The Management of Cerebrovascular Accident

Most cerebrovascular diseases (CVA) are manifest by the abrupt onset of a focal neurologic deficit. The deficit may remain fixed or may rapidly improve or progressively worsen. Therefore, the main objective of treatment in cerebrovascular disease is the prevention of stroke. The current treatment of CVA may be divided into three parts : (1) management in the acute phase (restoration of the circulation and arrest of the pathologic process), (2) physical therapy and rehabilitation, and (3) prevention of the further recurrent strokes. When faced with an acute stroke, the clinician must differentiate between infarction and hemorrhage immediately, because the method of emergency treatment depends on the cause. The clinician should try to prevent or reverse acute brain injury with thrombolysis, and to inhibit the progression of cerebral infarction with anticoagulation or antiplatelet agents, and to prevent further neurologic injury with neuroprotection and attending to acute medical issues of airway, blood pressure, and concomitant organ failure. In addition, the clinician should remove or control the risk factors of stroke and must elaborate a proper strategy in order to prevent the secondary stroke.