Cerebrovascular Accident (CVA)

* Progressive CVA, or stroke – in – evolution ( thrombus – in –
evolution ), begins

with slight neurologic deficit and worsens in a day or two.

* Complete CVA, the patient experiences maximal neurologic deficits
at onset.

Most common cause of CVA is a result from thrombosis. Other causes

embolism and hemorrhage. Risk factors increase the likelihood
of CVA, such as

atherosclerosis, hypertension, dysrhythmias, rheumatic heart disease, diabetes

gout, postural hypotension, and cardiac hypertrophy. Other risk factors
include high

serum triglyceride levels, and sedentary life – style ( inactive
habit ), the use of

contraceptives, cigarette smoking, and a family history of CVA.

CVA Symptoms:

Clinical features of CVA vary with the artery affected ( and , Consequently,
the portion

of the brain it supplies ), the severity of damage, and the extent of collateral

that develops to help the brain compensate for decreased blood supply.
If CVA occurs

in the left hemisphere, it produces symptoms on the right side; if in the
right hemisphere,

symptoms are on the left side. However, a CVA that causes cranial
nerve damage

produces signs of cranial nerve dysfunction on the same side as the hemorrhage.

Usually the symptoms are classified according to the artery affected.
It can also be

classified as premonitory, generalized, and focal.

Middle cerebral artery: This type of CVA may cause aphasia ( loss
of the power of

expression of speech, writing, or signs or of comprehending spoken or written

, dysphasia ( impairment of speech), visual field cuts, and hemiparesis
on the affected

side ( more severe in the face and arm than in the leg ).

Carotid artery: The patient may experience weakness, paralysis, numbness,

changes, visual disturbances on the affected side, altered level of consciousness,

headaches, aphasia, and ptosis ( paralytic drooping of the upper eyelid

Vertebrobasilar artery: patients may experience weakness on the affected

numbness around the lips and mouth, visual field cuts, diplopia ( the preception
of two

images of a single object ), poor coordination, dysphagia, slurred speech,

amnesia, and failure of muscular coordination (ataxia).

Anterior cerebral artery: This type of stroke can cause confusion,
weakness and

numbness on the affected side ( especially in the leg ), incontinence,
loss of coordination,

impaired motor and sensory functions, and may have personality changes.

Posterior cerebral arteries: Paralysis usually doesn’t occur.
Patient may experience

visual field cuts, sensory impairment, dyslexia, coma, and cortical blindness.

Diagnostic tests: CT scan shows evidence of thrombotic or hemorrhagic
stroke, tumor,

or hydrocephalus. Brain scan show ischemic areas but may not be positive
for up to 2

weeks after the CVA. Other tests includes; lumbar puncture, ophthalmoscopy,

angiography, EEG, and lab studies.


Medication useful in CVA include: anticonvulsants to treat seizures,
stool softeners, to

avoid straining, which increases ICP ( intracranial – pressure ), corticosteroids,

minimize associated cerebral edema, analgesics to relieve headache that
may follow

hemorrhagic CVA. Usually aspirin is contraindicated in hemorrhagic
CVA because it

increases bleeding tendencies, but it may be useful in preventing TIAs.

Surgery to improve cerebral circulation for patients with thrombotic or
embolic CVA

includes; endarterectomy ( removal of atherosclerotic plaques from inner
arterial wall),

or microvascular bypass ( extracranial vessel is surgically anastomosed
to an

intracranial vessel ).

For More On CVA, See Stroke: (click)