CEREBROVASCULAR DISORDERS Flashcards
1
Q
The functional abnormality of the CNS when the normal blood supply to the brain is disrupted
A
CEREBROVASCULAR DISORDERS
2
Q
What is cerebrovascular disorders
A
The functional abnormality of the CNS when the normal blood supply to the brain is disrupted
3
Q
What is stroke?
A
The primary type of CVD
4
Q
Types of stroke
A
-Ischemic stroke
- Hemorrhagic stroke
5
Q
Aka as cerebrovascular accident
A
Ischemic stroke
6
Q
Brain attack
A
Ischemic stroke
7
Q
Sudden loss of function resulting from disruption of the blood supply to a part of the brain
A
Ischemic stroke
8
Q
What is ischemic stroke?
A
-Aka as cerebrovascular accident
-Brain attack
-Sudden loss of function resulting from disruption of the blood supply to a part of the brain
9
Q
Types of ischemic stroke
A
- large artery thrombotic strokes
- small penetrating artery thrombotic strokes
- Cardiogenic embolic strokes
- Cryptogenic stroke
10
Q
What is large artery thrombotic stroke?
A
Caused by atherosclerotic plaques in the large blood vessels of the brain causing infarction
11
Q
What is small penetrating artery thrombotic strokes?
A
affect one or more vessels and are the most common type of ischemic stroke; leaves a cavity after death or infarcted tissue
12
Q
What is cardiogenic embolic strokes?
A
Associated with cardiac dysrhythmias, usually atrial fibrillation
13
Q
What is cryptogenic stroke?
A
-have no known cause
- Also known as “stroke of unknown cause
14
Q
-have no known cause
- Also known as “stroke of unknown cause
A
Cryptogenic stroke
15
Q
Caused by atherosclerotic plaques in the large blood vessels of the brain causing infarction
A
large artery thrombotic stroke
16
Q
affect one or more vessels and are the most common type of ischemic stroke; leaves a cavity after death or infarcted tissue
A
small penetrating artery thrombotic strokes
17
Q
Associated with cardiac dysrhythmias, usually atrial fibrillation
A
cardiogenic embolic strokes
18
Q
What is the main issue of the large artery thrombotic stroke?
A
Lack of oxygen-ischemia- lead to necrosis
19
Q
a cellular metabolic event
A
Ischemic cascade
20
Q
occurs after blood obstruction
A
Ischemic cascade
21
Q
in ischemic cascade how many blood decreases?
A
blood decrease less than 25 ml per 100g of blood per minute
22
Q
blood decrease less than 25 ml per 100 mg of blood per minute
A
ischemic cascade
23
Q
Aerobic respiration of neurons fails
A
ischemic cascade
24
Q
switches to anaerobic respiration
A
ischemic cascade
25
it generates large amounts of lactic acid, causing a change in the PH
anaerobic respiration
26
describe the characteristics of ischemic cascade
-a cellular metabolic event
-occurs after blood obstruction
-blood decrease less than 25 ml per 100 mg of blood per minute
-Aerobic respiration of neurons fails
-switches to anaerobic respiration
27
An area of low cerebral blood flow
Penumbra region
28
may be salvaged with timely intervention
Penumbra region
29
increase in intracellular calcium and the release of glutamate
Penumbra region
30
activate a number of damaging pathways; extends the stoke
glutamate
31
Characteristics of penumbra region
-An area of low cerebral blood flow
- May be salvaged with timely intervention
- increase in intracellular calcium and the release of glutamate
32
Toxic to brain if it increases and leads to necrosis
Glutamate
33
due to anaerobic activity
Glutamate
34
Memory enhancement
Glutamate
35
Characteristics of glutamate
-memory enhancement
- toxic to brain if it increases and leads to necrosis
- due to anaerobic activity
-memory enhancement
36
Clinical Manifestations of Ischemic stroke
MOTOR LOSS
-hemiplegia
-hemiparesis
COMMUNICATION LOSS
-Dysarthria
-Dysphasia
-Apraxia
PERCEPTUAL DISTURBANCES
-visual-perceptual disturbances
-homonymous hemianopsia
SENSORY LOSS
-Loss of Proprioception
-Agnosia
37
Loss of voluntary control over motor movements
Motor loss
38
What is motor loss?
Loss of voluntary control over motor movements
39
What is hemiplegia?
-Paralysis of one side of the body
-caused by a lesion of the opposite side of the brain
40
What is hemiparesis?
-weakness of one side of the body
-refer to pt
41
Paralysis of one side of the body
Hemiplegia
42
Weakness of one side of the body
Hemiparesis
43
caused by a lesion of the opposite of the brain
hemiplegia
44
difficulty in speaking; paralysis of the muscles
dysarthria
45
impaired speech or aphasia (loss of speech), which can be expressive aphasia, receptive aphasia or global (mixed) aphasia
Dysphasia
46
Types of aphasia
-Expressive aphasia
- Receptive aphasia
- Global (mixed) aphasia
47
Inability to perform a previously learned action
Apraxia
48
What is Dysarthria?
difficulty in speaking; paralysis of the muscles
49
What is Dysphasia?
impaired speech or aphasia (loss of speech), which can be expressive aphasia, receptive aphasia or global (mixed) aphasia
50
What is apraxia?
Inability to perform a previously learned action
51
caused by disturbances of the primary sensory pathways between the eye and visual cortex
visual-perceptual disturbances
52
What is visual-perceptual disturbances?
caused by disturbances of the primary sensory pathways between the eye and visual cortex
53
Loss of half of the visual field
Homonymous Hemianopsia
54
The affected side of vision corresponds to the paralyzed side of the body
Homonymous Hemianopsia
55
What is homonymous hemianopsia?
-Loss of half of the visual field
-The affected side of vision corresponds to the paralyzed side of the body
56
Deficit in the ability to recognize previously familiar objects perceived by one or more of the senses
Agnosia
57
Cognitive impairment and psychological effects
Frontal Lobe Damage
58
Impairment of learning capacity, memory or other higher cortical intellectual functions
Frontal Lobe Damage
59
What is Frontal Lobe Damage?
Impairment of learning capacity, memory or other higher cortical intellectual functions
60
What are the Frontal Lobe Damage?
-limited attention span
- difficulties in comprehensive
-forgetfullness
-lack of motivation
61
How to assess a child with ADHD?
-offer several tasks
62
Characteristics of Autistic Child?
head banging >8 minutes
63
What is Transient Ischemic Attack?
-a warning of impending stroke
- a neurologic deficit typically lasting less than 1 hour
- sudden loss of motor, sensory, or visual function due to temporary ischemia in the brain.
64
A warning of impending stroke
Transient Ischemic Attack
65
A neurologic deficit typically lasting less than 1 hour
Transient Ischemic Attack
66
Sudden loss of motor, sensory, or visual function due to temporary ischemia in the brain
Transient Ischemic Attack
67
Diagnosis of Ischemic Stroke
-Non-contrast CT Scan
- 12-Lead Electrocardiogram (ECG)
- Carotid Ultrasound
- CT Angiography
- MRI
68
What is non-contrast CT Scan?
Determine if the event is ischemic or hemorrhagic
69
Medical Management of Ishemic Stroke
-Antithrombotic
-Thrombolytic Therapy
70
Examples of Antithrombotic Drug
-Warfarin (Coumadin)
-Acetylsalicylic Acid/Aspirin
71
What is warfarin?
-an anticoagulant
- slows down blood clotting
- given to patients with atrial fibrillation
72
What is Acetylsalicylic Acid?
-Antiplatelet
-best option if warfarin is contraindicated
73
Best option if warfarin is contraindicated
Acetylsalicylic Acid
74
What is thrombolytic therapy?
Dissolves the blood clot that is blocking blood flow to the brain
75
Dissolves the blood clot that is blocking blood flow to the brain
Thrombolytic therapy
76
The DNA Composition of of Thrombolytic Therapy
Recombinant t-PA (tissue type plasminogen activator)
77
What is recombinant t-PA?
-a genetically engineered form of t-PA
- a thrombolytic substance made naturally by the body
78
what is kinase?
attenuated-weakened bacteria
79
Surgical Management of Ischemic Stroke
-Carotid Endarterectomy
- Carotid Angioplasty & Stenting
80
What is carotid endarterectomy?
The removal of an atherosclerotic plaque or thrombus from the carotid artery
81
What is carotid angioplasty & stenting?
-A less invasive procedure that is used for severe stenosis
- A carotid stent is placed inside the carotid artery at the site of the blockage and provides support to keep the artery open
82
A carotid stent is placed inside the carotid artery at the site of the blockage and provides support to keep the artery open
Carotid Angioplasty & Stenting
83
The removal of an atherosclerotic plaque or thrombus from the carotid artery
Carotid endarterectomy
84
Post Surgical Management of Ischemic Stroke
-Maintain adequate blood pressure levels
-Weakness on one side of the body
- Always maintain patent airway
85
Why we need to maintain adequate blood pressure levels?
Hypotension is avoided to prevent cerebral ischemia and thrombosis
86
Why there is a weakness on one side of the body?
Thrombus formation is suspected
87
What equipment/supply must be readily available?
Emerceny airway supplies must be available
88
What is hemorrhagic stroke?
-Caused by bleeding into the brain tissue, the ventricles, or the subarachnoid space
- Has more severe deficits and a longer recovery phase than ischemic stroke
89
Pathophysiology of Hemorrhagic stroke
-exposure to blood
- sudden entry of blood into the subarachnoid space
-increases ICP
-compresses and injures brain tissue
90
Clinical Manifestations of Hemorrhagic stroke (Left Hemispheric Stroke)
-Paralysis or weakness on right side of the body
- Right visual field deficit
- Aphasia (expressive, receptive, or global)
- Altered intellectual ability
- Slow, cautious behavior
91
Clinical Manifestations of Hemorrhagic stroke (Right Hemispheric Stroke)
-Paralysis or weakness on left side of the body
- Left visual field deficit
- Spatial-perceptual deficits
- Increased distractibility
- Impulsive behavior and poor judgement
- Lack of awareness of deficits
92
Medical Management of Hemorrhagic Stroke
-Fresh frozen plasma & vitamin K
- Antiseizures (phenytoin, phenobarbital)
93
Surgical Management of Hemorrhagic Stroke
Craniotomy
94
What is craniotomy?
-Done if diameter of the hematoma exceeds 3 cm and the glasgow coma scale score decreases
-prevents bleeding in an unrupted aneurysm or further bleeding in an already ruptured aneurysm
95
Post-Operative Complications of Craniotomy
-KORSAKOFF'S syndrome
-Intraoperative embolization
-Postoperative Internal Artery Occlusion
- Gastrointestinal Bleeding
96
Characterized by amnesia, deficits in explicit memory, and confabulation
Korsakoff's syndrome
97
Caused by severe deficiency of thiamine (Vitamin B1)
Korsakoff's syndrome
98
What is korsakoff's syndrome?
-Characterized by amnesia, deficits in explicit memory, and confabulation
-Caused by severe deficiency of thiamine (Vitamin B1)
99
Nursing Management of Hemorrhagic Stroke
-Bed rest with sedation (as prescribed)
- HOB is elevated 15 to 30 degrees
- Pain management for neck pain
-Anti-embolism stockings
- Seizure precaution
100
Rationale of Bed rest with sedation
Prevents agitation and stress
101
Why HOB needs to be elevated?
To promote venous drainage and decrease ICP
102
Purpose of wearing anti-embolism stockings
Prevents deep vein thrombosis
103
What is the Goal for hemorrhagic stroke?
-To allow the brain to recover from the initial insult
- To prevent or minimize the risk of rebleeding
- To prevent or treat complications
104
Why we need to give fresh frozen plasma & vitamin K?
If bleeding is caused by anticoagulation
105
Antiseizures must be given:
Given prophylactically
106
Seizures can occur
Seizures can occur after intracerebral hemorrhage
