Gorovitz & Borten, P.C.
Attorneys at Law

550 Cochituate Road, Suite 25
Framingham, Massachusetts
Tel: (781) 890-9095
Stroke Prevention
A stroke (cerebrovascular accident) is an acute loss of blood perfusion to the
brain that causes brain ischemia (lack of blood supply to the brain) and loss of
neurologic function that lasts longer than 24 hours. As blood flow to the brain
decreases, neurons cease to function and irreversible injury occurs.

A stroke manifests itself as a sudden onset of weakness, sensory deficit or
difficulties with language. A stroke in progress or in evolution describes a
neurological deficit that occurs in a stepwise or progressive fashion. Symptoms
associated with a stroke include:

  • Sudden numbness or weakness of face, arm, or leg, especially on one
    side of the body
  • Sudden confusion, difficulty in speaking or understanding
  • Sudden deterioration of vision of one or both eyes
  • Sudden difficulty in walking
  • Sudden loss of balance or coordination
  • Sudden severe headache with no known cause

Stroke is the third leading cause of death in the United States following cardiac
and cancer related deaths. Stroke is the leading cause of adult disability.
Approximately 30% of stroke survivors need assistance with daily living and
15% will require admission to a long-term care facility. Approximately one third
of stroke survivors will suffer depression as well as many of their care providers.

Strokes can occur in patients of all ages. In patients younger than 60 years,
the incidence of stroke is greater in men by a 3 to 2 ratio compared with
women. The incidence of stroke is greater in the black population than in the
white population. Black males also have a greater death rate from stroke
(approximately 50%) when compared with white males (approximately 25%).

Strokes can be divided into ischemic infarctions (which may be bland or
hemorrhagic) and hemorrhages which include intracerebral hemorrhages and
subarachnoid hemorrhages. Ischemic strokes can be due to a local vascular
occlusion (a thrombus) or by an occlusion of an artery from material that
originated from the heart or other vessels (an embolus).  Atherosclerosis of the
arteries that supply the brain is the most common cause of ischemic stroke.

Embolism of brain arteries accounts for up to 20% to 30% of strokes.
Approximately 20% of ischemic strokes come from or through the heart. Once
a stroke due to cardiac embolism has occurred, the likelihood of recurrence is
relatively high and secondary prevention becomes essential. Cardiac sources
of emboli include:

  • Atrial fibrillation
  • Recent myocardial infarction
  • Prosthetic valves
  • Native valvular disease
  • Endocarditis
  • Cardiac wall thrombi
  • Cardiomyopathy
  • Patent foramen ovale

Approximately 80% of emboli to the brain involve the anterior circulation
(Carotid artery territory) and the remaining 20% involves the vertebro-basilar

Thrombotic strokes are due to on-site occlusions on atherosclerotic lesions of
the carotid, vertebrobasilar and cerebral arteries typically closer to major
branches. Thrombotic strokes are thought to originates from ruptured
atherosclerotic plaques. Factors that facilitate the formation of a thrombus
include injury to the inner lining of a blood vessel with activation of the clotting
cascade, inhibition of fibrinolysis and blood stasis (blood pooling)
Brain hemorrhages can be subarachoid (bleeding into the subarachnoid
space), intraparenchymal (bleeding directly into the brain tissue) or a
combination of both. The accumulation of blood within the brain tissue may
form a brain parenchyma hematoma (a dangerous condition involving swelling
and pressure in the affected area of the brain).

Early diagnosis and management within the first few hours after symptoms of a
stroke appear are critical. Because proper management of  a stroke requires
an accurate diagnosis, it is essential to differentiate between an ischemic
stroke and a hemorrhagic stroke. Administration of t-PA (thrombolytic therapy)
to a patient with an acute stroke attempts to establish revascularization to
rescue brain cells before irreversible injury occurs.

Patients who are at an increased risk for ischemic stroke can be identified, and
appropriate intervention and management started.

If you are suffering from complications due to a delayed diagnosis of a stroke
or the mismanagement of a stroke, let
Dr. Borten and the medical malpractice
attorneys at Gorovitz & Borten review the specifics of your case. At Gorovitz &
Borten we have the necessary experience, understanding and resources
available to properly evaluate the complications of a stroke, and give you a
timely assessment of its merits.
Contact Information
For a free confidential consultation and receive a response within 24 hours
(when possible), please contact us by phone, fax or e-mail with your question or

Telephone:  781-890-9095     -     Fax:   781-890-9098
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