Cerebral Vascular Accident
Basics
Description
Interruption of blood flow to a specific brain region:Description
- 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
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
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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Citation
Schaider, Jeffrey J., et al., editors. "Cerebral Vascular Accident." 5-Minute Emergency Consult, 6th ed., Lippincott Williams & Wilkins, 2020. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307242/all/Cerebral_Vascular_Accident.
Cerebral Vascular Accident. In: Schaider JJJ, Barkin RMR, Hayden SRS, et al, eds. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307242/all/Cerebral_Vascular_Accident. Accessed December 9, 2024.
Cerebral Vascular Accident. (2020). In Schaider, J. J., Barkin, R. M., Hayden, S. R., Wolfe, R. E., Barkin, A. Z., Shayne, P., & Rosen, P. (Eds.), 5-Minute Emergency Consult (6th ed.). Lippincott Williams & Wilkins. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307242/all/Cerebral_Vascular_Accident
Cerebral Vascular Accident [Internet]. In: Schaider JJJ, Barkin RMR, Hayden SRS, Wolfe RER, Barkin AZA, Shayne PP, Rosen PP, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. [cited 2024 December 09]. 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
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