Cerebrovascular Accident Flashcards
ACA stroke px
- cognitive problems
- confusion
- contralateral weakness
- sensory loss in leg > arm
- incontinence
CVA types
Hemorrhagic (20%; HTN, excess anticoagulation; no therapy)
Ischemic (80%; thrombosis, emboli, systemic hypotension, vascular dissection)
Weber syndrome px
= branch of PCA stroke
- contralateral hemiplegia
- ipsilateral Cr III palsy
Benedikt syndrome px
= branch of PCA stroke
- contralateral ataxia or athetosis
- ipsilateral Cr III palsy
Wallenberg
= PICA stroke
= lateral medullary infarct
- ipsilateral facial sensory loss
- contralateral body sensory loss
- vertigo (fall to side of lesion)
- nystagmus
- ataxia
- dysarthria (ipsi vocal cord paralysis)
- dysphagia
- Horner’s syndrome
left vs right dominant hemisphere
right vs left-handed
Romberg test
= testing for absence of proprioception by having patient closing their eyes
- usually have vision + proprioception + vestibular function
- need 2/3 to remain balanced
thrombolytic therapy administration time limit?
3 hours - TPA
-contrindications: major surgery, major HTN, high PT, coagulopathy, low platelets, head trauma/tumor/bleeding history
CVA dx
-CT = best initial
(rule out hemorrhagic)
-MRI = most accurate
- ischemic takes ~48 hours to appear on CT
- hemorrhagic appear immediately on CT
blood appears what color on CT?
white
CVD tx?
after 3 hours (negative CT)
-ASA
(prevents new stroke)
- add dipyridamole
- replace ASA with clopidogrel (ASA allergy)
heparin tx indications?
- Afib
- basilar artery actively thrombosing
- stroke in evolution
ticlopidine tx indications?
-NEVER
- SE: neutropenia, TTP
- give clopidogrel
warfarin tx indications?
-chronic Afib
(needs long term anticoagulation)
-INR = 2-3
diagnostics to find cause of stroke?
- echo: clot (warfarin), mitral stenosis (balloon)
- EKG: Afib (warfarin, INR = 2-3)
- carotid duplex: carotid stenosis: >70% stenosis (carotid endarterectomy)
