Complications of cerebrovascular accident
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Complications of Cerebrovascular Accident (CVA)
Cerebrovascular accidents (CVAs), commonly known as strokes, can lead to a range of severe complications. These complications vary depending on the underlying conditions and the circumstances surrounding the stroke. This article synthesizes findings from multiple studies to provide a comprehensive overview of the complications associated with CVAs.
Hemiplegia and Neurological Deficits
Hemiplegia in Congenital Heart Disease
In patients with cyanotic congenital heart disease, hemiplegia is a common complication of CVA. This condition often arises due to acute febrile illness, cardiac catheterization, or hyperpneic spells. In a study of 29 cases, 20 patients experienced residual hemiplegia, and some developed seizure disorders or mental retardation 1.
Neurological Complications in Sickle Cell Disease
Patients with sickle cell disease are at high risk for both infarctive and hemorrhagic strokes. Infarctive strokes are more common in children and older adults, while hemorrhagic strokes peak in young adults aged 20-29. These strokes can lead to significant neurological deficits and have a high mortality rate, particularly in the case of hemorrhagic strokes 2.
Post-Interventional Complications
CVA After Percutaneous Coronary Interventions (PCI)
Cerebrovascular accidents following PCI are rare but severe. Patients with diabetes, hypertension, previous CVA, and reduced creatinine clearance are at higher risk. These strokes are associated with high rates of in-hospital death and acute renal failure, often necessitating dialysis 34.
CVA After Transcatheter Aortic Valve Implantation (TAVI)
In high-risk elderly patients undergoing TAVI, CVAs occur predominantly within the first day post-procedure. These events significantly increase the risk of all-cause and cardiovascular mortality within 30 days. Repeated device implantation attempts and chronic pulmonary disease are notable risk factors 5.
Infections and CVA
Blood Stream Infections in LVAD Patients
Patients with left ventricular assist devices (LVADs) who develop bloodstream infections (BSIs) are significantly more likely to experience CVAs. These infections can lead to both ischemic and hemorrhagic strokes, with a higher incidence of hemorrhagic strokes 67.
Special Populations
CVA in Diabetic Ketoacidosis
In pediatric patients with diabetic ketoacidosis (DKA), CVA is a rare but serious complication. The risk is heightened due to coagulation abnormalities and cerebral edema, which can be easily confused with or lead to CVA 8.
Elderly Patients
For elderly patients, a CVA can exacerbate existing fears and lead to significant psychological and physical challenges. The abrupt onset of a stroke can result in concerns about loss of control, disfigurement, and lengthy treatments, which can be particularly distressing for this age group 9.
Postoperative CVA
General Surgery
In non-cardiac, non-carotid artery surgeries, postoperative strokes are rare but tend to occur in older patients with pre-existing atherosclerosis. These strokes often happen late in the postoperative period and are more frequent after acute operations. Rapid atrial fibrillation and postoperative dehydration are common precipitating factors 10.
Conclusion
Cerebrovascular accidents can lead to a wide range of complications, from hemiplegia and neurological deficits to severe outcomes following surgical and interventional procedures. Understanding the risk factors and early identification of complications can help in managing and potentially mitigating these adverse outcomes.
Sources and full results
Most relevant research papers on this topic
Cerebrovascular accidents in infants and children with cyanotic congenital heart disease.
Medical treatment of anemia and surgical relief of hypoxemia can potentially prevent cerebrovascular accidents in infants and young children with cyanotic congenital heart disease.
Observational Study
Highly CitedCerebrovascular accidents in sickle cell disease: rates and risk factors.
Cerebrovascular accidents are more common in sickle cell anemia patients, with risk factors including prior transient ischemic attack, low steady-state hemoglobin, acute chest syndrome, and elevated systolic blood pressure.
Observational StudyHighly CitedCharacteristics of cerebrovascular accidents after percutaneous coronary interventions.
Cerebrovascular accidents after percutaneous coronary interventions are rare but can lead to high rates of in-hospital death and acute renal failure, often requiring dialysis.
Observational StudyHighly CitedCerebrovascular accidents after percutaneous coronary interventions from 2002 to 2014: Incidence, outcomes, and associated variables.
Neurologic events after percutaneous coronary intervention (PCI) are more common in African American patients, with prior CVA, chronic renal insufficiency, and insulin-dependent diabetes as risk factors.
Observational Study
Rigorous JournalCerebrovascular accidents complicating transcatheter aortic valve implantation: frequency, timing and impact on outcomes.
Cerebrovascular accidents after transcatheter aortic valve implantation are common, associated with multiple implantation attempts, and significantly impair prognosis within 30 days of the procedure.
Observational StudyHighly CitedBlood stream infection is associated with cerebrovascular accident in patients with left ventricular assist device: a systematic review and meta-analysis
Blood stream infection is associated with an increased risk of cerebrovascular accident in patients with left ventricular assist device.
Meta-AnalysisCerebrovascular accidents in patients with a ventricular assist device.
Longer ventricular assist device support periods and infections increase the risk of cerebrovascular accidents, with white blood cell count elevation potentially exacerbating the risk.
Observational StudyHighly CitedCerebrovascular Accident Complicating Diabetic Ketoacidosis in a Nigerian Adolescent: A Case Report and Review of the Literature
Cerebrovascular accidents in diabetic ketoacidosis patients can easily be missed or confused with cerebral oedema, highlighting the need for early diagnosis and treatment.
Case ReportOverview: cerebrovascular accident and the hospitalized elderly--a multidimensional clinical problem.
Cerebrovascular accidents in the elderly require individualized therapeutic approaches to address their unique needs, including concerns about loss of control, death, insanity, disfigurement, loss of physical function, and sexual impairment.
Postoperative cerebrovascular accidents in general surgery
Postoperative cerebrovascular accidents are more common in older patients with preexisting atherosclerosis and are not directly related to surgery or anesthesia.
Observational StudyHighly Cited