Cerebrovascular accident (CVA) is commonly known as stroke. In Canada, stroke is:

  1. The number one cause of disability
  2. The second leading cause of dementia
  3. The third leading cause of death

Between 2008 and 2009, over 10,500 people in British Columbia had been diagnosed with stroke for the first time. Of these, 4,500 patients had a severe stroke and needed hospitalization. The annual medical cost exceeds 330 million Canadian dollars. For every 100 first time stroke victims:

  • 27 died
  • 15 became severely disable and required long-term care

Two Main Types of Stroke:

  • Ischemic Stroke: 80% of patients
  • Hemorrhagic Stroke: 20% of patients

Types of Strokes and Risk Factors

Ischemic Stroke

Ischemic stroke occurs when the blood supply to the brain is interrupted due to blocked arteries (blood vessels). This results in oxygen and nutrients unable to be transported to the brain causing brain cell death. The respective body functions that are controlled by the damaged parts of the brain will be affected.

Hemorrhagic Stroke

Hemorrhagic Stroke is caused by ruptured (burst) arteries (blood vessels), resulting in leakage of blood into brain tissue.

Transient Ischemic Attack:

Transient ischemic attack (TIA) is a mini-stroke. Similar to stroke, TIA can happen without any warning signs or symptoms. The sudden onset can last for several minutes, or up to 24 hours. TIA has similar symptoms to stroke but the difference is TIA will resolve without treatment.

However, the occurrence of TIA strongly suggests that there may be a blockage of blood flow in the brain arteries, which will very likely progress into a stroke. Many stroke patients (15%) previously experienced TIA.

Risk Factors: Internal factors
  • Age
  • Gender
  • Family medical history
  • Race
  • History of having stroke/TIA
Risk Factors: External factors
  • High Blood Pressure
  • High cholesterol
  • Diabetes
  • Atrial fibrillation
  • Being overweight
  • Smoking
  • Excessive alcohol use
  • Lack of exercise
  • Stress 

Exercise to prevent stroke.

Does exercise help prevent stroke?

Yes, exercising with excessive mental stress, healthy balanced diet, salt, weight, smoking and drinking alcohol are risk factors that can be improved. We also know from proof that stroke victims usually have weak heart health. Because of this, the chance of having stroke again increases.

With aerobic exercise

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How to start exercise

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Some suggestions

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After how long?

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Provided by Barnard Lee

Partial Paralysis (Hemiplegia):

  • Experiencing sudden numbness or weakness on one side of the body, e.g. one arm, one leg, or half of the face
  • Delayed response and failure of the body to follow commands
  • Sensation of numbness
  • Uneven smile
  • Tendency to drool or have trouble swallowing

Communication barriers:

  • Suddenly unable to speak or express oneself
  • Slurred speech and confusion
  • Unable to understand others
  • Speech is confusing and hard to understand

Visual impairment:

  • Sudden loss of vision in one or both eyes
  • Sometimes the loss is temporary
  • Sometimes may only be peripheral vision loss


  • Sudden severe headache that has never been experienced before


  • Loss of balance
  • Difficulty walking
  • Falling with no apparent reason


1. In the initial assessment:

  • Checks for the onset of stroke symptoms
  • Patient’s medical history
  • Patient’s current medication
  • Any drug allergy
  • Past history of stroke
  • Risk factors of stroke
  • Past surgery, or bleeding problems

2. Conducts physical and neurological examinations

3. Orders laboratory tests (e.g. blood test)

4. Runs CT (Computerized Tomography) scan or CTA (Computed Tomography Angiography) scan

  • CT or CAT scan – uses electromagnetic radiation (such as X-rays) to form cross sectional images of the brain.
  • CTA – injection of a special dye into the patient’s vein, and photograph an image of blood vessels to identify anything unusual, such as the enlargement of a blood vessel (aneurysms).

5. Runs other potentially useful diagnostic tests

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How is an ischemic stroke treated? During the stroke, the goal is to restore the blood supply to the brain as soon as possible by dissolving blood clots. This will minimize the damage to the brain.

The only US Food and Drug Administration (FDA) approved drug treatment of ischemic stroke is Tissue Plasminogen Activator (tPA). tPA is a clot dissolving drug. It must be taken within 4.5 hours after the onset of stroke symptoms.

Emergency procedure:

Call 911 immediately at the first sign of stroke!

FAST is an easy way to remember the major signs of stroke. FAST stands for:

  • Face – is it drooping?
  • Arms – can you raise both them?
  • Speech – is it slurred or jumbled?
  • Time – to call 9-1-1 right away.

How is an ischemic stroke treated? During the stroke, the goal is to restore the blood supply to the brain as soon as possible by dissolving blood clots. This will minimize the damage to the brain.

DO: call 911, arrive at the emergency department within two hours!

DO NOT: simply monitor the symptoms

ics can immediately begin treatment on the way to the hospital. They can also notify the physicians at the ER, to make sure immediate examin

Key Event in the Emergency Room:

  • Patient – describes symptoms
  • Patient – provides details about onset of the stroke
  • Physician – conducts a quick examination
  • Physician – orders a CT scan
  • Physician – contacts the stroke expert team

Why is a CT scan so urgent? It provides the following information:

  • The size and abnormal changes of the brain
  • Whether there is bleeding or not
  • Size of the area of change
  • Other changes

Family members should help to provide the following information:

  • Details about the onset of the stroke
  • Symptoms (sudden onset, first or previous occurrences, normal state)
  • Other diseases
  • Medications and allergies (blood thinning medication, Chinese medicine, etc.)
  • Resuscitation rescue performed: CPR, AED?

Recovery assessments by health care workers typically include:

  • The recovery of the nerves (specifically motor neurons) for the hand, arm, leg, and feet. Shoulder pain. Posture control.
  • The ability to move, – e.g. sit, stand, turn the body, walk, and use the stairs.
  • Communication, e.g. comprehension, expression, interaction, problem solving and memory.
  • Bladder and bowel control.

After the stroke, will I still be mobile?

After suffering brain injury, the brain can recover. The nervous system and motor movements of the affected side of the body typically recover in a predictable way. The degree of recovery depends on a number of different factors, such as, the position and area of brain damage, the age of the patient, etc.

Helpful exercise to do after a stroke:

Treatment will vary based on individual assessment but usually focuses on:

  • Range of motion exercises
  • Upper limb function training
  • Torso control exercises
  • Bed mobility training
  • Body rotation exercises
  • Balance exercises
  • Walking posture training
  • Using the stairs training
  • Aerobic exercises

Mental or emotional health problems:

After a stroke, it is common to have some mental and psychological problems.

  • Depression (One-third of stroke patients will have depression, often occurring 3-6 months after onset
  • Anxiety
  • Post-traumatic stress syndrome (PTSS)
  • Unstable emotion
  • Irritability, change in reasoning
  • Loss of emotional control, memory loss 
  • Etc.

Cause of mental or emotional health problems

The physical changes that occur due to the brain being damaged during the stroke cause the loss of daily functional ability. Physical and mental disability will indirectly affect mental health and mood.

Mental and emotion problems usually go undetected by the patient so detection will rely on the family and caregivers. Some common symptoms are:

  • Disinterest in doing things, bored, lack of joy
  • Low spirit, feels of despair
  • Tired, low on energy, a constant lack of sleep (insomnia), or feeling sleepy all day
  • Poor appetite and weight loss
  • Unable to concentrate, feeling less important than others (inferior) and guilty, cannot pull oneself together
  • Very slow in movement, feel fidgety
  • Have suicidal thoughts

If any of the above symptoms are observed, seek help from physicians and health care professionals immediately to increase chance of recovery.

Content by Dr. Samuel Yip (Neurologist), Dr. Thomas Ho (Family Physician), Dr. Kendall Ho (Emergency Physician)


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