impairments
Specific types of medication may be needed in special cases. For
instance, those with a heart infection may be given antibiotics. Those
with arteritis are often given corticosteroids, such as prednisone, to
reduce inflammation in the brain.
If an individual has significant narrowing of the carotid arteries, a
carotid endarterectomy may be recommended to widen them. This
surgical procedure removes the cholesterol plaques and may prevent
future strokes. The decision to perform surgery will depend on the
person's neurological status, the type of plaque clogging the artery, and
whether the plaque has a break in it, known as a rupture.
Supportive therapy may also be needed with some strokes. This may
include an artificial breathing machine, or ventilator, and an artificial
feeding tube if the person cannot swallow.
Rehabilitation services can help to improve a person's function after a
stroke. Physical therapy and other therapy, such as speech therapy or
occupational therapy, may be used to maximize recovery.
What are the side effects of the treatments?
Side effects depend on the treatments used. For instance, aspirin may
cause allergic reactions, stomach upset, or bleeding. Clot-busting
medications can cause excessive bleeding. A ventilator may sometimes
cause damage to the lungs or an infection.
A carotid artery endarterectomy can cause bleeding, infections, and
allergic reactions to the anesthesia. On rare occasions, carotid
endarterectomy can cause a stroke or heart attack to occur.
What happens after treatment for the condition?
After the person is stable, treatment of the risk factors for stroke, as
well as the cause of the stroke, is important to prevent further strokes.
For instance, stopping smoking and controlling high blood pressure,
diabetes, and high cholesterol are advised for most people.
Those with arteritis are often maintained on medications to reduce
inflammation for long periods. Those with clots in the heart are often
put on medications to thin the blood, such as warfarin.
Many people need assistance of one form or another after a stroke. This
may range from using a walking cane to needing 24-hour-a-day skilled
nursing care. Ongoing therapy to improve function is usually advised for
at least 6 months if the person is able.
How is the condition monitored?
People having a stroke are often admitted to the hospital for close
monitoring. Once the person is stable, he or she can often be sent home
or to a skilled nursing facility or rehabilitation center for further therapy.
Other monitoring is related to the cause. For instance, those with clots
in their heart need repeat blood tests, such as a PT test, to monitor the
effects of medications used to thin the blood. Any new or worsening
symptoms should be reported to the healthcare provider.
Attribution
Author:Adam Brochert, MD
Date Written:
Editor:Ballenberg, Sally, BS
Edit Date:01/31/01
Reviewer:Eileen McLaughlin, RN, BSN
Date Reviewed:07/13/01
Sources
Harrison's Principles of Internal Medicine, 1998, Fauci et al.
+++++++++++++++++++++++++++++
+++++++++
http://seniorhealth.about.com/cs/stroke/g/def_cv
a.htm
Cerebral Vascular Accident
From Marian Anne Eure, former About.com Guide
Updated February 24, 2010
About.com Health's Disease and Condition content is reviewed by
our Medical Review Board
Filed In:
Senior Health
Definition: A cerebral vascular accident is another name for a
stroke. It is damage to the brain caused by a disruption of the blood
supply to a part of the brain. This disruption of blood supply can be
caused by a blood clot, or by a ruptured artery.
The symptoms of a cerebral vascular accident depend on which
part of the brain is affected. Common symptoms may include
paralysis of a part of the body, loss of all or part of the vision, or
loss of the ability to speak or to understand speech.
Pronunciation: ser'e-bral vas'ku-lar ak'si-dent
Also Known As: CVA, stroke, apoplexy
Alternate Spellings: cerebrovascular accident
Common Misspellings: cirebral vasscular accident
Examples:
My father had a cerebral vascular accident that caused the left side
of his body to be paralyzed.
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Suggested Reading
• Stroke Information
• Stroke Is An Emergency
• Stroke Prevention
Start a discussion on the Senior Health forums
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+++++++++++++++++++++++++++++
+++++++
http://www.eatatease.com/cva.html
CVA (stroke)
A stroke happens when there is a sudden break in the blood supply
to an area in the brain. This causes a deprivation of oxygen leading
to the death of brain tissue.
There are 2 main types of strokes:
Ischaemic stroke, these strokes result from an obstruction in the
blood vessels, most are caused by a blood clot (Thrombus), tissue
debris or an air bubble. There is a further classification of strokes
dependant on the area of damage.
Haemorrhagic stroke, these strokes result from a rupture of a
weakened or damaged blood vessel. This causes bleeding in the
brain.
The consequences of the stroke is very much dependant on the
location and extent of damage to the brain.
Some strokes may cause permanent damage, other strokes may
only cause temporary damage.
Clinical effects of the stroke include, weakness on one side of the
body, loss of balance, difficulty communicating, difficulty
swallowing, memory loss.
When one suffers a stroke, there is an admission to hospital where
the patient will be assessed thoroughly by a multidisciplinary
team.
Nutritional assessment is essential, and whilst in hospital you
would have been seen by a Dietitian. The last thing I want to mention here that when the temperature
How can an Eatatease Dietitian help? gets down to 98 or 98.4 or similar, she seems quite active, fresh
The UK registered Dietitians at Eatatease can advise on the most and obey various commands.
appropriate diet based upon your present medical condition. The e-
consultation option allows a comprehensive dietary review to be
The only question I have is about this Fever. Do you have any
undertaken by a UK registered Dietitian.
+++++++++++++++++++++++++++++++
ideas about the cause of fever? Did you see anyone with similar
condition? Do you think it is "Drug Fever"?
http://ehealthforum.com/health/topic114268.html
Any suggestion and ideas will be greatly greatly appreciated. I
shall be very thankful to you. May God bless you.

Sincerely,
Medical Questions > Conditions and Diseases > Stroke Forum ++++++++++++++++++++++++++++++
http://www.yinyanghouse.com/conditions-
Severe Infarct CVA Attack And treated/alternative-natural-options-for-stroke-cva
Paralysis - What Causes Fever?
Must Read Natural and Alternative
What Is A Stroke?
What happens during a stroke? What increases your chances of having a
stroke? Stroke basics and info on the two types of stroke here....
Stroke (CVA) Treatment
Options
Read more >>
Stroke Causes And Risk Factors
...
Read more >> Stroke (CVA) Treatment (Introduction)
Stroke Symptoms Stroke occurs when the flow of blood to a section of the brain is
Strokes can happen with virtually no warning signs. Learn the symptoms of suddenly cut off or when a blood vessel ruptures, spilling blood into
stroke so that you can take immediate action in case of emergency.... or around the brain. When this happens, brain cells begin to die,
Read more >> causing numbness or tingling on one side of the body, sudden
Conditions And Diseases confusion, difficulty speaking or seeing out of both or one eyes,
Severe Cramping After Gastric Bypass dizziness, headache, and other symptoms.
Severe Sciatia With Lower Back Pain Below you will find alternative and natural treatment options
Artery Severed During Knee Replacement including those from a Chinese Medicine perspective for Stroke.
Mri Results For Severe Lower Lumbar Spin...
I Fainted Today, Now I Have A Severe Hea...
Our "options" information is divided into the following sections.
My Dad Has Severe Gout - How Do I Avoid ... Please note that each condition may not yet have each section
Bump On Throat Caused By Severe Cough? completed. If you are not finding the information you are looking
Severe Lower Back Pain, Marble Sized Lum... please ask in our forums or read the sections for related
Tmj Severe X2 (Quick Post) conditions/symptoms.
Car Accident Caused Herniations: Severe ...
Stroke General/Public Information:
Stroke Victim Feeling Dizziness And Tied... •Introduction, • Articles, • Self-Help/Herbal
Chest Pain And My Eye Blacked Out
A Scar From A Infarction Insignificant? Formulas Available For Purchase, • Related
Do The Meds Lead To More Problems?
Stroke Treatment Acupuncture Points, • Related Forum Posts.
Panick Attack Or Mini Strokes? Practitioner Information:
Stroke / Aphasia ?
TIA Caused By Stress ? • Chinese Medicine Theory, • Acupuncture
TIA On Jan 16th ,
Multiple TIA , All The Standard Tests Protocols, • TCM Herbal Formulas, • TCM
Severe Infarct CVA Attack And Individual Herbs, • Case Studies, • Tong Ren
Therapy, • Western Individual Herbs,
Paralysis - What Causes Fever? • Western Medicine.
TOPICS DOCTOR QUESTIONS
Herbal Formulas for Stroke (CVA) Available
From Our Store
Herbal Formulas
You may click on any of the products below for more information,
or view all formulas listed by condition.
dexsense
November 6th, 2007
Hi and how are all of you? My mother got a severe CVA attack
on 25 of september. The type of CVA is "Infarct". About 8 or 9 View your cart/checkout
days back, she started moving her legs and feet little bit. Further
more, she could also move her face and neck but she cannot
speak, eat and perform ADLs(All Day Activities).

About 8 or 9 days back, she got fever and till now, the fever is
still there. Sometimes it is 99, sometimes, 100 or 100.2,
100.4....101, 102. It is continuously fluctuating. It is important to
mention here that we have been giving her Antibiotics like
Ciprofloxicin, Clathromycine, Vencomycine during these days.
Yesterday, we started giving her Cefixime. We gave her another
Antibiotic as well but sorry I cannot remember its name now. Zhong Feng Hui Chun
Wan - Stroke, Bells Palsy
 Herbal Formula or around the brain. When this happens, brain cells begin to die,
causing numbness or tingling on one side of the body, sudden
confusion, difficulty speaking or seeing out of both or one eyes,
• details... dizziness, headache, and other symptoms.
Uses: Stroke Recovery, Below you will find alternative and natural treatment options
including those from a Chinese Medicine perspective for Stroke.
Bell's Palsy. Zhong Feng Our "options" information is divided into the following sections.
Hui Chun Wan, literally Please note that each condition may not yet have each section
"Stroke Recovery Pills" in completed. If you are not finding the information you are looking
please ask in our forums or read the sections for related
Chinese, promotes blood conditions/symptoms.
circulation to remove General/Public Information:
blood stasis, relaxes •Introduction, • Articles, • Self-Help/Herbal
muscles and tendons Formulas Available For Purchase, • Related
and...
Top of Form Acupuncture Points, • Related Forum Posts.
Practitioner Information:
Add to cart
• Chinese Medicine Theory, • Acupuncture
Protocols, • TCM Herbal Formulas, • TCM
Bottom of Form
Individual Herbs, • Case Studies, • Tong Ren
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Therapy, • Western Individual Herbs,
catalog.
• Western Medicine.
Stroke (CVA) related articles
Below are articles related to this condition submitted by our Herbal Formulas for Stroke (CVA) Available
practitioner members. See our practitioner member From Our Store
section for all articles. Herbal Formulas
Comparison of Acupuncture Techniques in Stroke You may click on any of the products below for more information,
Recovery by Chad Dupuis or view all formulas listed by condition.
A recent study from researchers at the Department of Acu-
moxibustion in the College of Chinese Medicine in China looked at
differences in effectiveness between using auricular, scalp, and View your cart/checkout
body points in the recovery of patients who have had acute
cerebral infarction (ACI).
• read article

Stroke Rehabilitation with Acupuncture, Tuina,

and Tong Ren Therapy by Chad Dupuis
Stroke is the leading cause of long-term disability in the US and
the third leading cause of death. Every year strokes effect 15
million people worldwide with 5 million of those resulting in death.
Of the remaining 10 million survivors at least 5 million of those will Zhong Feng Hui Chun
be disabled to varying degrees requiring immediate and long-term Wan - Stroke, Bells Palsy
care to regain function, speech, memory, and other related
Herbal Formula
impairments. Smoking, obesity, diabetes, atrial fibrillation, and
high blood pressure are important risk factors for stroke, with high
blood pressure being the most strongly correlated. • details...
• read article Uses: Stroke Recovery,
Bell's Palsy. Zhong Feng
CAM Stroke Treatment Research by yyh_staff Hui Chun Wan, literally
Acupuncture and Chinese Medicine is widely used to aid a patients "Stroke Recovery Pills" in
recovery from a stroke. The first study listed below is a relatively
simple one to show basic changes from acupuncture in mobility. Chinese, promotes blood
The second study below is a small meta-analysis of a number of circulation to remove
studies showing positive changes. The authors of the second study
state "our observations demonstrate that patients may be more
blood stasis, relaxes
likely to remain independent and in their own homes one year post muscles and tendons
stroke if they receive acupuncture". and...
• read article Top of Form

Natural and Alternative

Add to cart

Stroke (CVA) Treatment Bottom of Form

For a complete list of our products, please see our store
Options catalog.
Stroke (CVA) related articles
Stroke (CVA) Treatment (Introduction)
Stroke occurs when the flow of blood to a section of the brain is
suddenly cut off or when a blood vessel ruptures, spilling blood into
 Below are articles related to this condition submitted by our
practitioner members. See our practitioner member Ischemic Stroke
section for all articles. The most common type of stroke --
accounting for almost 80% of all
Lifestyle Considerations and Self-Help for strokes -- is caused by a clot or other
Stroke by Chad Dupuis blockage within an artery leading to
For patients who have had a stroke the single most important the brain.
recommendation is to not delay in seeking acupuncture.
Muscular/facial paralysis, speech problems, urine/stool issues, etc.
can all be helped significantly with acupuncture. When patients
seek acupuncture within the first few months after a stroke, results
often come much sooner and a more systemic when compared with
people who come months or years later.
Intracerebral Hemorrhage
• read article
An intracerebral hemorrhage is a type
stroke caused by the sudden rupture
• « FIRST of an artery within the brain. Blood is
• ‹ PREVIOUS then released into the brain,
• 1 compressing brain structures.
• 2
Forum posts related to Stroke (CVA)
Listed below are forum posts related to this condition. You can click
on the posts to submit comments. If you would like to submit a
forum post/question related to this condition, please click to
submit. For all recent activity see our forum.
Subarachnoid Hemorrhage
At this time there are no forum posts related to this topic. To
submit a question/forum post, click to submit. A subarachnoid hemorrhage is also a
a type of stroke caused by the
Practitioner Information for Stroke (CVA) sudden rupture of an artery. A
Traditional Chinese Medicine subarachnoid hemorrhage differs
from a intracerebral hemorrhage in
Viewpoints that the location of the rupture leads
to blood filling the space surrounding
the brain rather than inside of it.
TCM Stroke Treatment Theory Ischemic Stroke
In the case of stroke, Chinese medicine plays both a preventative
and a rehabilitative role. In its prevention role, Chinese medicine is
used to treat many of the common risk factors for stroke, such
as hypertensionand diabetes. In its rehabilitative role, Chinese
medicine is used to treat the effects of stroke.
• continue reading tcm theory
Acupuncture Treatment Protocols
Listed below are articles describing related TCM diagnoses and
acupuncture treatment points. These generally require an
understanding of basic TCM Theory, however, general readers may
find the protocols illustrative of how Chinese Medicine views and
treats this condition.
+++++++++++++++++
http://www.strokecenter.org/patients/stroke_types.htm

In this Section: What is a Stroke? | Stroke Types | Warning

Signs | Stroke Statistics
Stroke Types: Ischemic Stroke | Intracerebral An ischemic stroke occurs when an artery in the
Hemorrhage | Subarachnoid Hemorrhage brain becomes blocked.

Types of Stroke What is it? Ischemic ("is-skeem-ic") stroke occurs when

troke or brain attack is a sudden problem affecting
the blood vessels of the brain. There are several types
of stroke, and each type has different causes. The
three main types of stroke are listed below. Click on
the individual name of each type for more detailed
information and images.
an artery to the brain is blocked. The brain depends on its
arteries to bring fresh blood from the heart and lungs. The
blood carries oxygen and nutrients to the brain, and takes
away carbon dioxide and cellular waste. If an artery is
blocked, the brain cells (neurons) cannot make enough
energy and will eventaully stop working. If the artery
remains blocked for more than a few minutes, the brain
cells may die. This is why immediate medical treatment is
absolutely critical.

What causes it? Ischemic stroke can be caused by

several different kinds of diseases. The most common
problem is narrowing of the arteries in the neck or
head. This is most often caused atherosclerosis, or gradual
cholesterol deposition. If the arteries become too narrow,
blood cells may collect and form blood clots. These blood
clots can block the artery where they are formed
(thrombosis), or can dislodge and become trapped in
arteries closer to the brain (embolism). Another cause of
stroke is blood clots in the heart, which can occur as a
result of irregular heartbeat (for example, atrial fibrillation),
heart attack, or abnormalities of the heart valves. While
these are the most common causes of ischemic stroke,
there are many other possible causes. Examples include
use of street drugs, traumatic injury to the blood vessels of
the neck, or disorders of blood clotting.

Are there different kinds of ischemic stroke? Yes.

Ischemic stroke can further be divided into two main
types: thrombotic and embolic.
A thrombotic stroke occurs when diseased or damaged
cerbral arteries become blocked by the formation of a blood
clot within the brain. Clinically referred to as cerebral
thrombosis or cerebral infarction, this type of event is
responsible for almost 50% of all strokes. Cerebral
thrombosis can also be divided into an additional two
categories that correlate to the location of the blockage
within the brain: large-vessel thrombosis and small-vessel
thrombosis. Large-vessel thrombosis is the term used when
the blockage is in one of the brain's larger blood-supplying
arteries such as the carotid or middle cerebral, while small-
vessel thrombosis involves one (or more) of the brain's
smaller, yet deeper penetrating arteries. This latter type of
stroke is also called a lacuner stroke.
An embolic stroke is also caused by a clot within an artery,
but in this case the clot (or emboli) was formed somewhere
other than in the brain itself. Often from the heart, these
emboli will travel the bloodstream until they become lodged
and can not travel any further. This naturally restricts the
flow of blood to the brain and results in almost immediate
physical and neurological deficits.
Deprived of oxygen and other nutrients, the brain
suffers damage as a result of the stroke.
Who gets it? Ischemic stroke is by far the most common
kind of stroke, accounting for about 88% of all strokes.
Stroke can affect people of all ages, including children.
Many people with ischemic strokes are older (60 or more
years old), and the risk of stroke increases with older ages.
Each year, about 55,000 more women than men have a
stroke, and it is more common among African-Americans
than white Americans. Many people with stroke have other
problems or conditions which put them at higher risk for
stroke, such as high blood pressure (hypertension), heart
disease, smoking, or diabetes. Click here for information
about stroke risk factorsand how to reduce your risk.
Intracerebral Hemorrhage
(Intraparenchymal hemorrhage, or intracranial hematoma,
ICH)
 A ruptured blood vessel will leak blood into the
When blood vessels within the brain become brain, eventually causing the brain to compress
damaged, they are more likely to burst and cause due to the added amount of fluid.
a hemorrhage.

Who gets it? Intracerebral hemorrhage occurs at all ages.

What is it? Intracerebral hemorrhage occurs when a The average age is lower than for ischemic stroke. Less
diseased blood vessel within the brain bursts, allowing common than ischemic strokes, hemorrhagic strokes make
blood to leak inside the brain. (The name up about 12% of all strokes.
means within thecerebrum, or brain). The sudden increase
in pressure within the brain can cause damage to the brain
Subarachnoid Hemorrhage
cells surrounding the blood. If the amount of blood
increases rapidly, the sudden buildup in pressure can lead
to unconsciousness or death. Intracerebral hemorrhage
usually occurs in selected parts of the brain, including
the basal ganglia, cerebellum, brainstem, or cortex.

What causes it? The most common cause of intracerebral

hemorrhage is high blood pressure (hypertension). Since
high blood pressure by itself often causes no symptoms,
many people with intracranial hemorrhage are not aware
that they have high blood pressure, or that it needs to be
treated. Less common causes of intracerebral hemorrhage
include trauma, infections, tumors, blood clotting
deficiencies, and abnormalities in blood vessels (such as
arteriovenous malformations). View an interactive tutorial
on arteriovenous malformations from the Toronto Brain
Vascular Malformation Study Group. (Requires Flash.)

When a cerebral aneurysm ruptures, blood will fill

the space surrounding the brain.

What is it? Subarachnoid hemorrhage occurs when a

blood vessel just outside the brain ruptures. The area of the
skull surrounding the brain (the subarachnoid space)
rapidly fills with blood. A patient with subarachnoid
hemorrhage may have a sudden, intense headache, neck
pain, and nausea or vomiting. Sometimes this is described
as the worst headache of one's life. The sudden buildup of
pressure outside the brain may also cause rapid loss of
consciousness or death.

What causes it? Subarachnoid hemorrhage is most often

caused by abnormalities of the arteries at the base of the
brain, called cerebral aneurysms. These are small areas of
rounded or irregular swellings in the arteries. Where the
swelling is most severe, the blood vessel wall become weak
and prone to rupture. View an interactive tutorial on
cerebral aneurysms from the Toronto Brain Vascular
 stroke is recognized in time. DO NOT try to diagnose the
problem by yourself, and DO NOT wait to see if the
symptoms go away on their own.
Even if the symptoms pass quickly, they could be an
important warning that requires prompt medical attention.
In this Section: What is a Stroke? | Stroke Types | Warning
Signs | Stroke Statistics

Stroke Statistics
U.S. Statistics
Stroke is the third leading cause of death in the
United States. Over 143,579 people die each year
from stroke in the United States.

Stroke is the leading cause of serious, long-term

disability in the United States.
Each year, about 795,000 people suffer a stroke.
About 600,000 of these are first attacks, and
185,000 are recurrent attacks.
Surgical treatment of aneurysms involves placing
clip on neck of aneurysm. Nearly
three-
Malformation Study Group. (Requires Flash.) quarters
of all
strokes
Who gets it? The cause of cerebral aneurysms is not occur in
known. They may develop from birth or in childhood and people
grow very slowly. Some people have not one, but several over the
aneuryms. Subarachnoid hemorrhage can occur at any age of 65.
age, including teenagers and young adults. Subarachnoid The risk of
hemorrhage is slightly more common in women than men. having a
stroke
more than
doubles
each
decade
after the
age of 55.
Strokes
can—and
do—occur
at ANY
age.
Nearly
Warning Signs of Stroke one
quarter of
he most common sign of stroke is sudden weakness of strokes
the face, arm or leg, most often on one side of the body. occur in
Other warning signs can include: people
under the
Sudden numbness of the face, arm, or leg, especially
age of 65.
on one side of the body
Stroke
Sudden confusion, trouble speaking or understanding
death
speech
rates are
Sudden trouble seeing in one or both eyes higher for
African
Sudden trouble walking, dizziness, loss of balance or Americans
coordination than for
Sudden severe headache with no known cause whites,
even at
The signs of a stroke depend on the side of the brain that's younger
affected, the part of the brain, and how severely the brain ages.
is injured. Therefore, each person may have different
stroke warning signs. Stroke may be associated with a Among adults age 20 and older, the prevalence of
headache, or may be completely painless. stroke in 2005 was 6,500,000 (about 2,600,000
If you or someone you know is having these signs, males and 3,900,000 females).
call 911 and seek medical help immediately. Stroke is a On average, every 40 seconds someone in the
medical emergency. Treatment is available, but only if a United States has a stroke.
 Each year, about 55,000 more women than men rate of stroke remains high due to the aging of the
have a stroke.Men’s stroke incidence rates are population.
greater than women’s at younger ages but not at
older ages. The male/female incidence ratio is 1.25 Sources: World Health Report - 2007, from the World
at ages 55–64; 1.50 for ages 65–74; 1.07 at 75–84 Health Organization; International Cardiovascular Disease
and 0.76 at 85 and older. Statistics (2007 Update), a publication from the American
Heart Association.
Of all strokes, 87 percent are ischemic, 10 percent
are intracerebral hemorrhage, and 3 percent are
subarachnoid hemorrhage.
Stroke accounted for about one of every 17 deaths
in the United States in 2005. Stroke mortality for
2005 was 143,579 (56,586 males, 86,993 females). Charts & Figures (from the U.S. Centers for Disease
Control and Prevention. Generate interactive maps at the
From 1995–2005, the stroke death rate fell 29.7 USCDCP's Maps Page)
percent and the actual number of stroke deaths
U.S. Stroke
declined 13.5 percent.
Deaths 35+,
The risk of ischemic stroke in current smokers is 1991-8, by
about double that of nonsmokers after adjustment County
for other risk factors. This map
Atrial fibrillation (AF) is an independent risk factor clearly shows
for stroke, increasing risk about five-fold. the "Stroke
High blood pressure is the most important risk factor Belt," an area
for stroke. in the
Southeastern
Sources: U.S. Centers for Disease Control and U. S. and
Prevention and the Heart Disease and Stroke Statistics - Mississippi
2010 Update, published by the American Heart Association. Valley with a
high rate of
stroke
mortality.

U.S. Stroke
Canadian Statistics Deaths for
In 2000, stroke accounted for 7% of all deaths - 15, Men 35+,
409 Canadians. 1991-8
Again, the
Every seven minutes, a Canadian dies of heart
"Stroke Belt" is
disease or stroke.
clearly visible.
Stroke was the second largest contributor to hospital
care costs among cardiovascular diseases (2000-1).
80% of Canadians have at least one of the risk
factors for heart and/or cerebrovascular disease:
daily smoking, physical inactivity, being overweight,
self-reported high blood pressure, or diabetes.
Between 1969 and 1999, death rates for U.S. Stroke
cerebrovascular disease decreased by 62%. Deaths for
Learn more about stroke in Canada from The Growing Women 35+,
Burden of Heart Disease and Stroke in Canada 2003, a 1991-8
report by the Centre for Chronic Disease Prevention and
Control, the Canadian Cardiovascular Society, and the Heart

and Stroke Foundation of Canada.

Worldwide Statistics
According to the World Health Organization, 15
million people suffer stroke worldwide each year. Of
these, 5 million die and another 5 million are
permanently disabled.
High blood pressure contributes to over 12.7 million
strokes worldwide.
Europe averages approximately 650,000 stroke
deaths each year.
In developed countries, the incidence of stroke is In this Section: How a Stroke is
declining - largely due to efforts to lower blood Diagnosed | Lab Tests & Procedures | Blood
pressure and reduce smoking. However, the overall Tests
Imaging Tests: CT
Scan | MRI | Angiography | Ultrasound | Ec
hocardiogram | EKG
How a Stroke is Diagnosed
f you
have
had a
stroke,
or have
had
stroke
warning signs or risk factors, it is
very important to seek prompt
medical attention. Your doctor will
work with you to find the cause of
your problem and determine the best
treatment. Even if your symptoms
resolve without treatment, you
should still discuss them with your
doctor. Don't assume that a problem
is unimportant if it goes away on its
own. Never try to make a diagnosis
by yourself.
IMPORTANT: If you or someone you
know is having stroke symptoms
now, call 911! Stroke is a medical
emergency. Click here to read about
the warning signs of stroke.
The first step in understanding your
problem is to obtain a careful
medical history. Your doctor or
health care provider will ask
questions about your situation. If
you can't communicate, a family
member or friend will be asked to
provide this information. Your doctor
will ask about the symptoms you are
having now and have had in the
past, previous medical problems or
operations and any illnesses which
run in your family. Be sure to bring a
current list of all the medicines you
take (prescription and non-
prescription). If your symptoms
lasted only a while, your doctor
might also want to talk with
someone else who was with you at
the time.
The next step is a thorough physical
examination. Your doctor will check
your pulse and blood pressure, and
examine the rest of your body
(heart, lungs, etc). The neurologic
examination includes detailed tests
of your muscles and nerves. The
doctor will check your strength,
sensation, coordination and
reflexes. In addition, you will be
asked questions to check your
memory, speech and thinking.
Depending on the results of your
evaluation, your doctor may need
additional tests to fully understand
your problem. Detailed information
about each of these tests can be
found on the following pages.
You may also be referred to a
medical specialist in brain disorders
(neurologist), brain surgery
(neurosurgery) or another area.
Be patient. Sometimes it takes a
while to discover the cause of stroke
symptoms, and sometimes the cause
of a stroke cannot be determined.
Be sure to discuss any questions or
concerns with your doctor or health
care provider.
In this Section: How a Stroke is
Diagnosed | Lab Tests & Procedures | Blood
Tests
Imaging Tests: CT
Scan | MRI | Angiography | Ultrasound | Echocar
diogram | EKG
Lab Tests and Procedures Used
for Stroke Diagnosis
f you
have
had a
stroke
or
stroke
warning
signs,
your doctor may need additional
information to fully understand your
problem or plan the best treatment. In
addition to blood tests, you may need to
schedule special tests or procedures to
examine your brain, heart or blood
vessels.
Here are the tests doctors use most often
in stroke diagnosis. Click on the test name
for more information.
Tests that View the Brain, Skull or
Spinal Cord
CT scan
(CAT Scan, Computed axial tomography)
CT scan uses x-rays to produce a 3-
dimensional image of your head. A CT
scan can be used to diagnose ischemic
stroke, hemorrhagic stroke, and other
problems of the brain and brainstem.
MRI scan
(Magnetic resonance imaging, MR)
MR uses magnetic fields to produce a 3-
dimensional image of your head. The MR
scan shows the brain and spinal cord in
more detail than CT. MR can be used to
diagnose ischemic stroke, hemorrhagic
stroke, and other problems involving the
brain, brainstem, and spinal cord.
Tests that View the Blood Vessels
that Supply the Brain
Carotid doppler
(Carotid duplex, Carotid ultrasound)
Painless ultrasound waves are used to
take a picture of the carotid arteries in
your neck, and to show the blood flowing
to your brain. This test can show if your
carotid artery is narrowed by
arteriosclerosis (cholesterol deposition).
Transcranial doppler
(TCD)
Ultrasound waves are used to measure
blood flow in some of the arteries in your
brain.
MRA
(Magnetic resonance angiogram)
This is a special type of MRI scan (see
above) which can be used to see the
blood vessels in your neck or brain.
Cerebral arteriogram
(Cerebral angiogram, Digital subtraction
angiography, [DSA])
A catheter is inserted in an artery in your
arm or leg, and a special dye is injected
into the blood vessels leading to your
brain. X-ray images show any
abnormalities of the blood vessels,
including narrowing, blockage, or
malformations (such
as aneurysms or arterio-venous
malformations). Cerebral arteriogram is a
more difficult test than carotid doppler or
MRA, but the results are the most
accurate.
Tests that View the Heart or Check
its Function
Electrocardiogram
(EKG, ECG)
This is a standard test to show the
pattern of electrical activity in your
heart. 3-10 electrical leads are attached
to your chest, arms and legs.
Sometimes the EKG is recorded
continuously over days, with the signals
sent to a portable recorder (Holter
monitor) or by radio to a hospital
monitoring station (telemetry).
Echocardiogram
(2-d echo, Cardiac echo, TTE, TEE)
Painless ultrasound waves are used to
take a picture of your heart and the
circulating blood. The ultrasound probe
may be placed on your chest (trans-
thoracic echocardiogram, TTE) or deep in
your throat (trans-esophageal
echocardiogram, TEE).
Routine Screening Tests
Chest X-ray
(CXR)
An x-ray of the heart and lungs is a
standard test for patients with acute
medical problems. Abnormalities may
alert your doctor to important problems
such as pneumonia or heart failure.
Urinalysis
(UA)
A urine sample is often obtained to
screen for bladder infection or kidney
problems. If infection is suggested,
a urine culture test may be required.
Pulse oximetry
(Blood oxygen)
This painless test is sometimes done in
the emergency room or hospital to
determine if your blood is receiving
enough oxygen from the lungs. A small
probe with a red light is usually attached
to one finger.
Other Neurologic Tests
Electroencephalogram
(EEG)
The EEG measures your brain waves
through several electrical leads painlessly
attached to your head. EEG is not
routinely used for stroke diagnosis, but
would be ordered if your doctor thinks
that you may have had a seizure.
Lumbar puncture
(LP, spinal tap)
A needle is inserted in your lower back to
obtain a sample of the fluid
(cerebrospinal fluid, CSF) which
surrounds your brain and spinal cord. LP
is not routinely used for diagnosis of
ischemic stroke. However, LP is often
required if subarachnoid hemorrhage
(bleeding from a cerebral aneurysm) is
suspected. LP may also be needed if your
doctor suspects a nervous system
infection (such as meningitis) or
inflammation.
 Electromyogram / Nerve conduction test
Blood Tests and Procedures
(EMG / NCV)
This test records the electrical activity of Used for
the nerves and muscles. EMG is not used Stroke
for stroke diagnosis, but might be needed Diagnosis
if your doctor suspects a problem with
the nerves in your arms or legs.
f you are being
Brain biopsy evaluated for
This is a surgical procedure in which a stroke, it is likely
small piece of the brain is removed for that your doctor will
microscopic examination. Biopsy is used order some blood
to diagnose lesions (such as tumors) tests. Stroke cannot
which cannot be identified by CT or MRI be diagnosed by a
scan. It is very rarely used for stroke blood test alone.
diagnosis, when cerebral vasculitis is However, these tests can provide
suspected. information about stroke risk factors and
other medical problems which may be
important.
Please note that the first set of tests are
commonly used for routine or emergency
evaluation of stroke, while the others are
In this Section: How a Stroke is used only in very specific situations.
Diagnosed | Lab Tests & Procedures | Blood Unless otherwise noted, each of these
Tests
tests require just one tube of blood (a few
Imaging Tests: CT
Scan | MRI | Angiography | Ultrasound | Echocar
teaspoons) drawn from a vein.
diogram | EKG Commonly Used Blood Tests

CBC (Complete blood count)

This is a routine test to determine the
number of red blood cells, white blood
cells, and platelets in your
blood. Hematocrit and hemoglobin are
measures of the number of red blood
cells. A complete blood count might be
used to diagnose anemia (too little blood)
or infection (shown by too many white
blood cells).

Coagulation tests
PT (Prothrombin time)
PTT (Partial thromboplastin time)
INR (International normalized ratio)
These tests measure how quickly your
blood clots. An abnormality could result
in excessive bleeding or excessive
clotting (which is difficult to measure).
If you have been prescribed a blood-
thinning medicine such as warfarin
(Coumadin or similar drugs), the INR is
used to be sure that you receive the
correct dose. It is very important that
you obtain regular checks. If you are
taking heparin, the PTT (or aPTT) test is
used to determine the correct dose.

Blood chemistry tests

These tests measure the levels of normal
chemical substances in your blood. The
most important test in emergency stroke
evaluation is glucose (or blood sugar),
because levels of blood glucose which are
too high or too low can cause symptoms
which may be mistaken for stroke. A
fasting blood glucose is used to help in
the diagnosis of diabetes, which is a risk
factor for stroke. Other blood chemistry
tests measure serum electrolytes, the
Computed Axial Tomography CAT scan uses very little x-ray radiation. If you receive
(CAT Scan, CT Scan) contrast dye, there is a chance
of an allergic reaction. This
reaction can be serious, and
he CAT scan (also called CT scan) is well-known by may require treatment with
name, but do you really know what it is and understand appropriate medication. If you
how it works? A CT scan is usually one of the first tests have allergies to any foods or
done in a stroke evaluation, particularly during an acute medicines, particularly seafood
stroke in the emergency room. This test can show areas of or iodine, it is important to
abnormalities in the brain, and can help to determine if inform the technologist before
these areas are caused by insufficient blood flow (ischemic the procedure. You should
stroke), a ruptured blood vessel (hemorrhage), or a also tell the technologist if you
different kind of a problem. CT scans can be obtained on could be pregnant.
any part of the body, but the information here applies only How does a CT scan work?
to CT scans of the head. CT is based on the same
What is a CT scan? principles as regular x-ray. The x-rays are absorbed
A CT scan uses x-rays to take pictures of your skull and differently by the different parts of the body. Bone absorbs
brain. The patient lies in a tunnel-like machine. The inside the most x-rays, so the skull appears white on the image.
of the machine rotates and takes x-rays of the head from Water (in the cerebral ventricles, fluid-filled cavities in the
different angles, which are later used by computers to middle of the brain) absorbs little, and appears black. The
make an image of a “slice” (or cross-section) of the brain. brain has intermediate density and appears grey. Most
Why do doctors use CT scans? ischemic strokes are less dense (darker) than normal brain,
CT scans use computers and rotating x-ray machines to whereas blood in hemorrhage is denser and looks white on
create images of slices, orcross-sections, of the brain. CT.
Unlike other techniques, CT scans (and MRI scans) can In brain CT imaging, a fan beam of x-rays is sent out
show the inside of the head, including soft tissue, bones, through the skull, and a device on the other side of the
brains and blood vessels. CT scans can often show the size scanner picks up the different strengths of the x-rays.
and locations of brain abnormalities caused by tumors, After the x-ray tube and detector have made one 360°
blood vessel defects, blood clots, and other problems. CT rotation, the image of one cross-section (a few millimeters
scans are a primary method of determining whether a in width) has been taken. During this rotation, hundreds of
stroke is ischemic orhemorrhagic (see the “About Stroke” snapshots are taken, which are later used by a computer to
section). make the final image.
Does a CT scan always diagnose a stroke? Magnetic Resonance Imaging
No. Even if you are having a stroke, it might not be seen
on CT scan for several reasons. In many cases, the
(MRI, MR)
involved area of the brain does not appear abnormal for the
first several hours after the onset of stroke. Also, the RI is a test that produces
stroke region may be too small to be seen on CT scan, or it very accurate pictures of the
may be in a part of the brain (brainstem or cerebellum) brain and its arteries without x-
which the CT scan does not image well. Depending on the rays or dyes. This test is
results of the CT scan, your doctor may wish to obtain useful for detecting a wide
additional testing, including an MRI scan. MRI can be variety of brain and blood
more accurate for stroke and other conditions, but it takes vessel abnormalities, and can
longer and is often not available under emergency usually determine the area of
conditions. the brain that
What happens during a CT scan? is damaged by
You will remove any metallic objects which could diminish an ischemicstr
the quality of the images (this includes jewelry, glasses, oke (see the
dentures, and hairclips). You may also be asked remove “About Stroke”
your clothing and put on a patient gown. A technologist will section).
help you to lie face up on the scanner table, with your During this
head toward the "donut hole" of the CT scanner. The painless test,
technologist will position you on the table, and a device to you lie on a
hold your head in place may be used. Then he or she table that
leaves the exam room and goes to the control room, where moves into the
you can still communicate by intercom. opening of the
An intravenous dye (contrast dye) may be given, through MRI machine.
injection. This can help to highlight any areas of The machine
abnormality in the scan. creates a
While CT images are being taken, it is important to lie still magnetic field
on the table, which will be moving very slowly in order to which briefly alters the water molecules in your brain cells.
image the brain. It is normal for the CT scanner to make a The response to this magnetic field is then detected and
whirring noise during the exam, so you should not be used to create an image of the brain. Although MRI scans
alarmed. The table will be moving a few millimeters at a can be used on any part of the body, the following
time in order to obtain images of small slices of the brain, description applies only to MRI of the head.
until the exam is finished. The procedure usually takes Why do doctors use MRI?
between 20 minutes and an hour. MRI is useful for imaging soft tissues such as the brain
What are the risks of CT scans? because it shows great detail. It can detect minute
The test is painless and there are few side effects. The differences, even between areas that are similar (unlike
CAT scans, which are useful in imaging bone and soft How does MRI
tissue, but with less detail). MRI can often demonstrate work?
brain abnormalities which are too small or located in During the exam, a
regions of the brain that cannot be seen well by CAT scans. radio signal is
Another benefit of MRI is that it can be performed without turned on in bursts,
x-rays or dyes (although many times, an intravenous dye and the energy is
called gadolinium is used to image the brain and its blood absorbed differently
vessels). Brain MRI is commonly used to detect and by the different
diagnose many kinds of abnormalities of the skull, brain, atoms in the body. This energy is reflected out of the body
and spinal cord. In addition to stroke, MRI is used to and detected by the MRI scanner. A digital computer
diagnose abnormal growths such as tumors, blood vessel constructs these reflections into a picture of the brain. The
abnormalities, infections, or disorders such as multiple switching on and off of the device that measures the
sclerosis.MRI can provide direct views of the body from reflected MR signals (called the gradient coils) produces the
almost any direction, while CAT scans only provide images knocking sound heard during the exam.
in anaxial orientation. Medical images taken of the human Cerebral Angiography
body are usually displayed in three orientations: (Cerebral angiogram, Cerebral arteriogram,
1. Coronal orientation: in a slice dividing the head into
Digital Subtraction
front and back halves.
2. Sagittal orientation: in a slice dividing the head into Angiography [DSA])
left and right halves.
3. Axial orientation: in a slice dividing the head into erebral angiography is used
upper and lower halves. to image the blood vessels of
There are several different kinds of MRI scan (called image the brain and the blood flowing
sequences). Each sequence highlights different aspects of through them. Angiography
brain tissue, and may be used to answer specific questions. involves entering a catheter
Some sequences (for example, diffusion-weighted MR) are into the body to inject a dye (a
particularly useful for detecting abnormalities in the first contrast medium) into the
few hours after ischemic stroke. MRI can also be used to carotid arteries, the vessels of
obtain an image of the blood vessels which supply the brain the neck that lead to the
(magnetic resonance angiography or MRA). brain. Then
What happens during an MRI? regular x-ray
Before the test, you will be asked a number of questions is used to
about previous operations or the presence of any metallic image the dye
objects in your body. If you have artificial joints, a that is flowing
pacemaker, aneurysm clips, or other metal in your body, through the
consult your doctor before having an MRI. You will be blood vessels.
asked to remove all jewelry and metallic objects, and you Although
may be asked to change into a patient gown. The cerebral
technologist will help you lie down on the scanner table. angiography
After you are in the proper place, your head will be put in can be used to
position and a special radio antenna (called a surface coil) to investigate
will be placed around your head. The technologist will many
leave the exam room and go to the control room, where abnormalities, only its relevance to stroke is discussed
you can still communicate with him or her by intercom. here.
You may have the option of listening to music during the Why do doctors use cerebral angiography?
test. While the MR images are being taken, it is important Cerebral angiographies show the brain's blood vessels.
for you to lie still on the table, which will be moving very Doctors use cerebral angiography to detect abnormalities in
slowly to image the brain. It is normal for the MRI machine the brain's blood vessels, such as narrowing or blockage. It
to make a loud knocking noise during the exam, so you is usually done after another test (such as a CT scan) has
should not be alarmed. The table will be moving a few already detected an abnormality. Angiography is useful in
millimeters at a time to obtain images of each "slice" of the detecting and diagnosing acute stroke and is especially
brain, until the exam is finished. The test takes between 30 beneficial since the images taken through cerebral
and 90 minutes to complete.A dye (contrast medium) may angiography cannot be taken through other techniques.
be given, through intravenous injection, to highlight the What happens during a cerebral angiography?
area being studied. You will be asked to remove all clothing and jewelry and
What are the risks of an MRI scan? wear a patient gown before undergoing the procedure.
The MRI does not involve X-rays and there are no side While you are lying on an x-ray table, a local anesthetic is
effects. However, if you have any metallic objects in your given, usually in the thigh, where an incision is made. The
body, the magnetic field can cause dangerous catheter (a long, narrow flexible tube) is put into your body
interactions. It is essential that you tell your doctor or the through the incision navigated to the carotid arteries, where
technologist about any previous surgery, implanted devices the dye is injected.
such as pacemakers, bullets or shrapnel wounds.You will After you are properly placed on the exam table, your head
have to lie flat within a relatively small space for as long as is positioned in the desired field of view, and regular x-ray
an hour. If you think this may be a problem for you (for is used to take pictures of the blood vessels in the brain.
example, if you are claustrophobic), you should discuss this While the procedure is being done, both the technologist
with your doctor before you schedule the test. If the MRI and radiologist remain by your side. Although you are
test involves contrast dye, you will have an injection by awake during the procedure, a medication may be given to
vein (usually in your arm). help you relax. The entire procedure can take from one to
two hours to complete.
What are the risks of cerebral angiography? computer into live pictures of the arteries and the blood
The use of a catheter in cerebral angiography may cause flow.
you some discomfort or pain, although an anesthetic is Echocardiogram
usually given to help alleviate most discomfort.
There is also a risk of stroke caused by the catheter. While
being navigated through the carotid arteries the catheter n echocardiogram can be
could break off a plaque that could block a smaller blood used to find out if there is an
vessel in the brain and lead to stroke. abnormality of the heart that
How does cerebral angiography work? could lead to stroke. There are
The basic principle behind cerebral angiography is the same two types of echocardiograms:
as that of regular x-ray imaging. As the x-rays pass one that examines the heart
through the body, they are absorbed at different levels. through the chest
The absorption of the x-rays by the injected dye allows the (calledtransthoracic echocardio
blood vessels in the brain to be imaged. The differences in gram, or TTE), and one that
absorption become one of many images detected by a examines the heart through the
camera, which finally become a “movie” of the blood flow throat
(and the flow of the intravenous dye) through the vessels. (calledtransesophageal echocardiogram, or TEE). The
information that follows applies only to the use of these
Carotid Ultrasound procedures in a stroke evaluation.
(Carotid Doppler, Carotid Duplex) Transthoracic echocardi
ogram is most
arotid ultrasound is a test that shows the carotid arteries commonly performed,
(vessels in the neck that provide blood flow to the brain), and it is a test that
as well as how much blood flows and how fast it travels gives information about
through them. Ultrasound waves -- the same ones used in the size of the heart
imaging the fetus in a pregnant woman -- are used to make chamber, the motion of
an image of the arteries. This image can be used to find out the heart walls, the
if there is an abnormality or blockage of the carotid arteries movements of the
that could lead to stroke. This test can be used to heart valves and changes in structure in and around the
investigate the carotid arteries for several reasons, but the heart. Ultrasound waves (the same ones used in imaging
information here applies only to stroke evaluation. the fetus in a pregnant woman) are used to make an image
Why do doctors use carotid ultrasound? of the heart's walls and valves.
Doctors often use carotid ultrasound on patients who have Transesophageal echocardiogram is provides images of the
had a stroke or who might be at high risk for a internal structures of the heart and its blood vessels using
stroke. Narrowing of the carotid arteries -- often caused by the same ultrasound technology.
cholesterol deposits -- and blood clots can be detected Why do doctors use echocardiogram?
using this procedure. These conditions can cause problems Doctors often use TTE on patients in whom they suspect
with the blood flow to the brain and lead to a stroke. The blood clotting (calledcardiac embolus), since clots that form
actual blood flow through the carotid arteries can also be in the heart can be detected using this procedure. Blood
imaged by this test. clots are a
What happens during carotid ultrasound? leading cause
You will be asked to lie down on an examination table. The of stroke, as
technician (or physician) will place a clear gel on the area of 80% of all
the neck where the carotid artery is located. The gel is clots in the
simply a lubricant that allows the transducer (a device that heart
both puts out and detects ultrasound signals) to slide eventually
around easily on your skin. come loose
When the transducer is placed against the skin, an image of and travel to
the artery is shown on a video screen. To view the arteries the brain. An
from many different angles, your doctor will re-position the
transducer several times. Because blood is flowing through
the artery, a sound similar to your heartbeat will be
heard.
The procedure is repeated for the carotid artery on the
other side of the neck. A carotid ultrasound usually only
takes 15 to 30 minutes to complete and the results are echocardiogram can help determine how to treat or prevent
immediately known by your doctor. a stroke (if a blood clot is found in the heart, a blood-
What are the risks of carotid ultrasound? thinner such as Warfarin may be prescribed). TTE is
Since the procedure is done without entering the body and performed routinely after heart attack and as part of a
does not use dyes or x-rays, there is no risk or pain stroke evaluation.
involved in having a carotid ultrasound. Transesophageal echocardiogram (TEE) is usually
How does carotid ultrasound work? prescribed after an abnormality is found in the results of a
The transducer emits high-frequency, ultrasound waves TTE. The images from TEE can provide more information
that pass into the body and bounce off the carotid arteries about the condition of the heart because they have better
and the red blood cells moving through them. The sound resolution and are taken from the inside of the body rather
waves are reflected differently by different parts of the than the outside.
body. The transducer detects the different reflections of the What happens during echocardiogram?
sound waves, which are then measured and converted by a In TTE, a clear gel is placed on the area of the chest where
the heart is located. This lubricating gel allows a device that
both puts out and detects ultrasound signals (called an
ultrasound transducer) to slide around easily on the skin.
When the transducer is placed against the skin, a picture of
the area is shown on a video screen. Depending on how the
transducer is positioned, the heart can be viewed from
several different angles. Due to blood flowing through the
heart, a sound similar to your heartbeat will be heard.
A dye, called agitated saline, may be injected to find any
leaking between the chambers of the heart.
The images, stored as a 15-minute recording, will be
viewed later by the physician. TTE requires about 45
minutes to complete.
TEE, unlike TTE, requires preparation before the test can be
done. You will be asked not eat or drink anything except
water during the eight hours before the test. You should
also not smoke for six hours before the test is done. Be
sure to ask your doctor how you should adjust your daily
medications, such as insulin if you are diabetic.
During the actual procedure, you will be sedated
intravenously to make it less uncomfortable. The doctor will
then ask you to swallow a thin, flexible tube with a special
tip (called a probe). You may be asked to gargle an
anesthetic that will numb your throat and tongue so that
you can swallow the probe more easily. The test takes 60-
90 minutes to complete, but you may have to stay for one
or two hours so that the sedative can wear off.
What are the risks of echocardiogram?
Since TTE is done without entering the body and does not
use dyes, there is no risk or pain in having a TTE.
In TEE, the swallowing of the probe may cause some
discomfort or pain. However, anesthetics are usually given
to make the procedure less uncomfortable.
How does echocardiogram work?
The transducer, or probe, emits high-frequency ultrasound
waves that pass into the body and bounce off the valves of
the heart and the muscles of the heart walls. The sound
waves are reflected differently by different parts of the
body. The transducer detects the different reflections of the
sound waves, which are then measured and converted into
live pictures of the heart by a computer. These images are
recorded on video tape and later viewed by your doctor.
Electrocardiogram
(EKG, ECG)
CG is done so often and routinely that most people do not
even consider it a special test. However, a lot can be
learned from an ECG about the regularity (or irregularity) of
the heartbeat. The fact that irregularities in the rhythm of
the heartbeat can lead to stroke makes it an important tool
in stroke evaluation.
What is an electrocardiogram?
An ECG is a painless test that is used to get information
about the electrical activity of the heart, such as the rate
and regularity of the heartbeat. The size and position of
the heart chambers as well as any damage to the heart can
also be obtained through an ECG. If you use an implanted
device, like a pacemaker, its effect on the heart can also be
studied through the results of this test.
Why do doctors use ECG's?
ECG is sometimes the only method of detecting
irregularities in heart rhythm -- such as atrial fibrillation --
that can lead to the forming of blood clots that can later get
flow to the brain. These blood clots can cause stroke by
forming in the heart, coming loose and then getting lodged
in a small artery of the brain.
ECG is performed on every stroke patient as part of the
routine evaluation. However, the test shows only a
"snapshot" of the electrical activity of the heart (about 5
minutes), and other devices may be used to find
irregularities that occur less frequently.
What happens during an ECG?
You will be asked to lie down while the sites where the
sticky electrodes will be attached are cleaned and shaven, if
necessary. About 12 electrodes are attached to various
parts of your body, six of which will be attached to the
chest. The other six (called limb leads) will be attached
accordingly: one on each arm, one on each leg, and two on
the abdomen.
You must usually lie still during the test, while holding your
breath for short periods at a time. The test requires ten to
15 minutes to complete.
What are the risks of ECG?
Since ECG is done without entering the body and does not
use dyes or x-rays, there is no pain or risk associated with
having an ECG.
How does an ECG work?
The electrodes contain wires that can detect the electrical
signals of the heart through the skin. These wires are
connected to a machine that traces the heart rhythm on
graph paper. Because the results are immediately known,
your doctor will instantly know the basic vital signs of your
heart.
Reducing Your Risk of Stroke
f you have ever had a
stroke (or stroke warning
signs), it is very
important that you work
with your doctor to
determine the most likely
cause of the problem and
the best course of
treatment for you.
Certain medical
conditions greatly
increase your likelihood of having a stroke (or another
stroke). Working with your doctor, you may need to begin
specific medical treatment to control these risk factors.
Medical conditions that increase your stroke
risk:
Previous stroke or "mini-stroke" (transient
ischemic attack, TIA).
Depending on the most likely cause of your stroke,
your doctor may prescribe specific medication or
consider surgery to remove fatty deposits in your
carotid artery.
High blood pressure.
Hypertension is one of the leading risks for heart
disease and stroke. Your physician may advise
dietary or lifestyle changes, or specific medications to
lower your blood pressure.
(Take a look at "Your Guide to Lowering Blood
Pressure" from the National Heart, Lung, and Blood Institute
- NHLBI. )
Diabetes.
High blood sugar can increase your risk, so you
should work closely with your doctor to manage it.
(Learn more about diabetes from the National Institute of
Diabetes and Digestive and Kidney Diseases - NIDDK.)
Heart disease.
Particularly heart beat irregularities (atrial fibrillation),
disease of the heart valves, congestive heart failure or
recent heart attack. If you have one of these
 conditions, your physician may prescribe medications
to thin your blood and/or reduce your cholesterol
level.
(Visit the National Heart, Lung, and Blood Institute -
NHLBI for more information on cardiovascular disease.)

Controllable risk factors & life style choices:

Smoking.
Tobacco use is a major preventable risk factor for
stroke and heart disease. Even if you have smoked
for years, you can still reduce your risk by quitting
now.
(Need help quitting? The Freedom From Smoking® plan is
freely available online at the American Lung Association.)
Obesity, elevated cholesterol, and elevated
lipids.
Reducing your dietary intake of saturated fats and
cholesterol may help reduce your risk of a stroke.
(Check the Dietary Guidelines for Healthy American
Adults from the American Heart Association to see how your
diet measures up.)
Physical inactivity.
A sedentary lifestyle void of regular exercise can
contribute to heart disease which may lead to stroke.
(Learn the facts about exercise from the Physical Activity
and Cardiovascular Health Fact Sheet from the American
Heart Association.)
Excessive alcohol intake.

Illegal drug use.

Uncontrollable risk factors:

Increasing age.
Stroke is more common in people over 60.
Male sex.
Men and women both have strokes, although stroke is
more common at younger ages in men.
Heredity and ethnicity.
Stroke is more common in people whose close
relatives have had stroke at an early age. African-
Americans and Hispanic Americans are at higher risk
than white Americans. This may be due in part to high
blood pressure and dietary differences.