Cerebrovascular disease (stroke)

The word cerebrovascular is made up of two parts – "cerebro" which refers to the large part of the brain, and "vascular" which means arteries and veins. Together, the word cerebrovascular refers to blood flow in the brain. Cerebrovascular disease occurs when there are restrictions in blood flow due to vessel narrowing, clot formation, blockage or blood vessel rupture. Lack of sufficient blood flow affects brain tissue and may cause a stroke.

The most common forms of cerebrovascular disease:

• Cerebral thrombosis is a blood clot/plaque that forms in the brain's blood supply
• Cerebral embolism is a clot or air bubble that blocks blood flow that's traveling in the body
• Cerebral hemorrhage is the escaping of blood from a ruptured blood vessel
• Aneurysms is swelling of the artery wall; protrusions can develop with a very thin wall due to weak parts in arteries. These can tear and cause brain bleeds.

The symptoms of cerebrovascular disease:

The symptoms of cerebrovascular disease depend on the location of the hemorrhage, thrombus or embolus and the extent of cerebral tissue affected. General symptoms of a hemorrhagic or ischemic event include motor dysfunction, such as paralysis of one side and weakness on one side of the body. You could also lose half of the visual field and ability to recognize objects.

Other symptoms of a cerebrovascular attack may include:

• Vomiting
• Seizures
• Fever
• Confusion that leads to a complete loss of consciousness
• Labored or irregular breathing
• Bowel and bladder incontinence

Communication deficits may occur such as:

• Difficulty in swallowing
• Difficulty putting thoughts into words
• Difficulty articulating speech or slurred speech

Cerebrovascular diagnostic tests

The majority of cerebrovascular problems can be identified through diagnostic imaging tests. These tests allow neurosurgeons to view the arteries and vessels in and around the brain and the brain tissue itself.

Cerebral angiography (also called vertebral angiogram, carotid angiogram): Arteries are not normally seen in an X-ray, so contrast dye is utilized. It is a minimally invasive medical test used to produce pictures of blood vessels in the brain.

Carotid duplex (also called carotid ultrasound): In this procedure, ultrasound is used to help detect plaque, blood clots or other problems with blood flow in the carotid arteries. There are no known risks and this test is noninvasive and painless.

Computed tomography (CT or CAT scan): A diagnostic image created after a computer reads x-rays. Bone, blood and brain tissue have very different densities and can easily be distinguished on a CT scan. A CT scan is a useful diagnostic test for hemorrhagic strokes because blood can easily be seen. However, damage from an ischemic stroke may not be revealed on a CT scan for several hours or days and the individual arteries in the brain cannot be seen. CTA (CT angiography) allows clinicians to see blood vessels of the head and neck and is increasingly being used instead of an invasive angiogram.

Magnetic Resonance Imaging (MRI): A diagnostic test that produces three-dimensional images of body structures using magnetic fields and computer technology. It can clearly show various types of nerve tissue and clear pictures of the brain stem and posterior brain. An MRI of the brain can help determine whether there are signs of prior mini-strokes.

Magnetic Resonance Angiogram (MRA): This is a noninvasive study which is conducted in a Magnetic Resonance Imager (MRI). The magnetic images are assembled by a computer to provide an image of the arteries in the head and neck. The MRA shows the actual blood vessels in the neck and brain and can help detect blockage and aneurysms.