CEREBROVASCULAR ACCICENT/TIA
Definition:
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Etiology:
CVA (cerebrovascular disease, stroke) is defined as an ischemic vascular injury to the brain
TIA (transient ischemic attack): a type of minor stroke; refers to focal neurologic abnormalities of sudden onset and
brief duration (typically minutes) that arise from injury or spasm in the internal carotid-middle cerebral or
vertebral-basilar arterial system
CVA
1. in a classic stoke, the neurologic defects continue to expand for 24-48 hours after the infarction occurs (“stroke in
evolution”)
2. the most frequently seen stroke is called a “complete stroke,” the whole symptoms develop rapidly and maximally
within a few minutes to an hour
3. the term “complete stroke” also refers to the fully established neurologic deficits after the stroke, whether from the
acute or gradual kind
4. neurologic symptoms solely relate to the area of cerebral infarction
TIA
1. often, the attacks are recurrent and are premonitions for a full stroke in the future
2. most TIAs are from arteriosclerotic emboli or spasm
3. risk factors include:
a. high blood pressure
b. heart disease
c. atherosclerosis
d. DM
e. polycythemia
Signs and Symptoms:
CVA
1. symptoms also depend on the arteries injured:
a. middle cerebral artery: contralateral hemiplegia; aphasia
b. internal carotid artery: same as middle cerebral artery
c. anterior cerebral artery: uncommon; contralateral hemiplegia; poor grasp reflex and urinary incontinence;
apathy; confusion
d. posterior cerebral artery: contralateral homonymous hemianopia; hemisensory loss; spontaneous thalamus
pain
e. vertebrobasilar system: ophthalmoplegia; pupillary abnormalities; changes in consciousness; dysarthria;
dysphagia; this type of stroke is often fatal
TIA
1. sudden onset
2. symptoms last from 2-10 minutes generally
3. symptoms expression is related to which arterial system sustained the injury:
a. carotid artery: unilateral presentation, with ipsilateral blindness; contralateral paralysis with paresthesias;
slurred speech; aphasia may occur
b. vertebrobasilar arteries: confusion; vertigo; diplopia or blindness; bilateral weakness and paresthesias of
the limbs; may cause the person to fall to the ground (“drop attacks”); slurred speech
Lab Findings:
CVA
1. lab not usually necessary; clinical diagnosis is typically adequate
2. rule out polycythemia, anemia, infections
3. x-ray (chest): to rule out lung tumor and CV problems
4. CSF: usually normal, may be bloody
5. angiography: to identify the site of the injury
6. CT scan: to differentiate ischemic stroke from intercerebral hemorrhage, hematoma or tumor
TIA
1. (+) Doppler sonography
2. (+) angiography
Course/Prognosis:
CVA
1. course or prognosis is unknown during the early days, unless death occurs
2. about 35% of patients of neurologic damage depends on the patient’s age, state of health and size and location of
the stroke
3. it is unusual for total recovery to occur but the sooner improvement is seen, the better the prognosis for minimal
deficits
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CEREBROVASCULAR ACCICENT/TIA
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any deficits present after 6 months is likely to be permanent but neurological retraining programs appear to be
having some success
further CVAs are common
TIA
1. treatment should be directed to correcting any present risk factors, such as lowering cholesterol or hypertension
2. anticoagulants, platelet inhibitors or resection of the artery are other conventional treatments
Differential Diagnosis:
1. migraine
2. convulsive seizures
3. neoplasms
4. Meniere’s disease
5. hyperinsulinism in DM
6. head injury
7. meningitis
8. uremia
9. hepatic coma
10. alcohol or drug intoxication
11. poisoning
12. epilepsy
Differentiate hemorrhagic from ischemic causes
Nutrition:
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low sugar
low cholesterol
low fat diet of unsaturated fats
calorie percentage: carbs 70%, protein 12-15%, fat 15-18%
high fiber
low sodium/sodium retention diet
vegetarian cleansing diet or short fasts
Vegetarian diet:
a. millet, buckwheat, oats, rice, raw goat’s milk, raw leafy vegetables, watermelon, garlic, onions, cornsilk
tea, broccoli, celery, cherries, nectarines, pineapple, kumquats, squash, pomegranate, guava, parsley,
cucumber, dandelion greens, egg yolk, kale, fish, veal joint broth, cod roe, rice polishings, brewer’s yeast
b. foods rich in potassium, rutin, calcium, phosphorus, manganese, sulfur, iodine, tryptophan
c. diuretic foods
d. increase omega-3 and –6 FAs: vegetables, nuts, seed oils, salmon, herring, mackerel, sardines, walnuts,
flaxseed oil, evening primrose oil, black current oil
Avoid:
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salt, salty foods: pickles, olives, chips, packaged snacks, meat (esp. pork, ham, frankfurters, bacon, bologna, corned
beef, lunch meats, frozen fish fillets, sardines, herring, caviar, anchovies, shellfish)
dairy products
spicy foods: salsa, white and black pepper, mustard, ginger
hot foods
canned tomato juice, V-8 juice, processed cheese, canned, dried or instant soups, frozen peas and beans
most processed and refined foods: MSG, mayonnaise, salad dressings, gravies, ketchup, sodium benzoate containing
foods, sodium proprionate in cheese and bread, baking powder, baking soda, ice cream, milkshakes, soft drinks,
smoked meats and fish, Jello, pretzels, potato chips, salted nuts, candy, rennet tablets, pudding mixes, beverage
mixes, fried foods,
alcohol
overeating
low levels of calcium
Supplements:
1. see atherosclerosis, hypertension
2. vitamin C (3g qd)
3. vitamin E (400-1600 IU qd)
4. coenzyme Q10
5. bromelain (250mg tid)
6. omega-3 FAs
Hydrotherapy:
1. lower body temperature as much as possible without inducing shivering:
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CEREBROVASCULAR ACCICENT/TIA
a.
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hot foot bath with cold compress to face and scalp
prolonged neutral bath
Manipulation:
1. NO ADJUSTMENT AFTER HEMORRHAGE, WAIT TILL SUBACUTE
2. Check and align T10-12
Physiotherapy:
1. aerobic exercise (to prevent)
Botanicals:
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Achillea millefolium: thrombotic conditions with hypertension, including cerebral and coronary thromboses; with Tilia
platyphyllos (lime blossom) in essential hypertension
Allium sativum
Arnica montana (toxic, homeopathic mother tincture): 25 drops tid, for tissue changes, to prevent further
coagulation
Aspidosperma quebracho-blanco: apoplexy
Capsicum frutescens: following stroke
Crataegus spp.: strengthens connective tissue
Ginkgo biloba (standardized extract): to increase circulation, dilates cerebral blood vessels
Trifolium pratense: contains coumarin; not in hemorrhagic stroke or for person on anticoagulants
Homeopathy:
1. Arnica: cerebral lesion is similar to a bruise, a hematoma (for post acute crisis survival)
2. Belladonna: face is flushed and throbbing headache, pain < light, noise, jar, lying down and in the afternoon, > ½
erect position
3. Kali muriaticum: absorbs clot (for post acute crisis survival)
4. Natrum muriaticum: face is pale and throbbing headache, nausea, vomiting
5. Nux vomica: when the stroke occurs after a heavy meal or too much alcohol, vertigo with momentary loss of
consciousness
6. Opium: when the patient is unconscious, breathing heavily; face is dusky and cyanosed
7. Sulphur: for the heavy red-faced, beer drinking type; heat on top of head
8. Veratrum album: when the clinical picture is one of collapse; shock, sweating and cold; cold sweat on forehead
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