Cerebrovascular Accidents Flashcards
Define stroke
- 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
What is the most common and most important risk factor for strokes
hypertension
Describe FAST
facial drooping
arm weakness
speech difficulty
time to call 911
What are the hallmark signs of a stroke
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
What are the 3 types of CVAs
ischemic (thrombotic or embolic), transient, hemorrhagic
What is first line imaging for CVA
CT without contrast
What are the 5 Ds of vertebral/basilar system symptoms
Dizziness
Diplopia
Dysarthria
Dysphagia
Dysmetria
Describe the characteristics of a large vessel ischemic stroke
- basilar artery, middle cerebral artery, circle of willis
- produces immediate, obvious, severe deficits
Describe the characteristics of a small vessel ischemic stroke (Lacunar infarcts)
- small intracerebral vessels that arise from larger arteries
- deficits may be minor or go unnoticed
- can be found accidentally during head CT/MRI
What are the 2 classes of ischemic stroke
Focal and non-focal
Describe focal ischemic strokes
- specific neurologic deficit
- often unilateral or affecting a specific cranial nerve
- due to thrombosis, embolism, or intracranial hemorrhage
Describe non-focal ischemic stroke
- results in encephalopathy
- deficits often bilateral and non-specific
- due to hypoperfusion/hypoxia
- seen after cardiac/respiratory arrest or drowning
Define thrombotic stroke
blood clot produced within a vein or artery local to the brain and disrupts flow of blood
Define embolic stroke
whole or portion of clot separates from where it formed and travels as an obstruction to different part of circulatory system
The most common cause of embolic stroke is ____ _____
Atrial fibrillation
Define Transient Brain Ischemia aka Transient Ischemic Attack
old: stroke symptoms that last briefly, <24 hrs
current: transient block of cerebral circulation that doesn’t create permanent damage
Causes and implications of a TIA
- same causes as ischemic stroke
- indications of unstable neurovasculature and warrant further eval to reduce risk for complete embolic event
Define amaurosis fugax
transient ischemia that creates temporary blindness (monocular or binocular) resulting from occlusion of retinal artery
“curtain falling”
serious sxs for possible larger event
What is the first line evaluation for a CVA
CT without contrast
Describe
Describe
Describe
What labs are indicated for a CVA workup
CBC, BMP, ESR, platelets, PT/PTT, glucose, lipids
blood cultures if suspicious of endocarditis
Treatment of ischemic stroke
- confirm non-hemorrhagic stroke
- Within 4.5 (ideally 3) hrs consider TPA vs thrombectomy
- assess risk of significant permanent functional deficit
What are the 2 main types of hemorrhagic stroke
subarachnoid hemorrhage and intracerebral hemorrhage (not to be confused with intracranial hemorrhage)
What are the risk factors for hemorrhagic CVA
intracranial aneurysm, malformations, trauma, HTN, anticoagulants, cocaine, bleeding from tumor/abscess, etc.
What are the hallmark signs of subarachnoid hemorrhage
thunderclap headache
worst headache of my life
- commonly from a ruptured aneurysm
- sudden onset, can have warning leak with slow progression from partial bleed
Management of hemorrhagic CVA
- reduce intracranial pressure
- manage HTN with Mannitol
- consider surgical management/clipping/coiling
- usually intubated and sedated
- first 24hrs are most critical
Characteristics of a Right CVA
Left Hemiparesis
- flaccid paralysis
- can’t find center, hang toward weakened left side
- left neglect/forget
- flat affect, lack of emotion
- impulsive
- normal speech
Focused therapy for right CVA
- PT focused on balance and safety (mirror therapy)
- OT focused on problem solving
- SLP focused on reasoning, logic problems
Characteristics of Left CVA
Right Hemiparesis
- spasticity
- acutely aware of loss of function
- emotionally labile
- significant speech/swallowing impact
- memory and new learning challenges
Focused therapy for left CVA
- PT focused on flexibility and safety
- OT focused on sequencing and flexibility
- SLP focused on swallowing, speech
Symptoms and PE findings of cerebellar strokes
- vertigo or gait change
- n/v
- clumsiness
- headache
- ataxia
- nystagmus
- Rhomberg
greater risk of herniation
Characteristics of brain stem stroke
Affects breathing rate, heartbeat, BP, eye movement, hearing, speech, swallowing
Define locked-in syndrome
Resulting from pontine injury
- complete paralysis of all active movements
- intact cognitive function, awake and aware of condition
