Cerebrovascular Accident (CVA) Overview

Cerebrovascular Accident (CVA) - Stroke

• Stroke is a sudden impairment in brain function.
• Symptoms result from diseases involving blood vessels, lasting over 24 hours.
• Stroke is a leading cause of death, and a common cause of adult disability.
• It occurs in 700,000 cases annually in the US; 500,000 are new strokes, 200,000 recurrent.

Stroke Definition

• A rapidly developing clinical sign of focal(or global) disturbance of cerebral function, involving symptoms lasting 24 hours or longer.
• It's a vascular origin, excluding tumors, poisoning, and trauma.

Epidemiology

• Fourth leading cause of death (30% die within first year)
• Common cause of disability among adults.
• Incidence is higher in men than women until age 75, then risk becomes higher in women.
• Risk increases with age; 20% of cases below 65 years.
• 80% of strokes are preventable.

Stroke Incidence

• Approximately 795,000 new or recurrent strokes annually in the US
• Every 40 seconds, someone in the U.S. has a stroke.
• Every 3.5 minutes, someone dies of stroke.
• The leading cause of long-term disability worldwide
• 6.4 million stroke survivors

Stroke Pathology

• Aging affects the small brain vessels, making them fragile.
• Lipohyalinosis involves arteriolar wall disorganization, thickening.
• Amyloid angiopathy relates to abnormal protein accumulation

Stroke Etiology

• Atherosclerosis (most common).
• Heart conditions(Atrial fibrillation, Myocardial Infarction, Valvular Disease, Heart failure).
• Embolization of intracardiac thrombi

Risk Factors

• Modifiable: Hypertension, heart disease, diabetes, smoking, sedentary lifestyle, obesity, high alcohol or cholesterol consumption.
• Non-modifiable: Age, gender, race, genetics.

Stroke Pathophysiology

• A blood vessel carrying nutrients/oxygen to the brain is blocked by a clot or bursts
• Part of the brain is unable to receive blood/oxygen, leading to cell death.

Stroke Symptoms/Complications

• Trouble walking, loss of balance or coordination, trouble speaking, vision changes, numbness or weakness, confusion, changes in alertness, dizziness, or emotional changes.

Stroke Definition

• Rapidly developing clinical signs of focal(or global) disturbance of cerebral function, with symptoms lasting 24 hours or longer, with no apparent cause other than of vascular origin.

Ischemic Stroke

• Incidence: 87%
• Mortality: 40%
• Thrombotic (most common) or embolic - Clot obstructs blood flow.
• Hemorrhagic stroke:
• Incidence 13%
• Mortality 80%
• Bleeding occurs inside or around brain tissue. (Aneurysm or AVM).

CT Scan – Ischemia vs. Hemorrhage

• Hemorrhagic stroke shows up as a white area in the brain right away.
• Ischemic stroke appears as a darker gray area, developing within hours or days.

Stroke Location

• Cortical and subcortical stroke locations and severity
• Left vs right hemisphere involvement affects performance in different ways

Left vs. Right Hemispheric CVA

• Left-side CVA: language, and speech difficulties, impaired awareness with slower recovery.
• Right-side CVA: spatial perceptual issues and impulsive behavior.

Terminology

• Transient Ischemic Attack (TIA): temporary loss of function (minutes to 24hrs), a warning sign of possible stroke.
• Major stroke: Stable severe stroke
• Deteriorating Stroke: Case gets worse over minutes/hours
• Young stroke: Patient under 45 years

Clinical picture

• Dependent on affected brain region.
• Motor and/or sensory impairments (gait, balance)
• Visual disturbances, speech & language impairments.
• Cognitive & perceptual dysfunction, swallowing dysfunction, respiratory issues.

Timeline after Stroke

• First 24 hours (hyperacute)
• Acute phase (1-7 days): initial response and recovery begins.
• Subacute (1 week to 3 months): recovery continues and rehabilitation starts.
• Late subacute (3 months to 6 months): further recovery and functional skill improvement.
• Chronic (6 months onwards): Ongoing rehabilitation and long-term care.

Post-stroke Motor Recovery

• Recovery of motor function varies depending on the severity of the stroke.

Complications and indirect impairments

• Musculoskeletal:
• Loss of ROM, contractures, edema, and pain, impacting range of motion. Shoulder subluxation, especially in flaccid stages
• Cardiac problems: exercise planning caution.
• respiratory problems, postural hypotension, and pressure sores.

Prognostic indicators

• Best neurological recovery, excellent prognosis in mild/moderate stroke.
• Recovery is usually seen within 11 weeks.
• Factors for good or poor prognosis are reported.

Video sections

• Demonstrations of stroke, gait, and movement patterns

This quiz covers the essential aspects of cerebrovascular accidents (CVA), commonly known as strokes. It includes definitions, symptoms, risk factors, and epidemiological data related to strokes. Learn about the impact of strokes on public health and how they can be prevented.