Cerebrovascular Accident or “Stroke” – Resources & FAQ

“CVA”. This might be a word that you think of every day or one that you’ve never heard before. What is a CVA? Are you at risk? What can you expect if you’ve had a CVA? How can I help my loved one through this experience? All these questions and more are just ahead.

What is a CVA?

CVA stands for a cerebrovascular accident. A CVA is also called a stroke.  Blood vessels (arteries) carry blood and oxygen from your heart to every part of your body. They are shaped like tubes or hoses. Our brain requires constant oxygen and blood to function well. They receive this from the blood vessels that bring it to them. There are different blood vessels within the brain.  A stroke happens when this flow of oxygen to the brain is interrupted. That part of the brain will die or become inactive. There are three common kinds of strokes.

• Ischemic strokes: An ischemic stroke happens when a clot physically blocks a blood vessel to the brain. Ischemic strokes make up for 87% of all strokes. Atherosclerosis (fat lining the inside of your blood vessels) is the main cause of ischemic strokes. When the fat within the blood vessels breaks loose- a clot is formed. The clot can travel and block oxygen and blood anywhere within the body. If the clot happens in a blood vessel that carries oxygen to the brain, a stroke occurs. Atrial Fibrillation (a condition that causes an irregular heartbeat and increases your risk of blood clots) is the main cause of ischemic strokes.
• Hemorrhagic strokes: A hemorrhagic stroke happens when a blood vessel to the brain gets a hole (ruptures). The hole causes the blood vessel to bleed into the surrounding areas, raising the pressure inside the brain. Aneurysms (a weakened area of a blood vessel) are a common cause of a hemorrhagic stroke. Hemorrhagic strokes make up 13% of stroke cases. The most common cause of hemorrhagic strokes is uncontrolled high blood pressure.
• Transient Ischemic Attack: These are commonly called TIA or mini-strokes. A TIA occurs when oxygen to the brain is temporarily blocked.

Am I having a stroke?

Fast used to be a word that described how quickly things happen. The word F.A.S.T. is the most important word you need to know for a medical emergency. It covers the three main signs of having a stroke. It is important to know that even just one of these signs could indicate a stroke. Do not wait until you experience all the signs. If you experience even one of these- seek immediate medical attention. Many healthcare facilities offer free F.A.S.T. magnets for easy use.

• F: Facial numbness. Ask them to smile. If their smile is uneven or droopy- this could indicate facial numbness.
• A: Arm weakness. Ask them to raise both arms. If one arm droops down, this could indicate weakness.
• S: Is their speech slurred? Are they hard to understand?
• T: Time to call 911. Call 911 and tell the operator that someone is having a stroke.

Other signs of a stroke include:

• Sudden numbness
• Sudden confusion
• Sudden trouble seeing
• Sudden dizziness or loss of balance
• Sudden severe headache

These signs usually happen with no warning or cause. They can happen on one side of the body or both sides.

If you or your healthcare provider suspects that you have diabetes, they will run some basic lab tests to confirm. A simple blood sugar test is done by pricking your finger with a small needle. This test checks the amount of sugar (glucose) in your blood at the time of the test. A normal result will be below 200 mg/dL. The most common lab test used is called the H1AC (glycated hemoglobin) test. This blood test measures your average blood sugar over the past 2-3 months. If you are diagnosed with diabetes type 2, you will most likely be checking your own blood sugar daily and take an H1Ac test multiple times throughout the year.

What happens after I call 911?

Time is the most important factor when someone is having a stroke.  The amount of time that the brain goes without oxygen can significantly affect a person’s recovery. Providers will take vital signs, begin an IV, and perform a physical assessment. You will be unable to eat or drink until they perform an assessment. They will also try to determine what kind of stroke is happening.  This is done through imaging. A CT scan or an MRI is often the first imaging procedure that will happen when you arrive.

• CT Scan: Computerized tomography scan. This is an x-ray of the brain. The x-ray can reveal the damaged areas of the brain or a bleed. An angiogram is a CT scan with dye injected into the blood vessels. The dye shows the affected blood vessels.
• MRI: Magnetic Resonance Imaging. This scan uses magnets to take a picture of the brain. It reveals areas of damaged brain tissue. MRIs can also use angiography by injecting dye into the blood vessels.

If a provider determines that you are having an ischemic stroke- their goal is to break up or dissolve the clot and improve the flow of oxygen to the affected brain tissue. The clot-busting drug called tPA (tissue plasminogen activator) can be given via IV injection within 4.5 hours after stroke symptoms begin. tPA can also be injected directly into the brain. Providers do this by making a small hole in your groin. They place a skinny tube (catheter) into the hole, through an artery and up to the brain. This tube can also be used to remove clots directly from the blood vessel inside the brain. The size, location, and timing of your clot will be considered in determining treatment options. Anticipate a hospital stay of at least one day or more.

If a provider determines that you are having a hemorrhagic stroke-their goal is to stop the bleeding and release pressure inside the brain. IV drugs can be given if you are on medications that thin your blood. IV drugs can also be given that lower the pressure inside your brain and lower your blood pressure. Surgery is another option for treating hemorrhagic strokes. Clipping or coiling is the most common. Anticipate a hospital stay of at least one day or more.

• Clipping: A small clip or clamp is placed inside the weakened area of the blood vessel (aneurysm) via surgery. The clip helps to stop the area from opening and bleeding.
• Coiling: Endovascular embolization. Providers do this by making a small hole in your groin. They place a skinny tube (catheter) into the hole, through an artery and up to the brain. Small coils are placed into the weakened area. This causes the blood to thicken and releases pressure in the brain.

If a provider determines that you are having a TIA- their goal is to determine why you are having a TIA and preventing a future stroke. Treatment options will be different depending on the cause of your TIA. The treatment options for a TIA are less time-sensitive than other strokes. You can anticipate a short hospital stay. Some hospitals may only observe you and then recommend further treatment in an outpatient setting. The effects of a TIA are temporary, but your provider will still be concerned about your future stroke risk.

Where should I go if I am having a stroke?

Many hospitals nationwide are classified as a “Stroke Center”. Facilities can become a primary or comprehensive stroke center. These facilities are tested every year to ensure that they meet goals in providing excellent stroke care. These goals include important things like treating stroke patients within sixty minutes of arriving at the hospital and having dedicated teams of providers for treating strokes. If you have told your 911 operator that you think you are having a stroke, many facilities will automatically send you to a hospital that is a Stroke Center. Your paramedics will ask you what facility you want to go to. It is a good idea to ask to go to a Stroke Center. This will improve the level of care that you receive.

How is a stroke treated?

The treatment options discussed above are classified as “emergency treatment”. This means that they are only available for a short time. Many people are alone when they have a stroke. The focus for these people and anyone who has received emergency treatment changes to recovery. The goal of your providers is to help you return to your normal life, as much as is possible. A neurologist is a doctor who is trained in treating the brain. A neurologist will oversee many aspects of your stroke treatment.

Blood pressure management is an important part of all stroke treatment. Your provider will check your blood pressure regularly while you are hospitalized. They will determine your goal blood pressure and use IV and oral medications to keep your blood pressure at this goal.

Every person is affected differently by a stroke. This is because strokes can happen anywhere inside the brain. Each side and part of the brain controls a different part of your body.

A stroke can affect the movement and feeling of a body area, such as an arm or leg. It can also affect your speech, thinking, and emotions. A stroke in the left side of your brain will affect the right side of your body. A stroke in the right side of your brain will affect the left side of your body.

Movement and pain issues are treated with physical therapy. Physical therapy is used to help you gain muscle strength and learn how to move your body properly. Physical therapy can be done in the hospital, at home, in a clinic or other facility. Your physical therapist will assess your mobility and talk to you about your personal goals. Physical therapy is often done multiple times per week. Occupational therapy is often done with physical therapy. Occupational therapy helps you regain the ability to do everyday things, like using the bathroom or cooking meals.

Strokes can often affect speech, making your speech slower or slurred. Speech therapy is used to strengthen the tongue and improve speech. Speech therapy can be done in the hospital, at home, in a clinic or other facility.  A stroke can also affect your ability to understand speech, called aphasia. This is an issue that is much harder to correct. Some people’s speech will never return to normal.    

A severe stroke can cause dysphagia, or problems swallowing. This makes eating and drinking dangerous.  Speech therapy is a long-term treatment for dysphagia. Tube feeding is used as a short-term treatment. Some feeding tubes are temporary and used while you’re hospitalized. These are called nasogastric (NG) tubes. They are inserted through your nose, into your stomach. Some people need a feeding tube for long term use at home. These tubes are called percutaneous endoscopic gastrostomy (PEG) tubes.  

A case manager or social worker can help manage the complexities of your treatment. Many patients will need care outside the hospital. The three main options for treatment after the hospital (called post-acute care) are inpatient rehab (IPR), skilled nursing facility (SNF), and home health.

• Inpatient Rehab (IPR): The average stay at this type of facility is 1-2 weeks. Rehab is for people that are medically stable but need access to daily therapies (speech, physical, and occupational).
• Skilled Nursing Facility (SNF): The average stay at this type of facility is 4 weeks. SNFs are for people that need access to daily therapies, are unsafe to be home alone, and have complex medical needs.
• Home Health (HH): Home Health can be given for any length of time. HH is for people that cannot leave their home to receive therapy or get medications.

How do I cope?

Life after a stroke is many things. Frustration and fear of the unknown are common reactions to a stroke diagnosis. It’s impossible to know exactly how a stroke will affect you or how soon you expect recovery. Some people take years to return to their normal function. Some people never do. It is important to stick to whatever your treatment is, whether that’s medications or therapies. Caregivers and loved ones can help by learning to accept a stroke survivor for who they are in the present. Comparing someone to even an old version of themselves is unfair.  Strokes often affect a person’s ability to control their emotions. Remembering this will help you to be patient in dealing with a stroke survivor.

Stroke is a leading cause of death and disability in the United States. This has led to many resources available to help you through a stroke. The American Stroke Association has trained specialists available by telephone to provide support and connections. Reach out for help often.  80% of strokes are preventable. Review our articles about hypertension and cardiovascular disease for detailed practical help. Ask your provider about your stroke risk and work hard to make healthy choices.

Remember that you are not alone and can thrive after a stroke.