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Surgical intervention for stroke is directed by:
Additional services are provided in Gainesville at:
- The Malcolm Randall VA Medical Center
VA hospital patients are treated by:
Please contact the Department of Neurosurgery for more information.
A stroke or cerebrovascular accident (CVA) occurs when the blood supply to a part of the brain is suddenly interrupted by occlusion, hemorrhage, or hypoperfusion. The area of brain affected stops functioning, often leading to neurological deficits.
Types of Stroke
- Ischemic stroke
- is usually caused by atherosclerosis (hardening of the arteries), embolism (obstruction of blood vessels by blood clots from elsewhere in the body), or microangiopathy (small artery disease, the occlusion of small cerebral vessels). (At right: CT scan shows a large area of stroke)
- Hemorrhagic stroke
- is usually caused by high blood pressure, arteriovenous malformation, cerebral aneurysms, and trauma. (At right: CT scan shows a white area of bleeding in the middle of the brain)
- Watershed strokes
- are usually the result of poor blood flow to the brain from occlusion of the arteries in the neck (from atherosclerosis) or periods of poor cardiac function, such as during a heart attack. (At right: CT angiogram of the neck with arrow pointing to blockage in the internal carotid artery)
A stroke is a medical emergency. It generally presents with sudden numbness or weakness, especially on one side of the body; confusion or aphasia (trouble speaking and understanding speech); difficulty seeing in one eye; trouble walking, dizziness, or loss of balance or coordination.
Some patients lose consciousness during a stroke. This is more common with hemorrhagic strokes.
If the symptoms resolve within 24 hours, the diagnosis is transient ischemic attack, also know as TIA or mini-stroke, and not a stroke. A TIA is a warning sign or impending stroke (permanent deficit) and should be taken very seriously.
Stroke is diagnosed through several techniques: a detailed neurological examination can localize the specific area of the brain which is involved. This is followed by a CT scan of the brain to evaluate for any hemorrhage. An MRI with special sequences called diffusion-weighting, is very sensitive for locating areas of ischemic stroke.
Further workup of stroke includes evaluation of the blood vessels in the neck using either Doppler ultrasound, MR-angiography or CT-angiography of the neck, or formal angiography. An echocardiogram may be performed looking for a cardiac source of emboli. Blood tests for risk factors may be ordered, including cholesterol levels, triglyceride levels, homocysteine levels, and blood coagulation tests.
The most important risk factors for stroke are hypertension, heart disease, diabetes, and cigarette smoking. Other risks include heavy alcohol consumption, illicit drug use, and genetic or congenital conditions.
It is important to identify a stroke as early as possible because recovery can be improved for patients treated earlier. The term “brain attack” is used to underline the urgency of early assessment and treatment similar in intensity to the management of a patient with a heart attack.
Acute care: Thrombolysis (“clot busting”) is sometimes used to dissolve the clot causing an acute stroked. This involves administering a medication into the blood stream (either intravenous or directly into the clot within an artery) within hours of the stroke. Studies indicate that after three hours of symptom onset the damage to the brain is irreversible, and that thrombolysis provides no benefit.
Long term care: This type of stroke is usually caused by hypoperfusion as a result of narrowing or occlusion of the arteries in the neck which supply blood to the brain. Often, this can be surgically corrected by a procedure called carotid endarterectomy, which cleans out the involved artery.
Alternatively an endovascular procedure called, carotid stenting, may be performed. These procedures are designed to prevent further strokes. If surgery is not indicated then the treatment involves blood thinning medication.
Patients with intracerebral hemorrhages require prompt neurosurgical evaluation. These type of strokes often cause mass effect on the brain and may require immediate surgical evacuation. This involves a craniotomy, removal of the blood clot and, sometimes, elimination of the problem causing the hemorrhage (like clipping of an aneurysm or removal of an AVM).
Stroke rehabilitation is the process by which patients with disabling strokes undergo treatment to help them return to normal life as much as possible by regaining and relearning the skills of everyday living. It is multidisciplinary, involving a team with different skills working together to help the patient. The team includes nursing staff, physiotherapy, occupational therapy, speech and language therapy and usually a physician trained in rehabilitation medicine.
Stroke rehabilitation can last from a few days to several months.