Stroke

Stroke (cerebrovascular accident or CVA) occurs when an artery supplying blood to the brain is blocked. This blockage usually occurs through a process of furring-up (atheroma). Less commonly it occurs when a small clot dislodges 'downstream' in the heart or in the major arteries supplying the head (carotid arteries) to impact higher up in the brain (embolism). A Transient Ischaemic Attack (or TIA) is simply a short-lived stroke, traditionally accepted as lasting less than 24 hours.

A less common example of stroke is not blockage but bleeding, usually under high pressure either into brain substance itself (intracerebral haemorrhage) or into the space surrounding the brain (subarachnoid haemorrhage or SAH).

Risk factors for stroke include high blood pressure (Hypertension), diabetes, high cholesterol levels, smoking, excess alcohol, similar blood vessel disease affecting the heart (coronary artery disease) or legs (peripheral vascular disease), other heart problems (rhythm disturbance & valve disease), some blood disorders, hormones and migraine. Premature vascular disease frequently runs in families.

Neurological examination attempts to determine the site of the stroke within the brain and the cause of the stroke with particular attention directed towards the heart and neck vessels.

Tests include CT Brain Scan, MR Imaging of Brain, MR Angiography, Ultrasound of neck vessels, Echocardiography, Chest X-Ray, ECG, 24-hour ECG tape & blood analysis.

Management is with aggressive rehabilitation following the stroke and importantly prevention of a further stroke with medications and control of obvious risk factors. Occasionally an operation on a narrowed carotid artery may be necessary.