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Geriatrics > Cerebrovascular Accidents > Flashcards

Cerebrovascular Accidents Flashcards

1
Q

Define stroke

A
  • a disease that affects arteries leading to/within the brain
  • stroke occurs when a blood vessel that carries oxygen and nutrients to the brain is blocked by a clot or ruptures, leading to brain cell death
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2
Q

What is the most common and most important risk factor for strokes

A

hypertension

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3
Q

Describe FAST

A

facial drooping
arm weakness
speech difficulty
time to call 911

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4
Q

What are the hallmark signs of a stroke

A

sudden…
- numbness/weakness of face, arm, leg, especially on one side of the body
- confusion, trouble speaking/understanding
- trouble seeing in one/both eyes
- trouble walking, dizziness, loss of balance/coordination
- severe headache

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5
Q

What are the 3 types of CVAs

A

ischemic (thrombotic or embolic), transient, hemorrhagic

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6
Q

What is first line imaging for CVA

A

CT without contrast

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7
Q

What are the 5 Ds of vertebral/basilar system symptoms

A

Dizziness
Diplopia
Dysarthria
Dysphagia
Dysmetria

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8
Q

Describe the characteristics of a large vessel ischemic stroke

A
  • basilar artery, middle cerebral artery, circle of willis
  • produces immediate, obvious, severe deficits
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9
Q

Describe the characteristics of a small vessel ischemic stroke (Lacunar infarcts)

A
  • small intracerebral vessels that arise from larger arteries
  • deficits may be minor or go unnoticed
  • can be found accidentally during head CT/MRI
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10
Q

What are the 2 classes of ischemic stroke

A

Focal and non-focal

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11
Q

Describe focal ischemic strokes

A
  • specific neurologic deficit
  • often unilateral or affecting a specific cranial nerve
  • due to thrombosis, embolism, or intracranial hemorrhage
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12
Q

Describe non-focal ischemic stroke

A
  • results in encephalopathy
  • deficits often bilateral and non-specific
  • due to hypoperfusion/hypoxia
  • seen after cardiac/respiratory arrest or drowning
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13
Q

Define thrombotic stroke

A

blood clot produced within a vein or artery local to the brain and disrupts flow of blood

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14
Q

Define embolic stroke

A

whole or portion of clot separates from where it formed and travels as an obstruction to different part of circulatory system

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15
Q

The most common cause of embolic stroke is ____ _____

A

Atrial fibrillation

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16
Q

Define Transient Brain Ischemia aka Transient Ischemic Attack

A

old: stroke symptoms that last briefly, <24 hrs
current: transient block of cerebral circulation that doesn’t create permanent damage

17
Q

Causes and implications of a TIA

A
  • same causes as ischemic stroke
  • indications of unstable neurovasculature and warrant further eval to reduce risk for complete embolic event
18
Q

Define amaurosis fugax

A

transient ischemia that creates temporary blindness (monocular or binocular) resulting from occlusion of retinal artery

“curtain falling”

serious sxs for possible larger event

19
Q

What is the first line evaluation for a CVA

A

CT without contrast

20
Q

Describe

A
21
Q

Describe

A
22
Q

Describe

A
23
Q

What labs are indicated for a CVA workup

A

CBC, BMP, ESR, platelets, PT/PTT, glucose, lipids

blood cultures if suspicious of endocarditis

24
Q

Treatment of ischemic stroke

A
  • confirm non-hemorrhagic stroke
  • Within 4.5 (ideally 3) hrs consider TPA vs thrombectomy
  • assess risk of significant permanent functional deficit
25
Q

What are the 2 main types of hemorrhagic stroke

A

subarachnoid hemorrhage and intracerebral hemorrhage (not to be confused with intracranial hemorrhage)

26
Q

What are the risk factors for hemorrhagic CVA

A

intracranial aneurysm, malformations, trauma, HTN, anticoagulants, cocaine, bleeding from tumor/abscess, etc.

27
Q

What are the hallmark signs of subarachnoid hemorrhage

A

thunderclap headache
worst headache of my life
- commonly from a ruptured aneurysm
- sudden onset, can have warning leak with slow progression from partial bleed

28
Q

Management of hemorrhagic CVA

A
  • reduce intracranial pressure
  • manage HTN with Mannitol
  • consider surgical management/clipping/coiling
  • usually intubated and sedated
  • first 24hrs are most critical
29
Q

Characteristics of a Right CVA

A

Left Hemiparesis
- flaccid paralysis
- can’t find center, hang toward weakened left side
- left neglect/forget
- flat affect, lack of emotion
- impulsive
- normal speech

30
Q

Focused therapy for right CVA

A
  • PT focused on balance and safety (mirror therapy)
  • OT focused on problem solving
  • SLP focused on reasoning, logic problems
31
Q

Characteristics of Left CVA

A

Right Hemiparesis
- spasticity
- acutely aware of loss of function
- emotionally labile
- significant speech/swallowing impact
- memory and new learning challenges

32
Q

Focused therapy for left CVA

A
  • PT focused on flexibility and safety
  • OT focused on sequencing and flexibility
  • SLP focused on swallowing, speech
33
Q

Symptoms and PE findings of cerebellar strokes

A
  • vertigo or gait change
  • n/v
  • clumsiness
  • headache
  • ataxia
  • nystagmus
    • Rhomberg

greater risk of herniation

34
Q

Characteristics of brain stem stroke

A

Affects breathing rate, heartbeat, BP, eye movement, hearing, speech, swallowing

35
Q

Define locked-in syndrome

A

Resulting from pontine injury
- complete paralysis of all active movements
- intact cognitive function, awake and aware of condition

Geriatrics (34 decks)

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