406 E2 - CVA

Question 1

CVA epidemiology

Answer 1

-lots per year
-4th leading cause of death
-strokes occur every 40 sec w/ a death every 4 mins
-leading cause of serious disability

Question 2

risk factors of CVA (11)

Answer 2

-htn&hld
-tabacco use
-DM
-race (AA)
-oral contraceptives
-age (older)
-gender (men)
-sickle cell anemia
-hx of TIA
-Afib (d/t blood pooling)

Question 3

CVA clinical manifestations (7)

Answer 3

-numbness or weakness on one side of body
-sudden confusion
-trouble speaking
-slurred speech (dysarthria)
-trouble sleeping
-ataxia
-severe headache

Question 4

what drives treatment for CVA

Answer 4

cat scan so need to get this first because treatment starts

Question 5

Ischemic Stroke

Answer 5

occlusion of cerebral artery by either thrombus or embolus resulting in an area of the brain losing blood supply, presentation depends on location of the occlusion shown by a cat scan and it can convert into a hemorrhagic stroke

Question 6

patho of occlusion in the brain

Answer 6

occlusion -> oxygen deprivation -> neuro deficits within 1 min -> continued loss of supply leads to irreversible damage
if within tiny vessel, damage might not be noticed

Question 7

what causes a thrombotic ischemic stroke

Answer 7

-atherosclerosis
-hyper coagulable state

Question 8

what cause an embolic ischemic stroke

Answer 8

-first look at cardiac sources: mural thrombus, Afib, venous clot if atrial septal defect or patent foramen ovale (hole in heart), or thrombus of vegetation of valves
-carotid plaque / carotid bruit

Question 9

penumbra

Answer 9

tissue around the ischemic area that is still viable / salvageable
goal is to get pt into treatment within 3hrs to reestablish blood flow & save the penumbra

Question 10

what is a hemorrhagic stroke

Answer 10

-bleeding within the brain parenchyma associated w/ standing, severe htn
-38% mortality rate
-can also be caused by a ruptured brain aneurysm
-can effected large area of the brain
-increases IOP w/ inflammation

Question 11

hemorrhagic stroke prognosis depends on

Answer 11

-age
-location & size
-how rapid the bleed causes brain distortion & shift on scan

Question 12

how does older age benefit stroke pts

Answer 12

as a persons ages, their brain shrinks -> more room for the blood to pool without causes damage

Question 13

hemorrhagic stroke presentation

Answer 13

-“worst headache of my life”
-rapid change in LOC
-irritation of the meninges (nuchal rigidity & photophobia)

Question 14

intracranial hemorrhage is

Answer 14

when bleeding occurs in the layers of the tissues that cover the brain

Question 15

epidural bleed is

Answer 15

between the skull & the dura

Question 16

subdural bleed is

Answer 16

below the dura

Question 17

subarachnoid bleeds

Answer 17

between the arachnoid membrane and the pia mater

Question 18

epidural bleeds characteristics

Answer 18

-usually skull fracture / trauma related
-arterial (tend to bleed a lot)
-injury is usually less sever

Question 19

subdural bleeds characteristics

Answer 19

-bridging veins / venous bleed
-if severe, can see rapid decline
-if mild, can be 2-10 days before symptoms
-brain moves within skull, vessels

Question 20

treatment for epidural & subdural bleeds

Answer 20

evacuate the blood collecting

Question 21

subarachnoid bleeds characteristics

Answer 21

-hemorrhages into the area filled w/ cerebral spinal fluid
-usually caused by aneurysm or arterio venous malformation
-lumbar puncture will show blood in CSF

Question 22

subarachnoid hemorrhage mgt

Answer 22

-bedrest w/ sedation
-BP tightrope
-surgical clipping as soon as possible
-prophylactic anticonvulsant
-nimodipine (narrows vessels & slows blood flow)
-triple H therapy: htn (pressors), hypervol (colloids) & hemodilution (Hct-33)

Question 23

BE FAST

Answer 23

balance
eyes
face
arm
speech
time

Question 24

intracerebral bleed

Answer 24

bleeding in the brain tissue