CEREBROVASCULAR ACCIDENT (CVA)

EMERGENCY TREATMENT Stroke/BRAIN ATTACK

Emergency treatment of stroke from a blood clot is aimed at dissolving the clot. This
"thrombolytic
A stroke ortherapy"
brain attackis currently
occurs when performed mosttooften
blood flow with
an area of tissue plasminogen
the brain activator,
is interrupted or t-PA.or
by a blocked
This t-PA
broken must
blood be administered
vessel. When a within
stroke three
occurs, it
Fig - Subarachnoid Hemorrhage hours
kills of
brainthe stroke
cells in event.
the Therefore,
immediate area. patients
When who
the awaken
brain cells
withthey
die, stroke symptoms
release chemicalsarethat
ineligible
set off afor t-PA
chain therapy,
reaction that as the timebrain
endangers of onset
cells incannot be surrounding
a larger, accurately
determined.
area of brain The t-PA
tissue. therapyprompt
Without has been shown
medical to improve
treatment, thisrecovery
larger areaandofdecrease long-term
brain cells will alsodisability
die. in
selected patients. The t-PA therapy carries a 6.4% risk of inducing a cerebral hemorrhage, and is not
appropriate
When brain for
cellspatients
die, thewith bleeding
abilities disorders,
that area verycontrol
of the brain high blood
are lostpressure, known
or impaired. Someaneurysms, any
people recover
evidence of from
completely intracranial hemorrhage,
less serious or incidence
strokes, while others oflosestroke,
their head
lives trauma, or intracranial
to very severe ones. A surgery
stroke is
within the pasttreated
occasionally three months. Patients with
with thrombolysis clot-related
("clot (thrombotic
buster"), but usually or embolic) stroke who
with supportive careare ineligible
(speech and
for t-PA treatment
language may be treated
therapy, physiotherapy with
and heparin ortherapy)
occupational other bloodin a thinners, or with
"stroke unit" and aspirin or other
secondary anti-
prevention
clotting
with agents indrugs
antiplatelet casesArtery
some (aspirin Blood Flow
and often dipyridamole), blood pressure control, statins, and in selected
Fig - Hemorrhagic Stroke
patients with carotid endarterectomy and anticoagulation.
Emergency treatment of hemorrhagic stroke is aimed at controlling intracranial pressure.
Intravenous
TYPES OF STROKE urea or mannitol plus hyperventilation are the most common treatments. Corticosteroids
may also be used. Patients with reversible bleeding disorders such as those due to anticoagulant
treatment should have these bleeding disorders reversed, if possible.

Surgery for hemorrhage due to aneurysm may be performed if the aneurysm is close enough to
the cranial surface to allow access. Ruptured vessels are closed off to prevent rebleeding. For aneurysms
that are difficult to reach surgically, endovascular treatment may be used. In this procedure, a catheter
is guided from a larger artery up into the brain to reach the aneurysm. Small coils of wire are discharged
into the aneurysm, which plug it up and block off blood flow from the main artery.

“Stroke is a medical emergency requiring immediate treatment. Prompt treatment improves the
chances of survival and increases the degree of recovery that may be expected. Fig - Ischemic
A person Stroke
who may have
suffered a stroke should be seen in a hospital emergency room without delay. Treatment to breakStroke
Ischemic up a
blood
In clot, the
ischemic major
stroke, cause
a clot of stroke,
blocks a bloodmust begin
vessel within
in the brain.three hours
A clot mayofform
the in
stroke to be
a blood effective.
vessel in the
Improved
brain medical
or leading treatment
to the of itallcan
brain, or types of stroke
be formed has resulted
elsewhere in theinbody,
a dramatic
usually decline in death
in the heart, and rates
travelinto
recent
the decade”
brain. Ischemic stroke can also happen as the result of the unhealthy blood vessels clogged with a
buildup of fatty deposits and cholesterol in the wall of an artery. Approximately 80 percent of all strokes
are ischemic.
DIAGNOSTIC TESTS
Hemorrhagic Stroke
In hemorrhagic strokes, a blood vessel in the brain breaks or ruptures. Hemorrhagic stroke can be caused
by a number of disorders which affect the blood vessels, including long-standing high blood pressure and
cerebral aneurysms. An aneurysm is a weak or thin spot on a blood vessel wall. Hemorrhagic strokes
account for about 20 percent of all brain attacks.

SIGNS AND SYMPTOMS

Even among thoseFig
who- Electroencephalogram
recognize brain attack- EEG
as a medical emergency, many are unable to recognize
stroke symptoms. The most typical symptoms include:

To fullySudden
understand
numbness
yourorproblem
weaknessand of face,
plan arm
the orbest
leg,treatment
especiallyfor
on one
you,side
theofphysician
the body. may need
additional information
o An entire such
side
as:ofblood
the body,
tests,face,
special
armtests
and leg
or procedures
(hemiparesis).
to examine your brain, heart or
blood vessels.
o An arm or a leg (monoparesis).
 Sudden confusion, troble speaking or understanding.
Tests to Define Expressing
o Stroke, or comprehending
Stroke Typing and where words (aphasia).
is the stroke:
o Slurring of words (dysarthria).
 Sudden
Computedtrouble seeing in(CT
Tomography one scan)
or both eyes.
o Loss
 Magnetic of visionImaging
Resonance in one eye.
(MRI)
o Loss of vision of one side.
o theDouble
Test to assess vision.
conditions of Blood Vessels in the Neck or Brain:
 Sudden trouble walking, dizziness, loss of balance or coordination.
o Loss
 Magnetic of balance
Resonance on standing(MRA)
Angiography or walking (truncal ataxia).
 Carotido Of arm or
Duplex leg(CDS)
Scan (limb ataxia).
 Transcranial Doppler (TCD)
 Cerebral Angiogram