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Cerebral Vascular Accident

Cerebral Vascular Accident is a topic covered in the 5-Minute Emergency Consult.

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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
  • Responsible for 1 in 18 deaths in US
  • 610,000 new strokes every year in US

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 is caused by 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 is caused by acute blockage of a cerebral artery by a piece of 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
    • 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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Citation

Rosen, Peter, et al., editors. "Cerebral Vascular Accident." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307242/all/Cerebral_Vascular_Accident.
Cerebral Vascular Accident. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307242/all/Cerebral_Vascular_Accident. Accessed April 26, 2019.
Cerebral Vascular Accident. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307242/all/Cerebral_Vascular_Accident
Cerebral Vascular Accident [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 April 26]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307242/all/Cerebral_Vascular_Accident.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Cerebral Vascular Accident ID - 307242 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307242/all/Cerebral_Vascular_Accident PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -