Cerebrovascular Accidents

Question 1

Define stroke

Answer 1

• 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

Question 2

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

Answer 2

hypertension

Question 3

Describe FAST

Answer 3

facial drooping
arm weakness
speech difficulty
time to call 911

Question 4

What are the hallmark signs of a stroke

Answer 4

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

Question 5

What are the 3 types of CVAs

Answer 5

ischemic (thrombotic or embolic), transient, hemorrhagic

Question 6

What is first line imaging for CVA

Answer 6

CT without contrast

Question 7

What are the 5 Ds of vertebral/basilar system symptoms

Answer 7

Dizziness
Diplopia
Dysarthria
Dysphagia
Dysmetria

Question 8

Describe the characteristics of a large vessel ischemic stroke

Answer 8

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

Question 9

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

Answer 9

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

Question 10

What are the 2 classes of ischemic stroke

Answer 10

Focal and non-focal

Question 11

Describe focal ischemic strokes

Answer 11

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

Question 12

Describe non-focal ischemic stroke

Answer 12

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

Question 13

Define thrombotic stroke

Answer 13

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

Question 14

Define embolic stroke

Answer 14

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

Question 15

The most common cause of embolic stroke is ____ _____

Answer 15

Atrial fibrillation

Question 16

Define Transient Brain Ischemia aka Transient Ischemic Attack

Answer 16

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

Question 17

Causes and implications of a TIA

Answer 17

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

Question 18

Define amaurosis fugax

Answer 18

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

“curtain falling”

serious sxs for possible larger event

Question 19

What is the first line evaluation for a CVA

Answer 19

CT without contrast

Question 20

Describe

Answer 20

Question 21

Describe

Answer 21

Question 22

Describe

Answer 22

Question 23

What labs are indicated for a CVA workup

Answer 23

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

blood cultures if suspicious of endocarditis

Question 24

Treatment of ischemic stroke

Answer 24

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

Question 25

What are the 2 main types of hemorrhagic stroke

Answer 25

subarachnoid hemorrhage and intra**cerebral** hemorrhage (not to be confused with intra**cranial** hemorrhage)

Question 26

What are the risk factors for hemorrhagic CVA

Answer 26

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

Question 27

What are the hallmark signs of subarachnoid hemorrhage

Answer 27

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

Question 28

Management of hemorrhagic CVA

Answer 28

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

Question 29

Characteristics of a **Right CVA**

Answer 29

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

Question 30

Focused therapy for **right CVA**

Answer 30

- PT focused on balance and safety (mirror therapy) - OT focused on problem solving - SLP focused on reasoning, logic problems

Question 31

Characteristics of **Left CVA**

Answer 31

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

Question 32

Focused therapy for **left CVA**

Answer 32

- PT focused on flexibility and safety - OT focused on sequencing and flexibility - SLP focused on swallowing, speech

Question 33

Symptoms and PE findings of cerebellar strokes

Answer 33

- **vertigo** or gait change - n/v - clumsiness - headache - ataxia - nystagmus - + Rhomberg **greater risk of herniation**

Question 34

Characteristics of brain stem stroke

Answer 34

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

Question 35

Define locked-in syndrome

Answer 35

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