Cerebrovascular Accident

Stroke, CVA, or brain attack

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 injured brain.

Arm or leg weakness and paralysis

Speech difficulties

Balance problems when walking

Numbness or lack of sensation

Hand clumsiness

Sudden vision loss

Confusion

Nausea

Room spinning

Seizure

Coma

Certain irregularities such as atrial fibrillation to the brain, cause the blood clot to move from the valve of the heart

The blood clot moves from the carotid arteries to the brain

Blood vessels to the brain become narrow due to cholesterol blockage

Severely Low Blood Sugar

Decreased oxygen in the blood due to lung problems

Myocardial Infarction (heart attack), in which the heart does not pump enough blood to the brain

A heart arrythmia does not allow the heart to pump enough blood to the brain

Very High Blood Pressure

Neurological examination
A CT scan can make an immediate diagnosis especially of hemorrhagic Strokes
A MRI may be performed, but usually is done for 2-3 days
Laboratory:

Complete blood count, Blood glucose, sedimentation rate, PT, PTT, Lipid (cholesterol) profile.
If a hypercoaguable (blood clots too easily) is suspected, then the lupus anticoagulant, and anticardiolipin antibodies are examined. Blood cultures are checked if endocarditis (heart infection) is suspected.

An EKG can rule out a cardiac problem

Pulse oximetry to check blood oxygenation

Cardiac monitoring to rule out an arrythmia

Echocardiogram (or Transesophageal echo) to check for blood clots on the heart valve

High Blood Pressure

Cigarette smoking

Diabetes

High cholesterol

Heart disease

Alcohol Abuse

Family history of Strokes

Nonhemorrhagic Stroke:

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
Low doses of intravenous heparin is sometimes an option
Supportive measures may be considered as an option
Blood pressure is cautiously controlled (Lowering blood pressure too much may cause another Stroke to occur)

Hemorrhagic Stroke:

Supportive measures only. All blood thinning medications will make a Stroke worse, and therefore need to be avoided.

Correct any bleeding problems. Again, blood pressure is controlled very cautiously (we do not want to lower blood pressure too much or a another Stroke may occur)

You need immediate emergency medical treatment.

If the patient has atrial fibrillation (a heart irregularity), Coumadin (Warfarin) is recommended. A secondary option here is aspirin.

If there is Carotid Stenosis (blockage or narrowing), then surgery is often recommended to open blockages -- the decision on when and on whom to do this on, is made by your doctor.

Cholesterol lowering medications such as Pravachol have been shown to lower the risk of a Stroke.

Cholesterol levels should be brought to a normal level.

Diabetes should be controlled