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Brain Attack

Cerebrovascular accident, CVA, or stroke

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

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

  • Certain irregularities of the heartbeat, such as atrial fibrillation, can disturb a blood clot (which is sitting inside a heart chamber) and cause that clot to move from the heart to the brain.  This blocks the flow of blood in the part of the brain where the clot is newly-lodged.
  • A blood clot (sitting inside a carotid artery) can suddenly break free, and move from a carotid artery to the brain.  This blocks the flow of blood in the part of the brain where the clot is newly-lodged.
  • Blood vessels to the brain can become narrow due to cholesterol blockage, so less blood flows to the affected part of the brain.
  • Severely Low Blood Sugar means that the brain will be starved for Calories, interfering with brain function.  Brain damage can result.
  • Decreased oxygen in the blood, due to lung problems, can cause brain damage (from lack of oxygen).
  • Myocardial Infarction (heart attack), in which the heart does not pump enough blood to the brain, can cause brain damage.
  • A heart arrhythmia might not allow the heart to pump enough blood to the brain, because the heart might have ineffective beating.
  • Very High Blood Pressure can be accompanied by narrowed, constricted blood vessels to the brain.

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

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

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

  • You need immediate emergency medical treatment.

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

  • Transient Ischemic Attack
  • Intracerebral Hemorrhage
  • Subarachnoid Hemorrhage


1 comment:

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