Cerebrovascular Disease

Excerpt

A stroke or cerebrovascular accident (CVA) is an acute compromise of the cerebral perfusion or vasculature. Approximately 85% of strokes are ischemic and rest are hemorrhagic. In this discussion, we mainly confine to ischemic strokes. Over the past several decades, the incidence of stroke and mortality is decreasing. Stroke is the leading cause of adult disability worldwide. It is thus critical to recognize stroke early and treat it rapidly to prevent or minimize morbidity and mortality. There are many causes of stroke. Hypertension is the leading cause of ischemic stroke. In the younger population, there are numerous causes of stroke including clotting disorders, carotid dissection, and illicit drug abuse. In the acute setting, a quick history and examination to be performed. As "time is brain", it is very important not to waste any time. As acute stroke management is evolving rapidly, one must consider patients for intravenous tissue plasminogen activator (IV tPA) up to 4.5 hours and mechanical thrombectomy for up to 6 hours. The recent DAWN trial showed that one can extend the window for mechanical thrombectomy up to 24 hours in selected cases of large vessel occlusion.