1. CEREBRO VASCULAR ACCIDENT.
Cerebro-vascular Accident(CVA) is a very common neurological disease
affecting a large number of the population worldwide. Itis the medical term
for Stroke, which arecompletely neurological in effect.
Strokes occur when there is a blood clot or rupture of the blood vessels that
prevent the flow of blood to a partof the brain and causes death of a few brain
cells. According to the WHO’s website, strokes arethe second leading cause of
death and the third leading cause of disability.
Strokes areof two types:
a) Ischemic Strokes: Itis the most common type of stroke, about 90%
wherea clot blocks a blood vesseland prevents blood and oxygen from
getting to a part of the brain. Asidefrom blood clots, an arterial
dissection can also causean ischemic stroke
b) Haemorrhagic Strokes: Here, the blood vessels opens and ruptures. It
prevents the blood from entering into brain.
During the course, Prof. Mason emphasised thateffects of strokeare
different depending on wherein the blood supply the strokehits. Oneof
the major signs of strokeis that it has a sudden onset and rapid timescale.
What are the major bloodvessel sources inthe brain?
The brain receives blood from two sources: the internal carotid arteries, which
arise at the point in the neck where the common carotid arteries bifurcate, and
the vertebral arteries.
What Blocks the BloodVessels inthe Brain?
Intracranialstenosis is a narrowing of the arteries inside the brain and is
caused by a formation of plaque (atherosclerosis plaques) in the inner wall of
the blood vessels. This narrowing of the blood vessels causes decreased blood
flow to the area of the brain that the affected vessels supply. Atherosclerosis
begins with damage to the inner wall of the artery caused by high blood
pressure, diabetes, smoking, and elevated cholesterol level.
2. As the blood flow is interrupted, signals for various functions of the body such
as breathing, heartbeat, eye movement and swallowing can be impaired or
altered after a massivestroke.
Signs and Symptoms:
Strokesymptoms include: difficulty in walking, loss of balance and
coordination, dizziness, blurred vision, paralysis on oneside of the body and
The symptoms of a strokecan vary depending on the individual and wherein
the brain it has happened. Symptoms usually appear suddenly, even if they’re
not very severe, and they may become worseover time.
The symptoms of intracranial artery stenosis are a transient ischemic attack
(TIA) or stroke, which can be described with the mnemonic FAST:
F: for facial weakness or droop, especially on one side
A: for arm or leg weakness, tingling, or numbness, especially on one side
S: for slurred speech
T: for time.
What are the risk factors?
The chances of having a strokegenerally increases with age and is often seen
in people fromthe age groups of 60s and onwards. However, therearea few
common factors that can resultin an early onset of stroke.
1. Hypertension (uncontrolled high blood pressure)
2. High Cholesterol level
4. Lifestyle choices such as smoking, physicalinactivity, alcohol and drug
Diagnosis and Treatment:
since the onset of CVA are very rapid a few tests are done to confirm the
type of strokeand it’s extent.
1. Clinical Examination : the doctor does somephysicalexamination of
the patient such as rate of heartbeat and blood pressure. A few
neurological tests are also done to check which part of the brain is
3. being affected by the stroke. Blood tests are also done to check the
2. Computerised Tomography (C.T.)Scan: Theseneuroimaging of the
brain shows theblood clot or the bleeding in the blood vessels.
Sometimes, doctors inject a dyeto view the blood flow in the head
and neck region.
3. Magnetic Resonance Imaging (MRI): An MRI can show the detailed
imaging of the brain and detect tissues that are damaged by an
ischemic strokeand haemorrhagic stroke.
4. Carotid Ultrasound: This test shows the formation of fatty plaques
within the carotid artery and the blood flow in our head-neck region.
For treatment of Ischemic stroke, a blood thinner or clot dissolving drug is
given to the patient. Aspirin is also given to prevent any further strokes.
In Haemorrhagic stroke, surgery is required to remove the excess blood and
repair the ruptured vessel. Drugs arealso administered to the patient to
reduce the pressurein the brain that is caused due to bleeding.
My paternal grandfather suffered from CVA in the year 2003. Hewas
77years old then. There was a history of hypertension for the last 30
years and was under medication to controlhis blood pressure. One
morning, while on his usualroutine, he suddenly felt that one half of his
body is not working properly as his movements werenot smooth and his
speech was slurred. Therewas no history of unconsiouness or fall. A CT
scan was done which showed an embolus which has blocked one of his
central blood vessels. Therewas right side hemiplegia and a cerebral
atrophy was evident in the CT scan report.
He was treated by a neurologistand started physiotherapy posthis
operation. He was gradually able to move his limbs of upper and lower
extremities of the right side and supportof family members, he was
even able to walk.
Through this extensive 10-weeklong course, I am now able to understand the
various working of our brain and in particular took an interest to the topic of
strokes. I havegained a wider knowledge and through Prof. Mason’s lectures, I
was able to incorporatethe study in my own words and havea better
comprehension towards the diseaseand the patient.