Stroke, also known as cerebrovascular accident (CVA), is the 2nd most common cause of death worldwide and the 3rd most common cause of death in the United States. It occurs when there is a decrease in blood supply to the brain resulting in damage to the brain tissue. The damage is usually due to a lack of oxygen and is irreversible in many cases. The key to survival is early recognition and prompt treatment.

In 2012, there were 6.7 million deaths result from stroke worldwide. This is second only to ischemic heart disease, which caused 7.4 million deaths. CVAs represent 6.7% of all deaths in the U.S. 3rd to cancer at 22.8% and heart disease contributing to 28.5%. This is a common problem, which can affect anyone but becomes more prevalent with age.

Stroke is an acute neurologic injury that occurs as a result of diminished oxygen supply to areas of the brain. Usually it is to one specific area but the entire brain can be affected. The most common type of stroke is the ischemic type representing 80% of all strokes while hemorrhagic strokes occur 20% of the time. An ischemic stroke results when there is a sudden obstruction of blood supply usually due to a thrombus or emboli lodge in a blood vessel. A hemorrhagic stroke occurs when there is a sudden bleed either in the brain or in the subarachnoid space- into the cerebrovascular fluid (CSF) surrounding the brain.

The symptoms of a stroke can be variable depending on the location within the brain, severity of the stroke and type of stroke. In general symptoms of sudden asymmetrical weakness, difficulty speaking, facial drooping, or blindness are highly concerning for an acute stroke. Other symptoms can include memory loss, headache, nausea, vomiting and fainting. There is a special case of stroke in which the neurologic deficits are reversible. This is called a TIA (Transient Ischemic Attack). The symptoms usually resolve in less than 24 hours.

The prognosis of stroke is dependent upon a number of factors but age is the primary predictor of outcome. Those greater than age 65 have a much higher risk of dying with 2 months of the event. The other factor is the type of stroke. The 30 day fatality rate for an ischemic stroke is 16-23% while the rate is much higher in those who experience a hemorrhagic stroke. Other predictors include severity of neurologic deficit, volume of brain involvement as determined by imaging studies, acute interventions and post-stroke rehabilitation care.

One large study examined the residual neurologic deficits still present after 6 months in those over 65 years of age. 50% had weakness on one side of the body, 46% had cognitive deficits, 20% experienced visual field deficits, 19% had aphasia (disturbance in comprehension and formulation of language) and 15% had sensory deficits. Approximately 30% or more experienced depression and were unable to have social independence, while more than 25% were institutionalized. In addition to the above, stroke victims are at risk of other medical complications and interventions. They may require intubation and mechanical ventilation of the stroke involves the area of the brain that controls respiration. They are at higher risk of acquiring pneumonia, experiencing falls, having cardiac arrest and developing thrombolic events such as pulmonary emboli or deep venous thrombosis. Even the treatment of stroke can lead to medical complications such as a gastrointestinal bleeding from thrombolytic agents used to treat ischemic strokes.

Stroke or CVA is a common event with a high mortality rate and can lead to significant morbidity. The signs and symptoms are well defined and the key to complete recuperation and survival is early recognition and timely intervention. You should seek immediate care if you are someone you know are experiencing symptoms of a stroke.

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