Stroke, Acute (Cerebrovascular Accident [CVA])

Description

The sudden onset of a focal neurologic deficit(s) resulting from either ischemia/infarction or hemorrhage within the brain

• Two broad categories: ischemic (thrombotic or embolic) (87%) and hemorrhagic (13%)
• Hemorrhage: intracerebral or subarachnoid

Pediatric Considerations
Incidence: 2 to 13/100,000; frequent risk factors: arteriopathies (53%), cardiac disorders (31%), and infection (24%) (1)

Epidemiology

Incidence
Annual incidence in the United States is ~795,000.

Prevalence
Prevalence in the United States: 550/100,000. Predominant age: Risk increases >45 years of age. Highest during the 7th and 8th decades. Predominant sex: male > female at younger age but higher incidence in women with age ≥75 years

Etiology and Pathophysiology

• 87% of strokes are ischemic; three main subtypes: thrombosis, embolism, and systemic hypoperfusion.
• 13% of strokes are hemorrhagic; most commonly due to hypertension (HTN)

Genetics
Stroke is a polygenic multifactorial disease.

Risk Factors

• Uncontrollable: age, gender, race, family history/genetics, prior stroke or TIA
• Controllable/modifiable/treatable
  • Metabolic: diabetes, dyslipidemia; lifestyle: smoking, alcohol, cocaine/amphetamine use, physical inactivity; cardiovascular: HTN, atrial fibrillation, valvular heart disease, endocarditis, recent MI, severe carotid artery stenosis, hypercoagulable states, patent foramen ovale (2)

General Prevention

Smoking cessation, regular exercise, avoid prolonged physical inactivity, weight control to maintain BMI <30 kg/m² and maximize glucose control, low-salt diet, moderate alcohol use; control BP; manage hyperlipidemia; antiplatelet therapy (e.g., aspirin) in high-risk persons; treat anticoagulation therapy for nonvalvular atrial fibrillation.

Commonly Associated Conditions

Coronary artery disease is the major cause of death in the first 5 years after a stroke.