Cerebral Vascular Accident

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

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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


  • 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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