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Cerebrovascular Disease

Cerebrovascular refers to blood flow within the brain. Cerebrovascular disease includes all disorders in which an area of the brain is temporarily or permanently affected by bleeding or lack of blood flow. Cerebrovascular diseases included stroke, carotid stenosis, vertebral stenosis and intracranial stenosis, aneurysms and vascular malformations.

Restrictions in blood flow may occur from vessel narrowing (stenosis), clot formation (thrombosis), blockage (embolism), or blood vessel rupture (hemorrhage). Lack of sufficient blood flow (ischemia) affects brain tissue and may cause a stroke.

Cerebrovascular Disease Statistics

  • Stroke is the third leading cause of death in the United States. Of the more than 700,000 people affected every year, about 500,000 of these are first attacks, and 200,000 are recurrent. About 25 percent of people who recover from their first stroke will have another stroke within five years.
  • Stroke is a leading cause of serious long-term disability.
  • Each year, an estimated 30,000 people in the United States experience a ruptured cerebral aneurysm and as many as 6 percent may have an unruptured aneurysm.

Cerebrovascular Diagnostic Tests

The majority of cerebrovascular problems can be identified through diagnostic imaging tests. These tests allow vascular specialists to view the arteries and vessels in and around the brain and the brain tissue.

Cerebral angiography: Arteries are not normally seen in an X-ray, so contrast dye is used to view them. The patient is given a local anesthetic, the artery is punctured, usually in the leg, and a needle is inserted into the artery. A catheter (a long, narrow, flexible tube) is inserted through the needle and into the artery. It is then threaded through the main vessels of the abdomen and chest until it is properly placed in the arteries of the neck. This procedure is monitored by a fluoroscope (a special x-ray that projects the images onto a TV monitor). The contrast dye is then injected into the neck area through the catheter, and x-ray pictures are taken.

Carotid duplex (doplar ultrasound): In this procedure, ultrasound is used to help detect plaque, blood clots, or other problems with blood flow in the carotid arteries. There are no known risks and this test is noninvasive and painless.

CT Scan: A diagnostic image created after a computer reads x-rays. In some cases, a medication will be injected through a vein to help highlight brain structures. Bone, blood and brain tissue have very different densities and can easily be distinguished on a CT scan. A CT scan is a useful diagnostic test for hemorrhagic strokes because blood can easily be seen. However, damage from an ischemic stroke may not be revealed on a CT scan for several hours or days and the individual arteries in the brain cannot be seen. CTA allows clinicians to see blood vessels of the head and neck and is increasingly being used instead of an invasive angiogram.

Electroencephalogram (EEG): A diagnostic test using small metal discs (electrodes) placed on a person’s scalp to pick up electrical impulses. These electrical signals are printed out as brain waves.

Lumbar puncture (spinal tap): An invasive diagnostic test that uses a needle to remove a sample of cerebrospinal fluid from the space surrounding the spinal cord. This test can be helpful in detecting bleeding caused by a cerebral hemorrhage.

Magnetic Resonance Imaging (MRI): A diagnostic test that produces three-dimensional images of body structures using magnetic fields and computer technology. It can clearly show various types of nerve tissue and clear pictures of the brain stem and posterior brain. MRI of the brain can help determine whether there are signs of prior mini-strokes. This test is noninvasive, although some patients may experience claustrophobia in the imager.

Cerebral Magnetic Resonance Angiogram (MRA): This is a noninvasive study which is conducted in a Magnetic Resonance Imager (MRI). The magnetic images are assembled by a computer to provide an image of the arteries located in a patient’s head and neck. The MRA shows the actual blood vessels in the neck and brain and can help detect blockage and aneurysms.

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Stroke

Stroke is an abrupt interruption of the constant blood flow to the brain that causes loss of neurological function.& The interruption of blood flow can be caused by a blockage, leading to the more common ischemic stroke, or by bleeding in the brain, leading to the more deadly hemorrhagic stroke.  Ischemic stroke constitutes an estimated 80 percent of all stroke cases.  Stroke may occur suddenly, sometimes with little or no warning, and the results can be devastating.

Stroke Symptoms

Warning signs may include some or all of the following symptoms, which are usually sudden:

  • Dizziness, nausea or vomiting
  • Unusually severe headache
  • Confusion, disorientation or memory loss
  • Numbness, weakness in an arm, leg or the face, especially on one side
  • Abnormal or slurred speech
  • Difficulty with comprehension
  • Loss of vision or difficulty seeing
  • Loss of balance, coordination, or the ability to walk

Types of Stroke and Treatment

Ischemic Stroke
Ischemic stroke is the most common type of stroke, accounting for a large majority of strokes. There are two types of ischemic stroke: thrombotic and embolic. A thrombotic stroke occurs when a blood clot, called a thrombus, blocks an artery to the brain and stops blood flow. An embolic stroke occurs when a piece of plaque or thrombus travels from its original site and blocks an artery. The materials that has moved is called an embolus. How much of the brain is damaged or affected depends on exactly how far downstream in the artery the blockage occurs.

Hemorrhagic Stroke
A hemorrhagic stroke can be caused by hypertension, rupture of an aneurysm or vascular malformation, or as a complication of anticoagulation medications. An intracerebral hemorrhage occurs when there is bleeding directly into the brain tissue, which often forms a clot within the brain. A subarachnoid hemorrhage occurs when the bleeding fills the cerebrospinal fluid spaces around the brain. Both conditions are very serious.

Hemorrhagic stroke usually requires surgery to relieve intracranial pressure caused by bleeding. Surgical treatment for hemorrhagic stroke caused by an aneurysm or defective blood vessel can prevent additional strokes. Surgery may be performed to seal off the defective blood vessel and redirect blood flow to other vessels that supply blood to the same region of the brain.

Recovery and rehabilitation are important aspects of stroke treatment. In some cases, undamaged areas of the brain may be able to perform functions that were lost when the stroke occurred. Rehabilitation includes physical therapy, speech therapy and occupational therapy.

Regardless of what type of stroke has been suffered, it is vital that victims receive emergency medical treatment as soon as possible for the best possible outcomes to be realized.

Transient Ischemic Attack (TIA)
A TIA is a temporary cerebrovascular event that leaves no permanent damage. Usually it entails an artery to the brain is temporarily blocked, causing stroke-like symptoms, but the blockage dislodges before any permanent damage occurs.

Symptoms of a TIA may be similar to a stroke, but they resolve quickly. In fact, symptoms may be so vague and fleeting that people just brush them off, especially when they last just a few minutes. TIA symptoms include:

  • Sudden numbness or weakness of the face, arm or leg, especially on one side of the body
  • Sudden confusion, trouble speaking or understanding
  • Sudden trouble seeing in one or both eyes
  • Sudden trouble walking, dizziness, loss of balance or coordination
  • Sudden, severe headache with no known cause

While there is no treatment for the TIA itself, it is essential that the source of the TIA be identified and appropriately treated before another attack occurs. If you experience TIA symptoms, seek emergency medical help immediately. About 30 percent of all people who suffer a major stroke experience a prior TIA, and 10 percent of all TIA victims suffer a stroke within two weeks. The quicker you seek medical attention, the sooner a diagnosis can be made and a course of treatment started.

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Risk Factors

Although they are more common in older adults, strokes can occur at any age. Stroke prevention can help reduce disability and death caused by the disease. Controllable or treatable risk factors for stroke include:

  • Smoking
  • High blood pressure
  • Carotid of other artery disease
  • History of TIAs
  • Diabetes
  • High blood cholesterol
  • Physical inactivity and obesity
  • Receiving hormone replacement therapy

Uncontrollable risk factors include:

  • Age: People of all ages, including children, have strokes. But the older you are, the greater your risk of stroke.
  • Gender: Stroke is more common in men than in women.
  • Heredity or race: You have a greater risk of stroke i