cerebrovascular accident (CVA)

Question 1

what is a stroke

Answer 1

acute neurological deficit d/t ischemia (loss of function to that are)

Question 2

two types of strokes

Answer 2

hemorrhagic (aka red stroke- presence of blood- 20%)

ischemic (aka white stroke- d/t decreased o2 and pallor of tissue- 80%)

Question 3

non modifiable risk factors for stroke?

Answer 3

race, aging, sex, heredity

Question 4

modifiable risk factors for stroke?

Answer 4

HTN, hyperlipidemia, smoking, diabetes, heart disease, Afib, carotid disease, coagulation disorders, obesity/inactivity, ETOH, cocaine

Question 5

pathology of CVA?

Answer 5

• brain sensitivity to O2 and glucose (no anaerobic metabolism)
• neurons die within mins of not having O2

Question 6

ischemic stroke?

Answer 6

vessel obstructed, leading to focal ischemia

• –> creates a necrotic core of infarcted tissue (cannot be recovered) in focal area
• —> area surrounding necrotic core= penumbra, can be salvaged with fast actions (function is lost, structure is intact)
• • if ischemia is not corrected= necrotic core enlarges

Question 7

hemorrhagic stroke?

Answer 7

WORSE

• severed vessel resulting in hemorrhage and compression of brain tissue from increased ICP
• dealing with ischemia bc blood is not reaching desired area and space-occupying hemorrhage
• potential for hypovolemia and hypovolemic shock

Question 8

etiology of strokes?

Answer 8

mostly HTN!! risk for aneurysms and aging r/t atherosclerosis
aneurysms= localized weakening of vessel wall causing an enlargement of the vessel, tumors are space-occupying and damage surrounding vessels
-when aneurysms rupture and be direct cause of hemorrhagic stroke

Question 9

complications of strokes?

Answer 9

coma and DEATH

Question 10

what is transient ischemic attack (TIA)

Answer 10

aka “mini stroke”

• TIAs are precursors to strokes—> eventually lead to stroke
• brief, reversible focal ischemia resolving before infarction occurs
• no permenant damage, increased risk of stroke
• symptoms can last for minutes —> hours

Question 11

manifestations of CVA?

Answer 11

depends on site, vessel, any collateral perfusion

• acute onset
• unilateral weakness/numbness in face/arm/or leg
• altered speech
• unilateral vision impairment
• signs and symptoms occur on opposite side of body where brain is injured (d/t decussation of pyramids in medulla oblongata—> nerve fibers cross over from right to left)

Question 12

treatment of stroke?

Answer 12

LIFE preservation—> act FAST

• treatment depends on if it is H or I stroke
• goal= salvage as much tissue as possible (penumbra!!!)

Question 13

treatment for ischemia stroke?

Answer 13

stat antiplatelet treatment (usually high dose of aspirin)
tPA (tissue plasminogen activator), which lyses clots
-CANT use these for hemorrhagic because the clotting pathway will be disrupted—> hemorrhage will worsen

Question 14

once pt is stabilized then decrease the risk factors, like?

Answer 14

• statins to decrease hyperlipidemia and risk of atherosclerosis
• smoking cessation
• antihypertensives to control BP
• diabetic education

Question 15

prevent recurrence by?

Answer 15

-anticoagulants, antiplatelets: warfarin, heparin, ASA

Question 16

surgery?

Answer 16

carotid endarterectomy (open carotid artery for stenosis)