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FINALS 304 LEC (22-23) > CHAPTER 15: MANAGEMENT OF PATIENTS WITH CEREBROVASCULAR DISORDERS > Flashcards

CHAPTER 15: MANAGEMENT OF PATIENTS WITH CEREBROVASCULAR DISORDERS Flashcards

1
Q

an umbrella term that refers to a
functional abnormality of the central nervous system (CNS) that
occurs when the blood supply to the brain is disrupted.

A

Cerebrovascular disorders

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2
Q

2 Major Categories of Stroke

A

Ischemic & Hemorrhagic

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3
Q

Ischemic Stroke

A
  • Approximately 87%
  • Vascular occlusion (blockage in the blood vessels) and significant hypoperfusion (reduced amount of blood flow) occur
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4
Q

Hemorrhagic Stroke

A
  • Approximately 13%
  • There is extravasation (leakage) of blood into the brain or subarachnoid space
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5
Q

The causes of ischemic stroke

A

Large artery thrombosis
Small penetrating artery thrombosis
Cardiogenic embolic
Cryptogenic (no known cause)
Others

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6
Q

The causes of hemorrhagic stroke

A

Intracerebral hemorrhage
Subarachnoid hemorrhage
Cerebral aneurysm
Arteriovenous malformation

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7
Q

Main presenting symptom of ischemic stroke

A

Numbness or weakness of the face, arm, or leg, especially on one side of the body

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8
Q

Main presenting symptom of hemorrhagic stroke

A

Exploding headache
Decreased level of consciousness

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9
Q

Functional recovery of ischemic stroke

A

Usually plateaus at 6 months

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10
Q

Functional recovery of hemorrhagic stroke

A

Slower, usually plateaus at about 18 months

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11
Q

It is also known as cerebrovascular accident (CVA) or “brain attack”

A

Ischemic Stroke

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12
Q

It is an ischemic stroke that are caused by atherosclerotic plaques in
the large blood vessels of the brain.

A

Large artery thrombotic strokes

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13
Q

What results to ischemia and infarction (death of tissue resulting from a failure of blood supply)?

A
  • Thrombus (blood clot) formation and occlusion (blockage) at the site of the atherosclerosis (thickening or hardening of the arteries caused by a buildup of plaque in the inner lining of an artery.)
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14
Q

There is disruption of the cerebral blood flow due to obstruction of a blood vessel.

A

Ischemic Brain Attack

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15
Q

Clinical Manifestations of Ischemic Brain Attack

A

Numbness or weakness of the face, arm, or leg, especially on one side of the body
Confusion or change in mental status
Trouble speaking or understanding speech
Visual disturbances
Difficulty walking, dizziness, or loss of balance or coordination
Sudden severe headache

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16
Q

VISUAL FIELD DEFICIT: Homonymous Hemianopsia (loss of half of the visual field)

A

Unaware of persons or objects on side of visual loss
Neglect of one side of the body
Difficulty judging distances

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17
Q

VISUAL FIELD DEFICIT: Loss of peripheral vision

A

Difficulty seeing at night
Unaware of objects or the borders of objects

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18
Q

VISUAL FIELD DEFICIT: Diplopia

A

Double Vision

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19
Q

MOTOR DEFICITS: Hemiparesis

A

Weakness of the face, arm, and leg on the same side (due to a lesion in the opposite hemisphere)

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20
Q

MOTOR DEFICITS: Hemiplegia

A

Paralysis of the face, arm, and leg on the same side (due to a lesion in the opposite hemisphere)

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21
Q

MOTOR DEFICITS: Ataxia

A

Staggering, unsteady gait
Unable to keep feet together; need a broad base to stand

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22
Q

MOTOR DEFICITS: Dysarthria

A

Difficulty in forming words

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23
Q

MOTOR DEFICITS: Dysphagia

A

Difficulty in swallowing

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24
Q

SENSORY DEFICIT: Paresthesia (occurs on the side opposite the lesion)

A

Sensation of numbness, tingling, or a “pins and needles” sensation
Difficulty with proprioception

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25
Q

VERBAL DEFICIT: Expressive Aphasia

A

Unable to form words that are understandable; may be able to speak in single-word responses

26
Q

VERBAL DEFICIT: Receptive Aphasia

A

Unable to comprehend the spoken word; can speak but may not make sense

27
Q

VERBAL DEFICIT: Global (mixed) aphasia

A

Combination of both receptive and expression

28
Q

Cognitive Deficits of Stroke

A

Short- and long-term memory loss
Decreased attention span
Impaired ability to concentrate
Poor abstract reasoning
Altered judgment

29
Q

Emotional Deficits of Stroke

A

Loss of self-control
Emotional lability
Decreased tolerance to stressful situations
Depression
Withdrawal
Fear, hostility, and anger
Feelings of isolation

30
Q

Left Hemispheric Stroke

A

Paralysis or weakness on right side of the body
Right visual field deficit
Aphasia (expressive, receptive, or global)
Altered intellectual ability
Slow, cautious behavior

31
Q

Right Hemispheric Stroke

A

Paralysis or weakness on left side of body
Left visual field deficit
Spatial-perceptual deficits
Increased distractibility
Impulsive behavior and poor judgment
Lack of awareness of deficits

32
Q

What is the most common motor dysfunction in stroke?

A

Hemiplegia (paralysis of one side of the body, or part of it) - caused by
a lesion of the opposite side of the brain.

33
Q

What is the most common effect of stroke in terms of communication loss?

A

Aphasia (inability to express oneself or to understand language).

34
Q

It is caused by paralysis of the muscles responsible for producing speech.

A

Dysarthria (difficulty in speaking)

35
Q

It can be expressive aphasia (inability to express oneself), receptive aphasia (inability to understand language), or global (mixed) aphasia.

A

Dysphasia (impaired speech)

36
Q

It may be seen when a patient makes verbal substitutions for desired syllables or words

A

Apraxia (inability to perform a previously learned action)

37
Q

It may occur from stroke and may be temporary or permanent.

A

Homonymous hemianopsia (blindness in half of the visual field)

38
Q

are deficits in the ability to recognize previously familiar objects perceived by one or more of the senses.

A

Agnosias

39
Q

Damage in this lobe may impair learning capacity, memory, or other higher cortical intellectual functions

A

Frontal Lobe

40
Q

What is the initial diagnostic test for a stroke patient?

A

a non-contrast computed tomography (CT) scan

41
Q

Other diagnostic tests for stroke

A

CT angiography or CT perfusion
magnetic resonance imaging (MRI)
magnetic resonance angiography of the brain and neck vessels

42
Q

MEDICAL MANAGEMENT: For atrial fibrillation (or cardioembolic strokes)

A

Dose-adjusted WARFARIN (Coumadin)

43
Q

MEDICAL MANAGEMENT: Anticoagulants that may be prescribed as alternative drugs

A

Dabigatran (Pradaxa)
Rivaroxaban (Xarelto)

44
Q

MEDICAL MANAGEMENT: Platelet-inhibiting medications

A

Aspirin
Extended-release dipyridamole plus aspirn (Aggrenox)
Clopidogrel (Plavix)

45
Q

The main surgical procedure for selected patients with TIAs and mild stroke

A

CAROTID ENDARTERECTOMY (which currently is the most frequently performed noncardiac vascular procedure)

46
Q

the removal of an atherosclerotic plaque or thrombus from the carotid artery to prevent stroke in patients with occlusive disease of the extracranial cerebral arteries

A

CAROTID ENDARTERECTOMY

47
Q

How many days does an acute ischemic stroke last?

A

1 to 3 days

48
Q

The patient who has had a stroke is at risk for multiple complications including:

A

deconditioning and other musculoskeletal problems
swallowing difficulties
bowel and bladder dysfunction
inability to perform self-care
skin breakdown

49
Q

It accounts for 15% to 20% of
cerebrovascular disorders and are primarily caused by
intracranial or subarachnoid hemorrhage.

A

Hemorrhagic Stroke

50
Q

Caused by bleeding into the brain
tissue, the ventricles, or the subarachnoid space.

A

Hemorrhagic Stroke

51
Q

The most common in patients with
hypertension and cerebral atherosclerosis,
because degenerative changes from these
diseases cause rupture of the blood vessel.

A

Intracerebral Hemorrhage (bleeding into the brain tissue)

52
Q

a dilation of the walls of a cerebral artery that develops as a result of weakness in the arterial wall

A

Intracranial (cerebral) aneurysm

53
Q

caused by an abnormality in embryonal development that leads to a tangle of arteries and veins in the brain that lacks a capillary bed. The absence of a capillary bed leads to dilation of the arteries and veins and eventual rupture

A

Arteriovenous Malformations

54
Q

It may occur as a result of an AVM, intracranial aneurysm, trauma, or hypertension.

A

Subarachnoid Hemorrhage (hemorrhage into the subarachnoid space)

55
Q

What does a conscious patient with hemorrhagic stroke commonly report?

A

Severe headache

56
Q

Other symptoms that may be observed more frequently in patients with acute intracerebral hemorrhage (compared with ischemic stroke)

A

vomiting
early sudden change in level of consciousness
possibly focal seizures due to frequent brain stem involvement

57
Q

Other symptoms that may be observed more frequently in patients with acute intracerebral hemorrhage (compared with ischemic stroke)

A

vomiting
early sudden change in level of consciousness
possibly focal seizures due to frequent brain stem involvement

58
Q

Assessment and Diagnostic Findings for Hemorrhagic Stroke

A

CT scan
MRI
Cerebral angiography
Lumbar puncture is performed if there is no evidence of increased ICP

59
Q

Complications of Hemorrhagic Stroke

A

Cerebral Hypoxia and Decreased Blood Flow
- Immediate complications of a hemorrhagic stroke include cerebral hypoxia, decreased cerebral blood flow, and extension of the area of injury.
Vasospasm
- The development of cerebral vasospasm (narrowing of the lumen of the involved cranial blood vessel) is a serious complication of subarachnoid hemorrhage and is a leading cause of morbidity and mortality in those who survive the initial subarachnoid hemorrhage.
Increased Intracranial Pressure
- An increase in ICP can occur after either an ischemic or a hemorrhagic stroke but almost always follows a subarachnoid hemorrhage, usually because of disturbed circulation of CSF caused by blood in the basal cisterns.
Hypertension
- Hypertension is the most common cause of intracerebral hemorrhage, and its treatment is critical.

60
Q

MEDICAL MANAGEMENT: The goals of medical treatment for hemorrhagic stroke

A
  • To allow the brain to recover from the initial insult (bleeding)
  • To prevent or minimize the risk of rebleeding
  • To prevent or treat complications
61
Q

MEDICAL MANAGEMENT: What to do if bleeding is caused by anticoagulation with warfarin?

A

Fresh-frozen plasma and Vitamin K

62
Q

MEDICAL MANAGEMENT: When seizure occurs in hemorrhagic strokes

A

Treat with antiseizure drugs such phenytoin (Dilantin)

FINALS 304 LEC (22-23) (3 decks)

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