Malapote, Chelza Jane L.

CEREBROVASCULAR DISEASE

Cerebrovascular disease refers to a group of conditions that can lead to a cerebrovascular event,
such as a stroke. These events affect the blood vessels and blood supply to the brain. If a
blockage, malformation, or hemorrhage prevents the brain cells from getting enough oxygen,
brain damage can result. Cerebrovascular diseases can develop in various ways, including deep
vein thrombosis(DVT) and atherosclerosis, where plaque builds up in the arteries.
Stroke, transient ischemic attack, aneurysms, and vascular malformations are all types of
cerebrovascular disease.

Different events may have different effects, but common signs and symptoms include:
 a severe and sudden headache
 paralysis of one side (hemiplegia)
 weakness on one side (hemiparesis)
 confusion
 difficulty communicating, including slurred speech
 loss of half of vision
 loss of balance
 loss of consciousness

Risk Factors
Stroke is the most common type of cerebrovascular event.
It is more likely among males aged over 65 years, and especially if they or a close relative have
previously had a stroke.
Factors that increase the risk of stroke and other types of cerebrovascular disease include:
 hypertension, or blood pressure of 140/90 mm Hg or above
 smoking
 obesity
 poor diet, and lack of exercise
 diabetes
 high blood cholesterol of 240 milligrams per deciliter (mg/dL) or over
Some of these can be prevented by making healthful lifestyle choices

Diagnosis
A cerebral angiography, vertebral angiogram, or carotid angiogram may be used. A CT Scan,
MRI and ECG can also detect it.

Treatment
In the case of an acute stroke, a medication called tissue plasminogen activator (tPA) may be
given. This breaks up the blood clot.
Rapid assessment and treatment is crucial, because some medications for stroke must be given
within a certain time from the onset of symptoms.
A brain hemorrhage must be evaluated by a neurosurgeon, who may carry out surgery to reduce
the pressure caused by the bleed.
Carotid endarterectomy involves making an incision in the carotid artery, and removing the plaque.
This allows the blood to flow again. The artery is repaired with sutures or a graft.
 In carotid angioplasty and stenting, a balloon-tipped catheter is inserted into the artery. The
balloon is inflated so that it presses against the plaque, squashing it flat and reopening the artery.

Prevention
Ways to reduce the risk of cerebrovascular disease include:
 not smoking
 getting regular physical exercise
 eating a low-fat diet
 maintaining a healthy weight
 controlling blood pressure
 lowering blood cholesterol with diet and medications if necessary

UPDATES ON TREATMENT

The goal for the emergent management of stroke is to assess the patient’s airway,
breathing, and circulation (ABCs); stabilize the patient as necessary; and complete initial
evaluation and assessment, including imaging and laboratory studies, within 60 minutes
of patient arrival. A Finnish study demonstrated that time to treatment with fibrinolytics
can be decreased with changes in EMS and ED coordination and in ED procedures for
treating acute stroke patients.

An rt-PA stroke study group from the National Institute of Neurologic Disorders and Stroke
(NINDS) first reported that the early administration of rt-PA benefited carefully selected patients
with acute ischemic stroke. ] The FDA subsequently approved the use of rt-PA in patients who met
NINDS criteria. In particular, rt-PA had to be given within 3 hours of stroke onset and only after
CT scanning had ruled out hemorrhagic stroke.
Subsequently, fibrinolytic therapy administered 3-4.5 hours after symptom onset was found to
improve neurologic outcomes in the European Cooperative Acute Stroke Study III (ECASS III),
suggesting a wider time window for fibrinolysis in carefully selected patients.

A 10-center European study of nearly 6900 patients found IV rt-PA to be most effective
when given within 90 minutes of the onset of stroke symptoms.

Although antiplatelet therapy may increase the risk for symptomatic intracerebral hemorrhage
with fibrinolysis, a study by Diedler et al that included 3782 patients who had received 1 or 2
antiplatelet drugs found that the risk of intracerebral hemorrhage was small compared with the
documented benefit of fibrinolysis. These researchers concluded that antiplatelet treatment
should not be considered a contraindication to fibrinolysis, although caution is warranted in
patients receiving the combination of aspirin and clopidogrel.