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Acute Cerebrovascular Disease (Stroke and Transient Ischemic Attack)

Acute cerebrovascular disease refers to conditions that either transiently (transient ischemic attack) or permanently (stroke) cause CNS dysfunction. The working criteria for establishing a diagnosis of stroke generally include the abrupt onset of focal neurologic symptoms that are attributable to one vascular territory and that have been present for at least 24 hours. Strokes can be ischemic or hemorrhagic. Ischemic strokes are caused by embolism or thrombosis and may become hemorrhagic. TIA is distinguished from stroke by resolution of ischemic symptoms within 24 hours, with the vast majority of cases resolving within a few hours. Careful neurologic examination is the key to diagnosis of stroke. Immediate neuroimaging may confirm a stroke, its type, and other significant pathologic conditions requiring care. However, CT scans within 24 to 48 hours of a nonhemorrhagic stroke may be normal. "Stroke mimics," such as Todd's paralysis secondary to seizure, tumor, metabolic derangements, infections, migraine headache, and Bell's palsy account for a significant minority of patients with neurologic deficits.

Causes

Atherosclerosis and subsequent plaque formation results in arterial narrowing and is the most and main common cause of arterial stenosis.
Thrombus formation is likely to occur in areas where atherosclerosis and plaque deposition have caused the greatest narrowing of vessels.

Symptoms

Focal neurologic symptoms (weakness is dominant, sensory accompanies) ++++; specific symptoms vary according to vascular territory involved.
Headache +++
In posterior circulation stroke, motor loss may be unilateral, bilateral, or absent depending on the lesion. Nausea, vomiting, dizziness, and occipital headache are common.

Signs

Focal neurologic signs ++++ ; specific signs are a function of which vascular territory is involved.
Atrial fibrillation is associated with increased incidence of stroke
In posterior circulation stroke, cranial nerve and cerebellar findings may be subtle.

Treatment

Proven therapies for acute stroke in Western countries consist of:

stroke care units
aspirin administered within 48 hours
thrombolytic therapy administered within 3 hours.

Reduction of secondary brain damage by maintaining adequate perfusion to marginally ischemic areas and decreasing edema.
Education of patient regarding risk-factor reduction and signs and symptoms of TIAs and mild stroke.
Surgical Interventions

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