Cerebrovascular Disorders Overview

Cerebrovascular Disorders (CVAs)

• CVAs are functional abnormalities of the central nervous system (CNS) caused by disrupted blood supply.
• Types:
  • Ischemic (80%): Blockage of blood flow. Peak recovery at 6 months.
  • Hemorrhagic (20%): Bleeding. Peak recovery at 18 months.

Ischemic Stroke

• Sudden loss of brain function due to impaired blood flow.
• Causes:
  • Large artery thrombosis: Plaque buildup (4.5-hour window for clot-busting therapy).
  • Small penetrating artery thrombosis (lacunar): Most common, often due to hypertension.
  • Cardiogenic embolism: Often from atrial fibrillation (anticoagulants used).
  • Cryptogenic: Unknown cause.
  • Other: Drug use, migraines.
• Manifestations (Symptoms vary by location & severity):
  • Numbness/weakness (face, arm, leg, especially one side).
  • Confusion/mental status changes (frontal lobe).
  • Sudden, severe headache (common).

Stroke Effects

• Language Impairments:
  • Aphasia: Understanding or producing speech.
    • Expressive (Broca's): Unable to form words.
    • Receptive (Wernicke's): Unable to understand spoken/written words.
    • Global/Mixed: Both.
• Other Impairments:
  • Apraxia: Impaired purposeful movement.
  • Dysarthria: Difficulty speaking.
  • Hemianopia: Loss of half the visual field.
  • Hemiplegia/hemiparesis: Paralysis/weakness of half the body.
  • Dysphagia: Difficulty swallowing.
  • Agnosia: Difficulty recognizing familiar objects.

Transient Ischemic Attack (TIA)

• Temporary neurological deficit from temporary blood flow impairment.
• Warning sign of impending stroke.
• Similar symptoms to stroke, lasting less than an hour.
• Differentiated from stroke by CT scan.

Risk Factors

• Nonmodifiable: Age (≥55), sex (male), ethnicity (Hispanic, African, South Asian, First Nations, Métis, Inuit).
• Modifiable: Hypertension, cardiovascular disease, high cholesterol/hematocrit, obesity, diabetes, oral contraceptive use, smoking, drug/alcohol use, periodontal disease.

Stroke Treatment

• Carotid endarterectomy: Surgical plaque removal.
• Anticoagulant therapy: e.g., heparin (for conditions like atrial fibrillation).
• Antiplatelet therapy: e.g., aspirin.
• Thrombolytic therapy (tPA): Clot-busting treatment (criteria apply).

Hemorrhagic Stroke

• Bleeding into brain tissue, ventricles, or subarachnoid space.
• 20% of strokes.
• Typically caused by spontaneous rupture of small vessels, often related to uncontrolled hypertension.
• No clot-busting treatment available.

Additional Stroke-Related Terms

• Flaccidity: Absence of muscle tone.
• Spasticity: Increased muscle tone, exaggerated reflexes.
• Subluxed shoulder: Dislocated shoulder. Support the affected arm.
• Deconditioning: Muscle wasting, cognitive decline.

Question Answer

• Non-modifiable risk factor for strokes: Race/ethnicity.