Stroke; causes, treatment, managment


Stroke (cerebrovascular accident [CVA]) is the sudden loss of neurological function caused by an interruption of the blood flow to the brain. Ischemic stroke is the most common type, affecting about 80% of individuals with stroke, and results when a clot blocks or impairs blood flow, depriving the brain of essential oxygen and nutrients. Hemorrhagic stroke occurs when blood vessels rupture, causing leakage of blood in or around the brain. Clinically, a variety of focal deficits are possible, including changes in the level of consciousness and impairments of sensory, motor, cognitive, perceptual, and language functions. To be classified as stroke, neurological deficits must persist for at least 24 hours. Motor deficits are characterized by paralysis (hemiplegia) or weakness (hemiparesis), typically on the side of the body opposite the side of the lesion. he term hemiplegia is often used generically to refer to the wide variety of motor problems that result from stroke. he location and extent of brain injury, the amount of collateral blood flow, and early acute care management determine the severity of neurological deficits in an individual patient.


Stroke is the leading cause of long-term disability in the United States. Of ischemic stroke survivors 65 or older, incidences of disabilities observed at 6 months include hemiparesis (50%), unable to walk without assistance (30%), dependent in activities of daily living (ADL) (26%), aphasia (19%), and depression (35%). Stroke survivors represent the largest group admitted to rehabilitation hospitals and about a third of patients receive outpatient rehabilitation services

Main Factor Causing Stroke

Atherosclerosis is a major contributory factor in cerebrovascular disease. It is characterized by plaque formation with an accumulation of lipids, fibrin, complex carbohydrates, and calcium deposits on arterial walls that leads to progressive narrowing of blood vessels. Interruption of blood flow by atherosclerotic plaques occurs at certain sites of predilection. hese generally include bifurcations, constrictions, dilations, or angulations of arteries. He most common sites for lesions to occur are at the origin of the common carotid artery or at its transition into the middle cerebral artery, at the main bifurcation of the middle cerebral artery, and at the junction of the vertebral arteries with the basilar artery



Cardiovascular diseases affecting the brain and heart share a number of common risk factors important to the development of atherosclerosis. Major risk factors for stroke are hypertension, heart disease (HD), disorders of heart rhythm, and diabetes mellitus (DM). In patients with ABI, approximately 70% have hypertension, 30% HD, 15% congestive heart failure (CHF), 30% peripheral arterial disease (PAD), and 15% DM. his coexistence of multiple pathologies increases significantly with age. Individuals with hypertension (blood pressure [BP] (140/90 mm Hg or higher) have twice the lifetime risk of stroke. Risk is increased with elevated total blood cholesterol (hypercholesterolemia), defined as 240 mg/dL or greater. Lipid profiles are also important. Risk is increased with elevated low-density lipoprotein (LDL [“bad”]) cholesterol. LDL levels are defined as borderline high levels of 130 to 159 mg/dL, high levels of 160 to 189 mg/dL,and very high levels of 190 mg/dL or greater. Low levels of high-density lipoprotein (HDL [“good”]) cholesterol, defined as below 40 mg/dL in adult males and below 50 mg/dL in adult females, also increases stroke risk. Fasting triglyceride level of greater than 150 mg/dL in adults is considered elevated and a risk factor for HD and stroke.

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