CEREBROVASCULAR DISORDERS Flashcards
The functional abnormality of the CNS when the normal blood supply to the brain is disrupted
CEREBROVASCULAR DISORDERS
What is cerebrovascular disorders
The functional abnormality of the CNS when the normal blood supply to the brain is disrupted
What is stroke?
The primary type of CVD
Types of stroke
-Ischemic stroke
- Hemorrhagic stroke
Aka as cerebrovascular accident
Ischemic stroke
Brain attack
Ischemic stroke
Sudden loss of function resulting from disruption of the blood supply to a part of the brain
Ischemic stroke
What is ischemic stroke?
-Aka as cerebrovascular accident
-Brain attack
-Sudden loss of function resulting from disruption of the blood supply to a part of the brain
Types of ischemic stroke
- large artery thrombotic strokes
- small penetrating artery thrombotic strokes
- Cardiogenic embolic strokes
- Cryptogenic stroke
What is large artery thrombotic stroke?
Caused by atherosclerotic plaques in the large blood vessels of the brain causing infarction
What is small penetrating artery thrombotic strokes?
affect one or more vessels and are the most common type of ischemic stroke; leaves a cavity after death or infarcted tissue
What is cardiogenic embolic strokes?
Associated with cardiac dysrhythmias, usually atrial fibrillation
What is cryptogenic stroke?
-have no known cause
- Also known as “stroke of unknown cause
-have no known cause
- Also known as “stroke of unknown cause
Cryptogenic stroke
Caused by atherosclerotic plaques in the large blood vessels of the brain causing infarction
large artery thrombotic stroke
affect one or more vessels and are the most common type of ischemic stroke; leaves a cavity after death or infarcted tissue
small penetrating artery thrombotic strokes
Associated with cardiac dysrhythmias, usually atrial fibrillation
cardiogenic embolic strokes
What is the main issue of the large artery thrombotic stroke?
Lack of oxygen-ischemia- lead to necrosis
a cellular metabolic event
Ischemic cascade
occurs after blood obstruction
Ischemic cascade
in ischemic cascade how many blood decreases?
blood decrease less than 25 ml per 100g of blood per minute
blood decrease less than 25 ml per 100 mg of blood per minute
ischemic cascade
Aerobic respiration of neurons fails
ischemic cascade
switches to anaerobic respiration
ischemic cascade
it generates large amounts of lactic acid, causing a change in the PH
anaerobic respiration
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
An area of low cerebral blood flow
Penumbra region
may be salvaged with timely intervention
Penumbra region
increase in intracellular calcium and the release of glutamate
Penumbra region
activate a number of damaging pathways; extends the stoke
glutamate
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
Toxic to brain if it increases and leads to necrosis
Glutamate
due to anaerobic activity
Glutamate
Memory enhancement
Glutamate
Characteristics of glutamate
-memory enhancement
- toxic to brain if it increases and leads to necrosis
- due to anaerobic activity
-memory enhancement
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
Loss of voluntary control over motor movements
Motor loss
What is motor loss?
Loss of voluntary control over motor movements
What is hemiplegia?
-Paralysis of one side of the body
-caused by a lesion of the opposite side of the brain
What is hemiparesis?
-weakness of one side of the body
-refer to pt
Paralysis of one side of the body
Hemiplegia
Weakness of one side of the body
Hemiparesis
caused by a lesion of the opposite of the brain
hemiplegia
difficulty in speaking; paralysis of the muscles
dysarthria
impaired speech or aphasia (loss of speech), which can be expressive aphasia, receptive aphasia or global (mixed) aphasia
Dysphasia
Types of aphasia
-Expressive aphasia
- Receptive aphasia
- Global (mixed) aphasia
Inability to perform a previously learned action
Apraxia
What is Dysarthria?
difficulty in speaking; paralysis of the muscles
What is Dysphasia?
impaired speech or aphasia (loss of speech), which can be expressive aphasia, receptive aphasia or global (mixed) aphasia
What is apraxia?
Inability to perform a previously learned action
caused by disturbances of the primary sensory pathways between the eye and visual cortex
visual-perceptual disturbances
What is visual-perceptual disturbances?
caused by disturbances of the primary sensory pathways between the eye and visual cortex
Loss of half of the visual field
Homonymous Hemianopsia
The affected side of vision corresponds to the paralyzed side of the body
Homonymous Hemianopsia
What is homonymous hemianopsia?
-Loss of half of the visual field
-The affected side of vision corresponds to the paralyzed side of the body
Deficit in the ability to recognize previously familiar objects perceived by one or more of the senses
Agnosia
Cognitive impairment and psychological effects
Frontal Lobe Damage
Impairment of learning capacity, memory or other higher cortical intellectual functions
Frontal Lobe Damage
What is Frontal Lobe Damage?
Impairment of learning capacity, memory or other higher cortical intellectual functions
What are the Frontal Lobe Damage?
-limited attention span
- difficulties in comprehensive
-forgetfullness
-lack of motivation
How to assess a child with ADHD?
-offer several tasks
Characteristics of Autistic Child?
head banging >8 minutes
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.
A warning of impending stroke
Transient Ischemic Attack
A neurologic deficit typically lasting less than 1 hour
Transient Ischemic Attack
Sudden loss of motor, sensory, or visual function due to temporary ischemia in the brain
Transient Ischemic Attack
Diagnosis of Ischemic Stroke
-Non-contrast CT Scan
- 12-Lead Electrocardiogram (ECG)
- Carotid Ultrasound
- CT Angiography
- MRI
What is non-contrast CT Scan?
Determine if the event is ischemic or hemorrhagic
Medical Management of Ishemic Stroke
-Antithrombotic
-Thrombolytic Therapy
Examples of Antithrombotic Drug
-Warfarin (Coumadin)
-Acetylsalicylic Acid/Aspirin
What is warfarin?
-an anticoagulant
- slows down blood clotting
- given to patients with atrial fibrillation
What is Acetylsalicylic Acid?
-Antiplatelet
-best option if warfarin is contraindicated
Best option if warfarin is contraindicated
Acetylsalicylic Acid
What is thrombolytic therapy?
Dissolves the blood clot that is blocking blood flow to the brain
Dissolves the blood clot that is blocking blood flow to the brain
Thrombolytic therapy
The DNA Composition of of Thrombolytic Therapy
Recombinant t-PA (tissue type plasminogen activator)
What is recombinant t-PA?
-a genetically engineered form of t-PA
- a thrombolytic substance made naturally by the body
what is kinase?
attenuated-weakened bacteria
Surgical Management of Ischemic Stroke
-Carotid Endarterectomy
- Carotid Angioplasty & Stenting
What is carotid endarterectomy?
The removal of an atherosclerotic plaque or thrombus from the carotid artery
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
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
The removal of an atherosclerotic plaque or thrombus from the carotid artery
Carotid endarterectomy
Post Surgical Management of Ischemic Stroke
-Maintain adequate blood pressure levels
-Weakness on one side of the body
- Always maintain patent airway
Why we need to maintain adequate blood pressure levels?
Hypotension is avoided to prevent cerebral ischemia and thrombosis
Why there is a weakness on one side of the body?
Thrombus formation is suspected
What equipment/supply must be readily available?
Emerceny airway supplies must be available
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
Pathophysiology of Hemorrhagic stroke
-exposure to blood
- sudden entry of blood into the subarachnoid space
-increases ICP
-compresses and injures brain tissue
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
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
Medical Management of Hemorrhagic Stroke
-Fresh frozen plasma & vitamin K
- Antiseizures (phenytoin, phenobarbital)
Surgical Management of Hemorrhagic Stroke
Craniotomy
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
Post-Operative Complications of Craniotomy
-KORSAKOFF’S syndrome
-Intraoperative embolization
-Postoperative Internal Artery Occlusion
- Gastrointestinal Bleeding
Characterized by amnesia, deficits in explicit memory, and confabulation
Korsakoff’s syndrome
Caused by severe deficiency of thiamine (Vitamin B1)
Korsakoff’s syndrome
What is korsakoff’s syndrome?
-Characterized by amnesia, deficits in explicit memory, and confabulation
-Caused by severe deficiency of thiamine (Vitamin B1)
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
Rationale of Bed rest with sedation
Prevents agitation and stress
Why HOB needs to be elevated?
To promote venous drainage and decrease ICP
Purpose of wearing anti-embolism stockings
Prevents deep vein thrombosis
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
Why we need to give fresh frozen plasma & vitamin K?
If bleeding is caused by anticoagulation
Antiseizures must be given:
Given prophylactically
Seizures can occur
Seizures can occur after intracerebral hemorrhage
