What Is a Cerebrovascular Accident?

A cerebrovascular accident (CVA) is an event involving an interruption of blood flow or bleeding in a region of the brain. The term cerebral refers to the brain tissue. A CVA refers to a vascular event in the brain. A stroke refers to brain damage due to a vascular event, and these terms are often interchangeable.

A CVA is an emergency that is often treatable if detected promptly, and rapid treatment can reduce or prevent stroke damage. This article will describe CVA's types, symptoms, causes, diagnosis, prognosis, and prevention and coping methods.

Types of Cerebrovascular Accident 

The main types of CVA involve either an obstruction of a blood vessel in a region of the brain or bleeding of a blood vessel in the brain.

A CVA due to an interruption in blood flow is often referred to as an ischemic stroke. Ischemia, which is inadequate blood supply, is the most common type of CVA. A hemorrhage, which is bleeding, is another type of CVA. 

Ischemic CVA can result from the following:

• Embolism: A cerebrovascular embolism is an interruption in arterial blood flow due to a particle or blood clot that came from another artery in the body, such as from the heart or the carotid arteries.
• Thrombosis: A cerebrovascular thrombosis occurs when a blood vessel in the brain becomes obstructed, often due to narrowing and a buildup of atherosclerosis plaques (deposits of cholesterol, calcium, and inflammatory cells).

Thrombosis in a cerebral artery is often referred to as a stroke. Thrombosis in a cerebral vein is often referred to as cerebral venous thrombosis. One type of venous thrombosis is called dural sinus thrombosis.

Sometimes, an embolism may occur in a cerebral blood vessel that atherosclerotic disease has already affected.

Hemorrhagic CVA can result from:

• A ruptured blood vessel: This is most commonly associated with an aneurysm, which is an outpouching of a blood vessel. A brain aneurysm that is fragile or becoming larger is most likely to rupture, especially if blood pressure is elevated.
• A leaking blood vessel: A cerebral aneurysm can slowly leak instead of rupturing. An arteriovenous malformation (AVM) is a malformed web of arteries and veins, which can sometimes leak.
• Traumatic injury: A traumatic injury to the head can cause different types of damage. This can include rupture or leaking of a blood vessel. Other injuries may include a concussion or a contusion (bruising of the brain tissue). 

Cerebrovascular Accident Symptoms

The symptoms of a CVA can vary depending on which type of CVA occurred, which area of the brain it affected, the size of the affected blood vessel, and other medical or neurological problems.

The most common symptoms of an ischemic stroke include:

• Weakness of one side of the face or body
• Numbness, tingling, or sensory changes on one side of the face or body
• Double vision or blurred vision
• Loss of vision of one visual field in both eyes
• Slurred speech
• Confusion
• Trouble understanding language and communicating

An ischemic stroke can cause one or more of these symptoms.

The most common symptoms of a cerebral hemorrhage include:

• A severe headache
• Profound dizziness and loss of balance
• Confusion
• Loss of consciousness
• Convulsions
• Very high blood pressure

The most common symptoms of cerebral venous thrombosis include:

• A severe headache
• Feeling disoriented
• Dizziness
• Loss of consciousness
• Vision changes

This condition is not common, and the risk is increased during preeclampsia or eclampsia, which are dangerous pregnancy complications.

Causes

A CVA occurs when there is an abnormality in blood flow in the blood vessels of the brain. This can include obstruction or bleeding, and it may affect cerebral arteries, veins, or capillaries.

There are many different risk factors for CVA. Some risk factors are more likely to cause some types of CVA than others.

Diagnosis

A CVA is a medical emergency that requires prompt medical attention. A quick and accurate diagnosis is often possible with a physical examination and brain imaging tests. If a person who is having a CVA can communicate, a description of the symptoms is also highly beneficial in the diagnosis. 

The physical examination, which includes a neurological examination, can quickly identify changes in vital signs (such as very high blood pressure) that may require urgent treatment. The neurological examination can detect evidence of a stroke, such as weakness on one side of the body. 

Imaging Tests 

Urgent testing may include a brain computerized tomography (CT) scan, which is a type of detailed X-ray that doesn’t take a long time. Brain magnetic resonance imaging (MRI) may take longer and can detect subtle areas of damage. 

A brain CT angiogram or MR angiogram might be necessary to visualize the blood vessels of the brain. Some circumstances may require a cerebral angiogram, by which a catheter inserted into the arm or leg passes through the body to the area of interest (using X-rays to show its location). When it reaches the right area, the area then receives an injection of contrast dye.

Other Tests 

Depending on the circumstances, other tests may be necessary to determine whether ongoing medical issues need treatment in association with a CVA.

These can include blood tests to identify whether there is a bleeding disorder or blood clotting disorder, electrolyte abnormalities (changes in concentration of essential charged particles in the blood), or evidence of an infection. These issues must also be treated promptly in the immediate phase of CVA treatment.

After a person has medically stabilized from the immediate stage of a CVA, other tests are necessary to determine whether there are any underlying risk factors and health issues that need treatment. These can include an echocardiogram, carotid ultrasound, cerebral angiogram, and blood tests that can detect inflammatory disorders or bleeding disorders.

If other signs point to less common underlying risk factors, such as an infection, blood cultures and/or lumbar puncture (spinal tap) could be necessary.

Treatment

Managing a CVA involves immediate medical stabilization and treatment to reduce the potential for brain damage. Long-term management focuses on rehabilitation and treatment of underlying risk factors.

Different causes of CVA require different interventions. Immediate treatment can include the following as needed and appropriate:

• Maintaining a healthy blood pressure, which includes treating low blood pressure or high blood pressure
• Stabilizing heart function
• Blood thinners 
• Glucose management

Rehabilitation can begin within the first few days after a CVA. For people who have had extensive brain damage from a CVA, physical therapy, occupational therapy, speech therapy, and swallow therapy may need to continue for months or longer.

Depending on the level of function and independence after a CVA, rehabilitation may take place on an inpatient or outpatient basis.

Prognosis

The prognosis after CVA is highly variable. Many people do very well and can function with minimal limitations. However, some people experience substantial changes in physical or cognitive abilities after a CVA.

As you recover from a CVA, your prognosis will become more apparent over the first few days and weeks. Many people who initially seem like they might not have a good prognosis can eventually experience good outcomes and independence after CVA.

Coping

A CVA can result in many physical, cognitive, and health changes. Coping with the outcome of a CVA can be emotionally and physically challenging. 

Practical support, along with rehabilitation, can help you adjust to day-to-day life.

Additionally, seeking out emotional support when learning to live with the limitations that may result from a CVA may prove helpful. Sometimes, speaking with a professional therapist who is experienced in counseling people who have recovered from a CVA can also help. Family members, especially primary caregivers, may also benefit from support.

Emotional support can come from a licensed therapist, and some people can also benefit from joining a support group for stroke survivors or caregivers of stroke survivors.

Summary

A cerebrovascular accident (CVA) is a disruption of blood flow or bleeding in the brain. It can affect an artery or vein of the brain and may cause harm to brain tissue. Three main types of CVA are an ischemic stroke, a cerebral hemorrhage, or a cerebral venous occlusion.

These events are medical emergencies that require prompt medical attention. The immediate effects of a CVA can include head pain, weakness, vision changes, and convulsions, Treatment can minimize the damage it causes. Long-term management involves rehabilitation and the prevention of another CVA.