Cerebrovascular accident (CVA)

Definition

A cerebrovascular accident (CVA) or “stroke” occurs when a part of the brain suddenly loses its blood supply. The brain suddenly stops working and no longer has enough oxygen and nutrients to function normally. This results in the death of the brain cells affected.

There are two different types of stroke: ischaemic stroke and haemorrhagic stroke. The first accounts for 80% of cases and is characterised by a blood clot blocking an artery. It is most frequently the result of atherosclerosis, i.e. a build-up of cholesterol deposits on the arteries, which cause them to harden. It can also be caused by a clot that forms elsewhere in the body and is carried to the brain in the blood. A haemorrhagic stroke, however, is characterised by an artery bursting in the brain as a result of high blood pressure.

The diagram below illustrates an ischaemic stroke:

ischemic stroke

Source: http://ischemicstroke.org

Key figures

Every year, there are 130,000 strokes in France, 1,400,000 in Europe and 12 million worldwide. The ageing population means that this figure is increasing. The average age of stroke victims is 73 but 25% of those affected are under the age of 65. So it is not only a disease of elderly people.

Two million neurones can be destroyed in one minute, hence the importance of reacting quickly as soon as the first symptoms are discovered. As a result, 15% of people die within a few days following a stroke and those who survive are often left with after-effects. Strokes are also the leading cause of disability in adults.

Causes, risk factors and high-risk individuals

The people most at risk are the elderly. The risk increases for men over the age of 50 and women over the age of 60. Family history can also play a role, as can atrial fibrillation, a condition that causes a faster, irregular heartbeat.

Among the risk factors we can influence, the main cause is high blood pressure. Other significant factors are:

  • Diabetes
  • Tobacco use: tobacco narrows the arteries and thus increases risk by 200%
  • Cholesterol, which is influenced by diet, excess weight and physical exercise
  • Obesity
  • Lack of physical exercise (less than 30 minutes a day)
  • Alcohol (more than 30 glasses a month)
  • Women who take the pill are also at risk

Symptoms

As mentioned earlier, it is very important to recognise the first signs to limit the lesions. The symptoms often affect one side of the body, depending on the part of the brain concerned. Other symptoms can be a limb that becomes very heavy, weak or paralysed or a partial paralysis of the face. Other potential symptoms are difficulties in speaking, visual disturbance, loss of balance or unexpected and inexplicable headaches.

What should you do in the case of a stroke?

If you see someone having a stroke, lay the person concerned in the recovery position, note the time of the first symptoms and don’t give them anything to eat or drink, or any medication. Then keep calm and call the emergency services. Describe the situation and stay on the phone to answer any questions. The patient is then hospitalised and given treatment (thrombolysis or fibrinolysis) to dissolve the clot. Treatment must be given within a few hours of the stroke to limit its consequences.

Consequences

Some people do recover completely from a stroke but the after-effects are often significant and can be as severe as a loss of independence or even death. In all cases, the lesions depend on the type of stroke, the part of the brain affected and the speed of medical treatment.

After-effects can include:

  • Paralysis on one side of the body
  • Difficulty speaking and visual impairment
  • Depression
  • Dementia or difficulties with recognising, learning and memorising information or things
  • Epilepsy

Treatment

If you have experienced the symptoms described but everything has returned to normal, you should still see a doctor. It may be a TIA or transient ischaemic attack, which is a sort of warning sign for a stroke. The risk of a stroke is increased during the following 24 hours.

Following an ischaemic stroke, your doctor will prescribe anti-aggregating medication to prevent the formation of clots or anticoagulants to prevent the enlargement of existing clots. Rehabilitation will also be provided to limit the after-effects and help the patient regain their independence. This may include speech therapy (to learn to speak and write again), physiotherapy (to learn to walk and move again) and occupational therapy (to organise day-to-day life).

Here is a list of common medicines prescribed for strokes.

  • Vitamin K antagonists: Acenocoumarol, Fluindione, Warfarin
  • Platelet aggregation inhibitors, except for heparins: Acetylsalicylic acid, Clopidogrel, Clopidogrel, Acetylsalicylic acid, Dipyridamole, Acetylsalicylic acid
  • Statins (HMG-CoA reductase inhibitors): Fluvastatin, Pravastatin, Simvastatin

In all cases, it is important to follow the treatment to regain your independence and limit the risks of another cerebrovascular accident. Pill dispensers can help clients to organise their medication and avoid them forgetting to take it.

Prevention

Most causes can be influenced and therefore limited by following a few rules. It is important to eat well and take physical exercise to avoid problems with cholesterol, excess weight or diabetes. It is also sensible to stop using tobacco and limit your consumption of alcohol. Finally, it is important to relax and keep an eye on your blood pressure.

Sources: http://www.ameli-sante.fr/, http://www.accidentvasculairecerebral.fr/