Stroke or Cerebral Vascular Accident
Strokes are related to heart function because they are often associated with conditions affecting the heart. In addition, many of the factors leading to the on-set of a stroke are similar to those of heart disease. Strokes are the third most common cause of death in the United States. Generally, strokes are more common in men than in women.

This "brain attack" occurs when there is not enough blood reaching the brain. A disturbance in blood flow can be attributed to one of two basic causes: blockage due to an arterial clot or fatty deposit and vessel rupture. When there is a malfunction in blood flow, cellular death or infarction ensues. When a stroke is left unattended, more cells in the brain die due to oxygen and nutrient starvation. Therefore, cellular death in the brain can be localized or systemic. There are two categories of strokes:

Ischemic strokes involve arterial or vessel blockage. The following are two types of ischemic strokes:

• Cerebral Embolism – This type of stroke is the most common of the three types. The carotid arteries serve as the major roadway for blood traveling to the brain. A stroke will occur if any smaller tributaries are occluded, thereby blocking the passage of blood. This can happen if cholesterol, a clot, or other material deposited in a vessel – usually within the carotid artery - breaks off into a smaller vessel where it becomes lodged between the vessel walls. A traveling clot or piece of debris traveling from elsewhere in the body to the brain is called an embolus. When blood supply is cut off from the brain, there is a very serious risk of brain damage and/or death.

• Cerebral Thrombosis – The carotid artery in the neck and the cerebral artery in the brain can also succumb to a blood clot or atherosclerosis. When this happens, the occlusion is called a thrombus, a stationary blockage of the artery that cuts off blood passage. TIA, transient ischemic attacks, which may cause stroke-related symptoms last just a short time. If this occurs, you should make immediate plans to see a doctor as TIAs are strong indicators that a stroke is imminent.

Hemorrhagic (bleeding) Stroke is highly fatal as it involves the instantaneous rupture of a blood vessel in the brain.

• Intracerebral Hemorrhage – When a vessel inside the brain ruptures, it spills blood into the surrounding area. The effect of vessel rupture is two-fold: the spilled blood irritates brain tissue causing inflammation and swelling and the broken vessel cuts continuous blood flow to the rest of the brain. Causes of this type of stroke include drug and alcohol abuse as well as hypertension. Hypertension, or high blood pressure, puts excess pressure in the brain’s blood vessels thereby causing the walls to weaken. The risk for this stroke increases with age and is found to be higher in the African-American population. This is because more African-Americans have hypertension than any other group in the United States. This is frequently seen in young women and is congenital in nature.

• Subarachnoid Hemorrhage – An aneurysm is a weakened part of a vessel wall that may become so thin that it causes a bulge in the wall. If the aneurysms breaks or bursts, a subarachnid hemorrhage will occur. This is a rupture, or trauma causing rupture in a certain area between coverings.

Symptoms

Unfortunately, most strokes occur without warning or, if they do come with symptoms, many people do not know how to recognize the associated symptoms. Symptoms may last for a short period of time or may last all day. The longer you wait to receive proper medical care, the more damage can be done. The best way to avoid a stroke is to practice all preventive measures and to see a physician regularly. Common symptoms of a stroke include:

• Sudden lack of coordination and imbalance
• Sudden weakness in limbs and face, especially on one side of the body
• Sudden lack or impairment of speech (slurred) and vision (blurred)
• Sudden, severe headache
• Impaired swallowing
• Confusion or dementia

As soon as you recognize any of these signs, call a doctor immediately or call 911.

Detection

Once a patient arrives at the hospital, initial testing will most likely involve a CT scan or magnetic resonance imaging or MRI. These tests help locate the type of stroke and where the problematic area is located. A CT scan and MRI can also tell the physician what damage exists.

Other tests include an MRA which uses MRI technology coupled with an angiogram. This test shows the internal structure of arteries and vessels to show if there is any blockage or aneurysm. Another test using the angiogram is a cerebral angiogram. An angiogram uses contrast dye to reflect the interior of blood vessels and arteries. The movement of the contrast dye is picked up by an x-ray camera.

Two types of ultrasounds may be used for further testing. A carotid ultrasound uses sound waves to detect the existence of arterial blockage. A transcranial doppler ultrasonography works the same way as the carotid ultrasound but detects blocked vessels within the brain.

Treatment

Treatment is based on the severity of the stroke and the extent of brain damage. If brain damage is great, rehabilitation may be advised for an extended period. Since stroke can effect many different capabilities, the patient may have to relearn how to understand and complete basic tasks. In some cases, temporary or permanent effects of a stroke may include incontinence, depression, dysphagia (difficulty swallowing) and/or dysphasia (difficulty speaking). In such cases, a team of health care providers including speech and physical therapists, nutritionists and counselors can help the patient return some or all of her/his former functions.

Oral medicines to relieve symptoms may be provided by the physician. Stroke due to thrombosis or embolus may require surgical removal of the blockage. Surgery may also be recommended to mend a ruptured vessel.