Cerebrovascular Attack (Stroke)

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Alternative Names

Cerebrovascular disease; CVA; Cerebral infarction; Cerebral hemorrhage; Ischemic stroke; Stroke -
ischemic; Cerebrovascular accident

Definition of Stroke:

A stroke is an interruption of the blood supply to any part of the brain. A stroke is sometimes called a
"brain attack."

See also: Arteriovenous malformation (AVM)

Causes, incidence, and risk factors:

A stroke happens when blood flow to a part of the brain is interrupted because a blood vessel in the
brain is blocked or bursts open.

If blood flow is stopped for longer than a few seconds, the brain cannot get blood and oxygen. Brain
cells can die, causing permanent damage.

There are two major types of stroke: ischemic stroke and hemorrhagic stroke.

ISCHEMIC STROKE

Ischemic stroke occurs when a blood vessel that supplies blood to the brain is blocked by a blood clot.
This may happen in two ways:

 A clot may form in an artery that is already very narrow. This is called a thrombus. If it
completely blocks the artery, it is called a thrombotic stroke.
 A clot may break off from somewhere in the body and travel up to the brain to block a smaller
artery. This is called an embolism. It causes anembolic stroke.

Ischemic strokes may result from clogged arteries, a condition called atherosclerosis. (See: Stroke
secondary to atherosclerosis) This may affect the arteries within the brain or the arteries in the neck
that carry blood to the brain. Fat, cholesterol, and other substances collect on the wall of the arteries,
forming a sticky substance called plaque. Over time, the plaque builds up. This often makes it hard for
blood to flow properly, which can cause the blood to clot.

Stroke
Ischemic strokes may also be caused by blood clots that form in the heart. These clots travel through
the blood and can get stuck in the small arteries of the brain. This is known as a cerebral embolism.

Certain drugs and medical conditions can make your blood more likely to clot and raise your risk for
ischemic stroke. A common cause of ischemic stroke in people under age 40 is carotid dissection, or a
tear in the lining of the carotid artery. The tear lets blood flow between the layers of the carotid
artery. This causes narrowing of the carotid artery that is not due to plaque buildup.

Stroke - secondary to cardiogenic embolism


HEMORRHAGIC STROKE

Hemorrhagic stroke occurs when a blood vessel in part of the brain becomes weak and bursts open,
causing blood to leak into the brain. Some people have defects in the blood vessels of the brain that
make this more likely. The flow of blood that occurs after the blood vessel ruptures damages brain
cells.

For more information on this type of stroke, see: Hemorrhagic stroke


STROKE RISKS

High blood pressure is the number one risk factor for strokes. The following also increase your risk for
stroke:

 Diabetes
 Family history of stroke
 Heart disease
 High cholesterol
 Increasing age

Hypertension - overview
Certain medications make blood clots more likely, and therefore your chances for a stroke. Birth
control pills can increase the chances blood clots, especially in woman who smoke and who are older
than 35.
Men have more strokes than women. But, women have a risk of stroke during pregnancy and the
weeks immediately after pregnancy.

The following can increase the risk of bleeding into the brain, which makes you more likely to have a
stroke:

 Alcohol use
 Bleeding disorders
 Cocaine use
 Head injury

For more information see: Stroke risk factors and prevention

PICTURES:

A carotid arteriogram is an x-ray study designed to determine if there is narrowing or other


abnormality in the carotid artery, a main artery to the brain. This is an angiogram of the left common
carotid artery (both front-to-back and side views) showing a severe narrowing (stenosis) of the
internal carotid artery just beyond the division of the common carotid artery into the internal and
external branches.
The major areas of the brain have one or more specific functions.

==============================================================

This is an angiogram of the right carotid artery showing a severe narrowing (stenosis) of the internal
carotid artery just past the carotid fork. There is enlargement of the artery or ulceration in the area
after the stenosis in this close-up film. Note the narrowed segment toward the bottom of the picture.
A stroke involves loss of brain functions caused by a loss of blood circulation to
areas of the brain. The blockage usually occurs when a clot or piece of
atherosclerotic plaque breaks away from another area of the body and lodges
within the vasculature of the brain.

A stroke affecting the brain stem is potentially life threatening since this area of the brain controls
functions such as breathing and instructing the heart to beat. Brain stem stroke may also cause
double vision, nausea and loss of coordination.
The cerebellum processes input from other areas of the brain, spinal cord and
sensory receptors to provide precise timing for coordinated, smooth movements of
the skeletal muscular system. A stroke affecting the cerebellum may cause
dizziness, nausea, balance and coordination problems.

The Circle of Willis is the joining area of several arteries at the bottom (inferior)
side of the brain. At the Circle of Willis, the internal carotid arteries branch into
smaller arteries that supply oxygenated blood to over 80% of the cerebrum.
The left cerebral hemisphere controls movement of the right side of the body.
Depending on the severity, a stroke affecting the left cerebral hemisphere may
result in functional loss or motor skill impairment of the right side of the body, and
may also cause loss of speech.

The right cerebral hemisphere controls movement of the left side of the body.
Depending on the severity, a stroke affecting the right cerebral hemisphere may
result in functional loss or motor skill impairment of the left side of the body. In
addition, there may be impairment of the normal attention to the left side of the
body and its surroundings.==

Endarterectomy is a surgical procedure removing plaque material from the lining of


an artery.

A heart attack or stroke may occur when an area of plaque (atherosclerosis)


ruptures and a clot forms over the location, blocking the flow of blood to the
organ's tissues.

Part 1:

Much of the brain is supplied blood by the internal carotid arteries.

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