Cerebral Vascular Accident
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Basics
Description
Interruption of blood flow to a specific brain region:- Neurologic findings are determined by specific area affected
- Onset may be sudden and complete, or stuttering and intermittent
- 795,000 strokes every year in the U.S.
Risk Factors
- Diabetes
- Smoking
- HTN
- Coronary artery disease
- Dysrhythmias
- Peripheral vascular disease
- Oral contraceptive use
- Polycythemia vera
- Sickle cell anemia
- Deficiencies of antithrombin III, protein C or S
Etiology
- May be ischemic (thrombotic, embolic, or secondary to dissection/hypoperfusion) or hemorrhagic
- Thrombotic stroke: Occlusion of blood vessels:
- Clot formation at an ulcerated atherosclerotic plaque is most common
- Sludging (sickle cell anemia, polycythemia vera, protein C deficiency)
- Embolic stroke: Acute blockage of a cerebral artery by foreign material from outside the brain, including:
- Cardiac mural thrombi associated with mitral stenosis, atrial fibrillation, cardiomyopathy, CHF, or MI
- Prosthetic or abnormal native valves
- Atherosclerotic plaques in the aortic arch or carotid arteries
- Atrial myxoma
- Ventricular aneurysms with thrombi
- Arterial dissection:
- Carotid artery dissection
- Arteritis (giant cell, Takayasu)
- Fibromuscular dysplasia
- Global ischemic or hypotensive stroke is caused by an overall decrease in systemic BP: Sepsis, hemorrhage, shock
- Hemorrhagic stroke:
- Intracranial hemorrhage (ICH)
- Subarachnoid hemorrhage
Pediatric Considerations
- Usually attributable to an underlying disease process, such as sickle cell anemia, leukemia, infection, or a blood dyscrasia
- Younger children often present with seizures and/or altered mental status
-- To view the remaining sections of this topic, please log in or purchase a subscription --
Basics
Description
Interruption of blood flow to a specific brain region:- Neurologic findings are determined by specific area affected
- Onset may be sudden and complete, or stuttering and intermittent
- 795,000 strokes every year in the U.S.
Risk Factors
- Diabetes
- Smoking
- HTN
- Coronary artery disease
- Dysrhythmias
- Peripheral vascular disease
- Oral contraceptive use
- Polycythemia vera
- Sickle cell anemia
- Deficiencies of antithrombin III, protein C or S
Etiology
- May be ischemic (thrombotic, embolic, or secondary to dissection/hypoperfusion) or hemorrhagic
- Thrombotic stroke: Occlusion of blood vessels:
- Clot formation at an ulcerated atherosclerotic plaque is most common
- Sludging (sickle cell anemia, polycythemia vera, protein C deficiency)
- Embolic stroke: Acute blockage of a cerebral artery by foreign material from outside the brain, including:
- Cardiac mural thrombi associated with mitral stenosis, atrial fibrillation, cardiomyopathy, CHF, or MI
- Prosthetic or abnormal native valves
- Atherosclerotic plaques in the aortic arch or carotid arteries
- Atrial myxoma
- Ventricular aneurysms with thrombi
- Arterial dissection:
- Carotid artery dissection
- Arteritis (giant cell, Takayasu)
- Fibromuscular dysplasia
- Global ischemic or hypotensive stroke is caused by an overall decrease in systemic BP: Sepsis, hemorrhage, shock
- Hemorrhagic stroke:
- Intracranial hemorrhage (ICH)
- Subarachnoid hemorrhage
Pediatric Considerations
- Usually attributable to an underlying disease process, such as sickle cell anemia, leukemia, infection, or a blood dyscrasia
- Younger children often present with seizures and/or altered mental status
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