CVA: Cerebrovascular Accident

Cerebrovascular accidents are the third leading cause of death in the United States. The highest incidence of stroke is among those older than 65 years of age. Strokes tend to run in families and are more frequent in women. In its most benign state it can be so minimal that it can almost go unnoticed. In its most severe state it has been known to cause paralysis, coma and even death. There are three types of strokes: Thrombotic, Embolic and Hemorrhagic.

Thrombotic strokes are caused from blood clots formed in the arteries that surround the brain. Some of the risk factors for these types of strokes include: use of oral contraceptives, arteriosclerosis or thickening and hardening of the blood vessel wall (resulting from hypertension, cigarette smoking, elevated blood cholesterol, diabetes and sedentary lifestyle), and sickle cell disease. These types of strokes occasionally have an abrupt onset but more often occur in an evolving step-by-step manner that can occur over minutes to hours.

Thrombotic strokes can be further divided into three categories: Transient Ischemic strokes, strokes in evolution and completed strokes. In a true transient ischemic stroke, all neurological deficits must be completely clear in 24 hours after onset, leaving no long lasting dysfunction. Stroke in evolution is the more typical development of a thrombotic stroke. It is an intermittent progression of a neurological (brain) deficit over hours to days. The completed stroke is a CVA that has reached its maximum destruction in producing neurological (brain) deficits.

Embolic strokes evolve from fragments that break from a blood clot formed outside the brain. The blood clot usually involves small vessels and obstructs at a bifurcation or area where there is narrowing, thus causing the resulting ischemia (a state in which the blood cells are temporarily deprived of their blood supply). Patients who experience this type of event usually experience a second stroke at a later point because the source of the blood clot continues to exist.

Hemorrhagic strokes are also known as intracranial strokes. They are the third most frequent cause of CVA’s. The most common causes of hemorrhagic strokes are hypertension, and ruptured aneurysms. A hypertension hemorrhagic stroke is associated with increased blood pressure over several years and typically occurs within the brain tissue. A mass of blood is formed, and its volume increases. Adjacent brain tissue is displaced and compressed.

Treatment for thrombotic strokes is directed at supportive management to control cerebral edema and increased intracranial pressure. Later, surgical intervention to restore blood supply may be performed. In embolic strokes, treatment is aimed at preventing further blood clots and correcting the primary problem. Rehabilitation is indicated in both thrombotic and embolic strokes. For hemorrhagic strokes, care is focused on stopping or reducing the bleeding, preventing a new occurrence or preventing a spasm in the vessels.

For more information on CVA’s, please contact us to set up an in-house presentation. Other services that we can provide in relation to cases that involve CVA’s are:

• Preparation of medical chronologies of the medical events surrounding the case
• Organize, tab and paginate the medical record for easy reference
• Summarize, translate, and clarify the medical record
• Assess damages and injuries
• Identify contributing factors
• Construct written report for attorney-client use
• Research medical and nursing literature for integration into case analysis
• Identify and locate experts need for the case
• Prepare medical aspects of interrogatories and requests for production
• Analysis and summation of deposition and past testimony
• Assist in demonstrative evidence preparation

Reference:

McCance, Kathyrn L & Sue E. Heuther. Pathophysiology: The Biologic Basis for Disease in Adults and Children. pp. 547-548, 1001, 1018

For more information on this issue please see Contact Us and see how our services can work for you.