The signs and symptoms of cerebrovascular disease depend on the location of the hemorrhage, thrombus, or embolus and the extent of cerebral tissue affected. General signs and symptoms of a hemorrhagic or ischemic event include motor dysfunction, such as hemiplegia and hemiparesis.

Early in a CVA, the patient may experience flaccid paralysis, followed by increased muscle tone and spasticity. He may lose his gag reflex and ability to cough. He may have communication deficits, such as dysphagia, receptive or expressive aphasia, dysarthria, and apraxia. He also may develop spatial and perceptual deficits, such as the loss of half of his visual field (homonymous hemianopia) and the inability to recognize an object (agnosia).

Other signs and symptoms of a CVA include vomiting, seizures, fever, ECG abnormalities, confusion that leads to a complete loss of consciousness, labored or irregular respirations, apneic periods, increased blood pressure, and bowel and bladder incontinence.

Signs and symptoms specific to a hemorrhagic CVA include abrupt onset of a severe headache, nuchal rigidity, and rapid onset of complete hemiplegia. As the hematoma enlarges, the patient's neurologic deficits worsen from gradual loss of consciousness to coma.

Signs and symptoms of a thrombotic CVA follow the "stroke in evolution" pattern and include the progressive deterioration of motor and sensory function, slow deterioration of speech, and lethargy. These signs and symptoms peak when edema develops, usually about 72 hours after the onset of the thrombotic event.

For a patient with an embolic CVA, signs and symptoms include a sudden onset of motor and sensory deficits, deteriorated speech, and headache on the side of the head where the embolism is occurring. If the embolus breaks into smaller pieces and the occlusion resolves, these signs and symptoms may dissipate.

Thrombi

Thrombi-the most common cause of cerebral injury-form from platelets and fibrin that collect on vessel walls. If atherosclerosis narrows the cerebral vessels, a thrombus may form in the narrowed section, occluding the vessel. The resulting ischemia can cause cerebral edema in the occluded area.

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