Stroke

Alternative names:

cerebrovascular accident; cerebrovascular disease; CVA

Symptoms:

• loss of movement (paralysis) of any body area
• weakness
• decreased sensation
• numbness
• tingling or other sensation changes
• decreased vision
• language difficulties (aphasia):
  • slurred, thick, difficult speech
  • inability to speak
  • inability to understand speech
  • may have difficulty with reading or writing

• inability to recognize or identify sensory stimuli (agnosia) resulting in "neglect" of one side of the body
• loss of memory
• vertigo (abnormal sensation of movement)
• loss of coordination
• swallowing difficulties
• personality changes
• mood/emotion changes (such as depression or apathy)
• consciousness changes:
  • sleepy
  • stuporous/somnolent/lethargic
  • comatose/unconscious

• urinary incontinence (lack of control over bladder)
• lack of control over the bowels
• cognitive decline
  • dementia
  • easily distracted
  • impaired judgment
  • limited attention

Additional symptoms that may be associated with this disease:

• tongue problems
• seizures
• movement, unpredictable - jerky
• movement, uncontrollable
• movement, dysfunctional
• incontinence
• fatigue
• fainting
• facial paralysis
• eye movements, uncontrollable
• eye lid drooping
• drooling
• breathing, absent temporarily
• behavior, unusual or strange
• abnormal lack of sweating

Note: Specific changes in brain function (neurologic deficits) depend on the location and amount of injury to the brain. The symptoms are typically on one side of the body but may be isolated to specific functions, may involve one side of the body and the opposite side of the face, or may involve the face only.

Signs and tests:

A history of the pattern of symptom development is important in the diagnosis of a stroke. Maximum neurologic deficits may be present at the beginning (onset) of the stroke, or symptoms may progress or fluctuate for the first day or two (stroke in evolution). Once there is no further deterioration, the stroke is considered a complete stroke.

Examination may include neurologic, motor, and sensory examination to determine the specific neurologic deficits present, because they often correspond closely to the location of the injury to the brain. An examination may show changes in vision or visual fields, changes in reflexes including abnormal reflexes or abnormal extent of "normal" reflexes, abnormal eye movements, muscle weakness, decreased sensation, and other changes. A bruit (an abnormal sound heard with the stethoscope) may be heard over the carotid arteries of the neck. There may be signs of atrial fibrillation.

Tests may be used to determine underlying disorders, the location and cause of the stroke, and to rule out other disorders that may cause the symptoms.

• a head CT or MRI of head may be used to rule out bleeding (hemorrhage) or other lesions and to define the location and extent of the stroke
• an ECG (electrocardiogram) may be used to determine underlying heart disorders
• an echocardiogram may be used if the cause is suspected to be cardiac embolus
• a carotid duplex (ultrasound) may be used if the cause is suspected to be carotid artery stenosis
• a cerebral (head) arteriography may be used if disorder involving the blood vessels is suspected

This disease may also alter the results of the following tests:

• platelet aggregation test
• osmolality
• LDH isoenzymes
• LDH
• cytometric study
• CSF collection
• CPK isoenzymes
• BERA (brainstem evoked response audiometry)