From the Guidelines
A cerebrovascular accident (CVA) or stroke is defined as an acute loss of neurological function caused by an ischemic or hemorrhagic event with residual symptoms at least 24 hours after onset, as documented in the acc/aha key data elements and definitions for measuring the clinical management and outcomes of patients with atrial fibrillation 1.
Definition and Etiology
The definition of a CVA or stroke is crucial for accurate diagnosis and treatment. According to the study, a stroke is characterized by an acute loss of neurological function caused by an ischemic or hemorrhagic event with residual symptoms at least 24 hours after onset. The most likely etiologies include:
- Larger-artery disease (e.g., carotid)
- Small-artery disease (lacunar)
- Embolism
- Other, specify
- Not specified These etiologies are essential to identify, as they can impact treatment and management strategies.
Diagnosis and Assessment
Diagnosis of a stroke is typically confirmed by CT, MRI scan, or cerebral angiography. The current level of functioning is assessed using categories such as:
- Complete/near-complete recovery (able to return to prestroke level of function)
- Mild to moderate deficit (deficits present, but patient can perform activities of daily living, such as dressing and feeding, with no or little assistance)
- Severe deficit (required assistance to complete activities of daily living) Accurate diagnosis and assessment are critical for determining the best course of treatment and management.
Importance of Early Detection and Treatment
Early detection and treatment of stroke are crucial to prevent permanent brain damage, disability, or death. The study highlights the importance of prompt medical attention, as treatment effectiveness depends on how quickly it's administered. Immediate medical attention is essential, as clot-dissolving medications like tissue plasminogen activator (tPA) must be given within a specific time frame of symptom onset. Risk factors, such as high blood pressure, smoking, diabetes, high cholesterol, obesity, and family history, should be identified and managed to prevent stroke.
From the Research
Definition of Cerebrovascular Accident (CVA) or Stroke
- A cerebrovascular accident (CVA), also known as a stroke, occurs when the blood supply to the brain is interrupted or reduced, leading to damage to brain tissue due to a lack of blood supply 2, 3, 4, 5, 6.
- Ischemic stroke, the most common type of stroke, happens when the arteries supplying blood to the brain are narrowed or blocked, inducing damage to brain tissue 2, 3, 4, 5, 6.
- The pathogenesis of ischemic stroke is similar to myocardial infarction, where the loss of blood supply to the tissue can result in irreversible damage if blood flow is not restored quickly 4.
- Stroke can be caused by a variety of factors, including reduced cerebral blood flow, leading to a cascade of events initiated by oxygen and nutrient deprivation, triggering excitotoxicity, oxidative stress, and inflammation, and finally culminating in neuronal injury and death 3.
Key Characteristics of Stroke
- Stroke is a major cause of death and disability globally, with diagnosis depending on clinical features and brain imaging to differentiate between ischemic stroke and intracerebral hemorrhage 5.
- Management of ischemic stroke has greatly advanced, with rapid reperfusion by use of intravenous thrombolysis and endovascular thrombectomy shown to reduce disability 5.
- Prevention of recurrent stroke requires an understanding of the mechanism of stroke to target interventions, such as carotid endarterectomy, anticoagulation for atrial fibrillation, and patent foramen ovale closure 5.
- Oxidative stress is an important pathophysiological mechanism of ischemic stroke, with alterations of oxidative stress biomarkers suggesting a severity-reflecting diagnosis of ischemic stroke 6.