Cerebrovascular disease: clinical, diagnostic and therapeutic approach to stroke

Cerebrovascular disease was described as a set of neurological disorders caused by alterations in cerebral circulation, capable of generating temporary or permanent damage to the brain parenchyma. Its main subtypes, ischaemic and haemorrhagic, were presented, highlighting that the former represented the highest proportion of cases. The different clinical forms of presentation were also addressed, including asymptomatic cerebrovascular disease, transient ischaemic attack and established stroke, together with their main neurological complications. The article developed the aetiological classification of cerebral infarction according to the TOAST system, describing the most frequent pathophysiological mechanisms and their clinical relevance. The main modifiable and non-modifiable risk factors were analysed, highlighting the predominant role of high blood pressure, diabetes mellitus, and atrial fibrillation in increasing the risk of stroke. The clinical manifestations were also described according to the vascular territory involved and the mechanisms responsible for early neurological deterioration. The importance of timely diagnosis through adequate clinical and neurological evaluation, supported by validated scales such as NIHSS, ASPECTS, and ABCD2, together with laboratory studies and neuroimaging methods, was emphasised. Finally, current therapeutic strategies were presented, highlighting intravenous thrombolysis and mechanical thrombectomy as pillars of acute treatment, as well as secondary prevention measures through antiplatelet and anticoagulation therapy. Overall, the comprehensive approach provided an understanding of the complexity of stroke and the importance of early care in reducing morbidity and mortality and functional sequelae.