Types of Cerebrovascular Accidents (CVA)
Cerebrovascular accidents are broadly classified into two major categories: ischemic stroke (87% of cases) and hemorrhagic stroke (13% of cases), with hemorrhagic strokes further subdivided into intracerebral hemorrhage (10%) and subarachnoid hemorrhage (3%). 1
Primary Classification
Ischemic Stroke (87% of all strokes)
Ischemic stroke results from occlusion of a cerebral blood vessel, depriving the brain of oxygen and glucose. The mechanisms include:
- Thrombotic occlusion - due to degenerative vessel wall disease (atherosclerosis or lipohyalinosis)
- Embolic occlusion - from cardiac sources or artery-to-artery embolism 2, 3
Hemorrhagic Stroke (13% of all strokes)
Hemorrhagic stroke results from rupture of a blood vessel wall and is divided into:
- Intracerebral (intraparenchymal) hemorrhage (10%) - bleeding directly into brain parenchyma
- Subarachnoid hemorrhage (3%) - bleeding into the subarachnoid space 1, 3
Additional Cerebrovascular Entities
Transient Ischemic Attack (TIA)
While not technically a "stroke," TIA represents a critical stroke-related condition characterized by:
- Self-limited focal neurologic deficits from temporary interruption of blood supply
- No permanent clinical deficit or demonstrated infarct on imaging
- Symptoms typically resolve within 1 hour
- High subsequent stroke risk: 8.8% at 7 days and 11.6% at 90 days 4
Important caveat: The traditional time-based definition (symptoms <24 hours) has been replaced by an imaging-based definition that restricts TIA to cases without neuroimaging evidence of tissue damage 4.
Stroke-Related Vascular Conditions
The 2024 ACR guidelines also recognize additional cerebrovascular disease presentations that may manifest with stroke-like symptoms:
- Cerebral venous sinus thrombosis
- Carotid dissection
- Large vessel occlusion 4
Clinical Note on Terminology
The term "cerebrovascular accident" (CVA) is outdated and should be avoided, as it inappropriately implies stroke is an accident rather than a preventable medical event with identifiable risk factors 5. The preferred terminology is simply "stroke" or "cerebrovascular disease."