Understanding CVA and Stroke

CVA meaning, in plain words

CVA stands for cerebrovascular accident. It means exactly the same as stroke: part of the brain has suddenly lost its blood supply, or been damaged by bleeding, and the brain cells in that area stop working properly. "Cerebro" is the brain, "vascular" is the blood vessels. The word "accident" is old-fashioned and a bit misleading, since most strokes come from years of strain on the vessels rather than bad luck, which is why many doctors now simply write "stroke".

In everyday Hindi, families often say "lakwa" or "paralysis attack". That usually means a stroke, though not always, as one of the questions below explains.

The two main kinds: ischemic and haemorrhagic

Ischemic stroke (also spelt ischaemic) is caused by a blockage. A clot or a narrowed artery stops blood reaching part of the brain, and that patch of tissue is damaged. This is the most common kind. The damaged area is called an infarct, so "cerebral infarction" on a report means an ischemic stroke. More about this type is in the ischemic stroke recovery guide.

Haemorrhagic stroke is caused by bleeding. An intracerebral haemorrhage (ICH) is bleeding into the brain tissue, often linked to high blood pressure. A subarachnoid haemorrhage (SAH) is bleeding around the brain, frequently from a ballooned artery called an aneurysm, and typically starts with a sudden, severe headache.

The type changes some early rehab decisions. After a bleed, blood pressure limits are often stricter, so sessions are paced with readings before and after. If part of the skull was removed to relieve swelling (a decompressive craniectomy), the unprotected side of the head must be guarded during every transfer and the patient shouldn't lie on it until the surgeon says so.

TIA and silent strokes

A TIA (transient ischemic attack, or mini stroke) produces stroke symptoms that go away, usually within minutes, normally without visible damage on the scan. It's an emergency warning, not a minor event, and our guide to the mini stroke explains why.

A silent stroke is the opposite: damage shows on a scan, but nobody noticed symptoms when it happened.

Reading the scan report

Here are phrases that commonly appear on CT and MRI reports, with what they mean and why a physiotherapist cares.

• "Acute infarct in left MCA territory". A new ischemic stroke in the area supplied by the left middle cerebral artery. Expect right arm and face weakness more than the leg, and possible language difficulty.
• "Lacunar infarct, internal capsule". A small, deep stroke in a pathway where movement fibres are packed tightly. Small on the scan, but it can cause marked weakness of the whole side.
• "Diffusion restriction". An MRI sign that the infarct is recent.
• "Haemorrhagic transformation". Some bleeding into an area that was originally an ischemic stroke. The team may hold blood thinners and slow down mobilisation for a few days.
• "Old infarct" or "gliosis". Scar from an earlier stroke, sometimes one nobody knew about.
• "Chronic small vessel ischemic changes". Wear in tiny vessels from long-standing blood pressure or diabetes. Often linked to slower walking, balance problems and slower thinking over time.
• "Perilesional oedema" and "midline shift". Swelling around the damaged area, and the brain being pushed sideways by it. The team will be cautious with early mobilisation while this is settling.
• "ICA stenosis" on a neck Doppler. Narrowing of the internal carotid artery in the neck; a likely source of the clot.

One point that confuses families: a CT on the first day can look normal even when a stroke has happened, because early infarcts often take hours to show. CT is still done first because it's fast and shows bleeding clearly, which decides whether clot-dissolving treatment is safe. An MRI later picks up smaller and newer areas of damage.

Words on the discharge summary

These describe what the stroke has done to the body.

Hemiparesis is weakness of one side; hemiplegia is paralysis, little or no movement. Dysarthria is slurred speech from weak mouth and tongue muscles, while aphasia is a language problem: finding, understanding or ordering words. They need very different approaches. Dysphagia means difficulty swallowing, and it's why a nasal feeding tube (Ryle's tube) may be in place; the page on swallowing and chest risks explains the link to pneumonia.

Hemianopia is loss of half the field of vision in both eyes. Neglect is when the brain stops paying attention to one side, usually the left. Spasticity is stiffness and tightness that develops in weak muscles over weeks. Sensory complaints like pins and needles are covered in numbness and tingling after stroke.

Scores you might see: GCS measures alertness, NIHSS measures stroke severity (higher is more severe), and mRS measures overall disability from 0 (none) upward. Abbreviations like HTN (hypertension), T2DM (type 2 diabetes) and AF (atrial fibrillation) list the risk factors.

What these terms mean for CVA rehab planning

The report gives me a starting map. A right-handed person with a left MCA stroke probably has a weak right arm and a language problem, so instructions in sessions are shown, not just spoken, and short. A right-hemisphere stroke with neglect raises the falls risk because the person may not notice obstacles on the left and often overestimates what they can do. A cerebellar or brainstem stroke shifts the focus to balance and coordination. A deep lacunar stroke often leaves thinking intact, so the person can drive their own home programme.

But the scan isn't the patient. Two people with similar reports can function very differently, and that's why a hands-on rehabilitation assessment matters more than any single line on paper. The stroke condition overview and the stroke rehabilitation service explain how we build a plan from both.

Questions to ask before discharge

Cerebrovascular accident recovery goes more smoothly when the handover is clear. Before leaving hospital, ask: what type of stroke was it, and where? Is swallowing safe, and on what textures? Are there any activity limits, and what blood pressure range is the target? When is the follow-up, and with whom? Bring the discharge summary and scan reports to the first physiotherapy visit. The follow-up after discharge guide and the main stroke recovery guide cover the next steps.

Frequently asked questions