Cerebrovascular accidents (CVAs, stroke)

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• pathology of the blood vessels in the brain and includes lesions of the vessel wall, vessel occlusion or rupture, and altered vessel permeability.
– Stroke is the third leading cause of death in the United States; it is most often the result of atherosclerotic disease involving the extracranial or intracranial arteries. Stroke also can result from blood clots that travel to the brain from the heart or from a hemorrhage into the brain.

 

• Cerebrovascular accidents (CVAs, stroke) are most commonly called strokes, although more recently they are being referred to as brain attacks to highlight the fact that the risk factors for stroke and heart attack are similar. CVAs can be broadly categorized into ischemic or hemorrhagic.

• There are different categories of stroke, including the following:
Ischemic (Acute brain infarction)

• Atherothrombotic

• Embolic

• Lacunar

• Other causes of ischemic stroke (including global hypoperfusion)

• Hemorrhagic

• Intracerebral hemorrhage

• Subarachnoid hemorrhage

• The most common cause of acute brain infarction is atherothrombotic disease. The risk factors for this type of stroke are the same as for atherothrombotic disease of the coronary vessels and include:

• Age

• Smoking

• Hypertension

• Diabetes

• Dyslipidemia

• Increased lipoprotein A and C-reactive protein.

• Other known risk factors include:

• Hormone replacement therapy and

• Syndromes that can increase blood viscosity, such as polycythemia vera.

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• Endothelial injury to extracranial or intracranial vessels results in the formation of an atherosclerotic plaque that can rupture with subsequent thrombus formation.

• This process results in rapid occlusion of the vessel and ischemia in the brain tissue that is normally perfused by that vessel.

• If the thrombus breaks up quickly, most individuals will experience a brief episode of neurologic dysfunction (lasting less than 24 hours) called a transient ischemic attack (TIA).

• If the thrombus builds up over several hours, the individual may experience slowly progressive neurologic dysfunction called stroke-in-evolution.

• Although there is an extensive system of collateral cerebral vessels (e.g., circle of Willis), persistent vessel obstruction will result in cerebral infarction unless perfusion is restored rapidly. This is termed a completed stroke.

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