cerebrovascular accident

Last edited 06/2019 and last reviewed 10/2022

Stroke is defined by the World Health Organization as a clinical syndrome consisting of 'rapidly developing clinical signs of focal (at times global) disturbance of cerebral function, lasting more than 24 h or leading to death with no apparent cause other than that of vascular origin' (1).

  • a transient ischaemic attack (TIA) is defined as stroke symptoms and signs that resolve within 24 hours

  • strokes result from:
    • cerebral infarction (84%):
      • secondary to thrombosis (53%); or
      • embolus (31%)
    • primary intracerebral haemorrhage (10%)
    • subarachnoid haemorrhage (6%)

  • a non-disabling stroke is defined as a stroke with symptoms that last for more than 24 hours but later resolve, leaving no permanent disability

  • symptoms experienced depend on the part of the brain that is affected
    • usually occur suddenly and without any warning
    • common symptoms include loss of movement or sensation in an arm or leg, problems speaking, a drooping of one side of the face or problems with vision

  • a stroke can occur at any age
    • average age for stroke varies across the UK, with a median age of 77 years (interquartile range 67 to 85)
    • a quarter of strokes occur in people of working age

  • first-ever stroke affects 230 people per 100,000 each year, with over 80,000 people hospitalised per year in England

  • the Sentinel Stroke National Audit Programme show that 13.6% of people admitted to hospital with stroke in England and Wales died (either in hospital or after being discharged from inpatient care) within 30 days
    • are approximately 1.2 million stroke survivors in the UK

  • risk of recurrent stroke is 26% within 5 years of a first stroke and 39% by 10 years

Notes:

  • there are limitations to these definitions of stroke and TIA outlined
    • for example, they do not include retinal symptoms (sudden onset of monocular visual loss), which should be considered as part of the definition of stroke and TIA. The symptoms of a TIA usually resolve within minutes or a few hours at most, and anyone with continuing neurological signs when first assessed should be assumed to have had a stroke
    • definition of stroke excludes transient ischaemic attacks, subdural haematomas, and infarction or haemorrhage due to infection or tumour. However, practically it is often difficult to discriminate between a small stroke and a transient ischaemic attack
    • the term 'brain attack' is sometimes used to describe any neurovascular event and may be a clearer and less ambiguous term to use
  

Reference:

Related pages:

epidemiology

pathogenesis

definitions

approaches to thinking about stroke

risk factors

aetiology of thrombotic stroke

aetiology of intracerebral haemorrhage

aetiology of subarachnoid haemorrhage

clinical features

investigations

differential diagnosis

management

complications

prognosis

referral criteria from primary care - admission for CVA

transient ischaemic attack

NICE guidance - stroke rehabilitation - long-term rehabilitation after stroke

FAST tool for stroke and TIA