A CVA, also known as a "brain attack," is a sudden neurologic deficit resulting from an ischemic or hemorrhagic event that interrupts cerebral blood flow, causing reversible or irreversible damage to brain tissue. A CVA may cause an infarction (complete stroke) or a reversible event transient ischemic attack or TIA, such as:
- Stroke, an irreversible neurologic event, causes permanent disability. The typical signs and symptoms of a stroke are characterized by:
Face – Does one side of the face droop? Ask the patient to smile.
Arms – Is one arm weak or numb? Ask the patient to raise both arms. Does one arm drift downward.
Speech – Is speech slurred? Ask the patient to repeat a sentence.
Time – If the patient shows any of these symptoms, alert EMS immediately.
- Transient ischemic attack, a reversible focal neurologic event lasting from a few minutes to 24 hours. This type of event is a warning sign; the patient can expect more TIAs or even a full stroke. The typical signs and symptoms of a TIA are characterized by:
WALK (Is your balance off?)
TALK (Is your speech slurred or face droopy?)
REACH (Is your vision all or partly lost?)
FEEL (Is your headache severe?)
- Reversible ischemic neurologic deficit (RIND), a reversible focal neurologic event lasting longer than 24 hours. This type of event is a warning sign; the patient can expect more RINDs or even a full stroke.
Apart from these traditional risk factors, certain diseases and conditions put the patient at risk for the development of stroke. These comorbid maladies are other cardiovascular conditions, congestive heart failure, left ventricular dysfunction, mitral and aortic stenosis, prosthetic heart valve, and atrial fibrillation.
An assessment tool can be used to estimate a person’s risk for developing a stroke. See: Stroke Risk Calculator.
Residual neurologic deficits of varying degree and duration are common after a CVA. These include, among others, minimal to severe motor dysfunction, sensory impairment, visual defects, speech difficulties, dysphagia, dizziness, seizures, dyspnea, sleep problems, and memory deficits. In addition, depression is a common condition affecting many patients after a stroke.
Medications are given based on underlying conditions, as well as to prevent the patient from developing a stroke. Most patients at risk for, or those who have experienced, an ischemic stroke will be on anticoagulation therapy.
New alternative medications to warfarin include apixaban (Eliquis) and rivaroxaban (Xarelto), both direct factor Xa inhibitor, and dabigatran (Pradaxa) a direct thrombin inhibitor.
- Medical disorders
- Oral Health Care Considerations
- Laboratory Values
- Medical Emergencies
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- What is a stroke? UCLA Health.
- Transient Ischemic Attack Information Page. National Heart, Lung, and Blood Institute.
- Transient Ischemic Attack. MedlinePlus. U.S. National Library of Medicine. April 12, 2021.