Introduction

Cerebrovascular accident ( CVA ) or stroke is the prime killer of health for aged people. CVA has been the second leading cause of death in Taiwan and it affects the health of our population significantly.

Definition

Stroke means that  the neurological deficits caused by brain tissue damage due to sudden onset of occlusion or rupture of cerebral vessels. CVA usually happens  to aged people or patients with multiple stroke risk factors.

Risk Factors of Stroke

1. Hypertension ( systolic blood pressure > 140 mmHg; diastolic blood pressure > 90 mmHg )
2. Diabetes mellitus ( DM )
3. Heart diseases ( e.g.: arrhythmia, valvular heart disease, ischemic heart disease or myocardial infarction )
4. Previous stroke
5. Obesity and hyperlipidemia
6. Long-term smoking
7. Long-term alcoholism
8. Old age
9. Oral contraceptive use

Classification of Stroke

1. Ischemic stroke
2. Hemorrhagic stroke

Symptoms and Signs

1. Weakness of limbs or hemiplegia
2. Numbness of limbs or dysesthesia
3. Slurred speech
4. Difficulty in swallowing
5. Loss of language ability or difficulty in speech or comprehension
6. Defect of visual fields
7. Unsteady gait
8. Double vision

Diagnosis and Treatment

1. Diagnosis: confirm causes and risk factors of the stroke

• Clinical symptoms and signs
•  Brain CT scan
• Carotid and intracranial vascular sonography
• Angiography
• Electroencephalograpy (EEG)
• Brain MRI

2. Treatment

• Medicine : To prevent further stroke and reduce permanent brain injury
• Rehabilitation : Once acute stroke is stabilized, patients should start rehabilitation to regain motor and language function.

Prevention

1. If you have the symptoms aforementioned, please visit the doctor as soon as possible. Early medical treatment helps prognosis and recovery.
2. If you have hypertension, diabetes mellitus, heart diseases, previous stroke, and hyperlipidemia, please take medicine timely and return to the hospital for follow-up regularly.
3. Quit cigarette-smoking.
4. Rehabiliation with patience.
5. Avoid high-fat, high-sugar, salty and spicy food
6. Prevent the conditions which may cause sudden rise of blood pressure, such as :

• Getting angry or overexcited
• Stress, e.g., rushing from places to places or playing mah-jong
• Intense physical exertion e.g., heavy object lifting and defecation
• Sudden cold surrounding
• Drink too much liquor or alcohol
• Exercise intensely in the early morning when cold weather 

7. Avoid sudden drops of blood pressure especially when you feel giddiness, hemiparesis, or deviation of mouth angle.
8. Avoid sudden change of your postures like prompt standing up from a lying-down position.
9. Avoid sudden gulping and overeating. Exercise regularly and gently. Appropriate temperature  when taking shower.

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