Cerebrovascular Disease

(emphasis on CVA)
By: Olynsie Morris
10/0537/1686
BMR 3106
What is CVD and CVA?
CVD is a group of diseases that affect blood
vessels, especially those that supply the brain.

Just remember, the word cerebrovascular
refers to blood flow in or to your brain.

A cerebrovascular accident (CVA) or stroke is
the result of an impeded blood supply to some
part of the brain.

The lack of oxygen causes damage to the brain.
The long-term effects of a stroke depend on
what part of the brain is involved and on how
much tissue is affected.

Types of stroke
A stroke can happen in
two main ways.
Either:

there is a blood clot or
plaque that blocks a
blood vessel in the
brain (ischemic)
OR

a blood vessel in the
brain ruptures
(hemorrhagic).
Blocked Artery: Ischemic Stroke
Strokes caused by a blood clot is called an ischemic stroke.

In everyday life, blood clotting is beneficial. When you are
bleeding from a wound, blood clots work to slow and
eventually stop the bleeding.

In the case of stroke, however, blood clots are dangerous
because they can block arteries and cut off blood flow.

About 4 out of every 5 strokes are ischemic (i.e. 80%).

Bleeding in the brain (hemorrhagic stroke)
Strokes caused by a break in the wall of a blood vessel in the
brain are called hemorrhagic strokes. This causes blood to leak
into the brain, again preventing the delivery of oxygen and
nutrients.

Hemorrhagic stroke can be caused by a number of disorders
which affect the blood vessels, including long-standing
hypertension and cerebral aneurysms.

An aneurysm is a weak or thin spot on a blood vessel wall. The
weak spots that cause aneurysms are usually present at birth.
Aneurysms develop over a number of years and usually dont
cause detectable problems until they break.

About 1 in every 5 strokes is hemorrhagic.

Mini Stroke (TIA)
A transient ischemic attack (TIA) is sometimes termed a minor
stroke or mini stroke.

When the signs of stroke are present but go away within 24 hours,
the term TIA is used.

The causes and symptoms of a transient ischemic attack (TIA) are
similar to those of a stroke. TIA episodes usually last only a few
minutes but may last for several hours. They generally disappear
quickly and unfortunately, are often ignored. Just like a stroke, a TIA
will require emergency treatment.

About 1 in 5 people who have a TIA will have a major stroke within
the next three months and a large part of the risk occurs in the first
few days. TIA should never be ignored.

Aetiology (ischemic)
The most common causes of ischemic strokes include:

Thrombotic stroke this occurs when a blood clot
(thrombus) forms in one of the arteries that supply blood to
your brain. A clot may be caused by fatty deposits (plaque)
that build up in arteries and cause reduced blood flow
(atherosclerosis) or other artery conditions.

Embolic stroke this occurs when a blood clot or other
debris forms away from your brain (commonly in your heart)
and is swept through your bloodstream to lodge in narrower
brain arteries. This type of blood clot is called an embolus.

Aetiology (hemorrhagic)
Brain hemorrhages can result from many conditions that
affect your blood vessels, including uncontrolled high blood
pressure (hypertension) and weak spots in your blood
vessel walls which can lead to aneurysms.

A less common cause of hemorrhage is the rupture of an
abnormal tangle of thin-walled blood vessels
(arteriovenous malformation) present at birth.

Table of
causes
Pathophysiology
The two major mechanisms causing brain damage in
stroke are ischemia and hemorrhage.

The commonality between them is the fact that they
both are caused by blockage or occlusion of blood
vessels.

The main cause of this is ATHEROSCLEROSIS.
ATHEROSCLEROSIS
Firstly, atherosclerosis is a type of arteriosclerosis.

Atherosclerosis is the building up of fatty plaques in
the arteries which reduces blood flow hence
reducing oxygen and nutrient delivery to vital organs.

It shouldnt be confused with the general term
arteriosclerosis which is the thickening, hardening
and loss of elasticity of the walls of arteries.

Before Atherosclerosis
Beginning of Atherosclerosis
Blocked Artery
Diagnosis
To recognise if someone has suffered a stroke, perform
the FAST (Face, Arms, Speech, Time) test:

Look at their face:
Ask them to smile.
If they have had a stroke, they may only be able to
smile on one side; the other side of the mouth may
droop.

Ask them to raise both arms:
If they have had a stroke, they may only be able to lift
one arm.

Find out whether they can speak:
Ask them to speak.
If they have had a stroke, they may struggle to respond
appropriately.


Time to call 911/912:
Call 911 for emergency help.
Tell the operator you have used the FAST test and
suspect a stroke.
Keep them comfortable and supported.


Treatment (Surgery)
Carotid endarterectomy, also called carotid artery surgery, is
a procedure in which blood vessel blockage (fatty plaque) is
surgically removed from the carotid artery.
Management
The good news is that 80 % of all strokes are preventable.

It starts with managing key risk factors, including high
blood pressure, cigarette smoking, atrial fibrillation and
physical inactivity.

More than half of all strokes are caused by uncontrolled
hypertension, making it the most important risk factor to
control.

Exercise and eating healthy foods play significant roles in
preventing and recovering from stroke and other heart
disorders.


Medical Management
Medical treatments may be used to control high blood pressure
and/or manage atrial fibrillation among high-risk patients. Those
medicines include:

Anticoagulants/Antiplatelets
Antiplatelet agents such as aspirin and anticoagulants, such as
warfarin, interfere with the blood's ability to clot and can play an
important role in preventing stroke.

Antihypertensives

Antihypertensives are medications that treat high blood pressure.
Depending on the type of medication, they can lower blood
pressure by opening the blood vessels, decreasing blood volume
or decreasing the rate and/or force of heart contraction. (e.g.
Captopril)

Medical Management (Prevention)
Exercise and You

Exercise has been repeatedly proven to benefit your
whole body, including the cardiovascular system.

Lack of physical activity increases the risk of premature
mortality in general, and of coronary heart disease,
hypertension, some cancer, and diabetes.

Regular aerobic repeated rhythmic movements, such
as walking, cycling, swimming and other exercise
strengthens the heart and lungs. It also tends to raise the
level of HDL - good cholesterol and promotes general
wellbeing and relaxation.


Management (Recovery)
Physiotherapy

Physical therapy has proven to be extremely useful in
the recovery of stroke patients.

Additionally, it is quite imperative that a stroke patient
begin therapy as soon as it is medically safe for the
patient as this will increase the likelihood of a full or
close to full recovery.

Across the globe, and increasingly popular here in
Guyana, doctors and physical therapists (& RAs) are
working hand in hand so that the patient can regain
optimum function.
References
Clinical Methods: The History, Physical, and Laboratory
Examinations; 3rd edition; Walker HK, Hall WD, Hurst JW,
editors; Boston: Butterworths; 1990.

http://strokefoundation.com.au/what-is-a-stroke/types-
of-stroke/

http://www.ncbi.nlm.nih.gov/books/NBK378/

http://www.world-heart-federation.org/cardiovascular-
health/heart-disease/different-heart-diseases/