CVA

Question 1

BEFAST

Answer 1

Way to remember symptoms for CVAs:

B=Balance Lost
E=Eyes Blurry
F=Face Uneven
A=Arm is Weak
S=Speech Difficulties
T=Time to Call 911

Question 2

How Heart Attacks relate to CVA?

Answer 2

Myocardial infarctions can result in clots forming, which can move into the brain and cause a CVA.

Question 3

CVA vs. Heart Attack

Answer 3

NOT the same thing. CVAs are actually CEREBRAL incidents having nothing to do with the heart. Heart attacks or heart problems can lead to CVAs because they can cause clot formation, and the clots can travel into the brain to cause the CVA. But heart attacks are not directly the same as CVA.

Question 4

Musculo-skeletal Activity Affected by CVA

Answer 4

The upper motor neuron damage caused by strokes can result in HEMIPLEGIA (motor paralysis on one side of body, incl limbs and trunk and sometimes the face and oral structures contralateral to the lesion). There can also be a change in the RESTING STATE of limbs/postural muscles. The acute state of the stroke is called the “LOW-TONE STAGE,” when limbs/trunk become influenced by pull of gravity, with little to no available muscle activity. This results in the DEVIATIONS from normal resting alignment. **This inactivity can lead to secondary problems like: EDEMA, OVERSTRETCHING of joint capsule of GH, shortening of muscles (and possible SPASTICITY) to support weak limb, overstretching of those muscles’ ANTAGONISTS, and risk of joint and soft tissue INJURY during ADLs/mobility.

Question 5

Neuroplasticity

Answer 5

The brain’s ability to repair itself or reorganize its neural pathways to allow relearning of functions lost as result of neural damage sustained in accident.

Question 6

Brain Stem Stroke

Answer 6

Most devastating stroke; regulatory center that keeps you alive; controls your breathing, heart and other vital functions.

Question 7

Embolic vs. Thrombolitic Stroke

Answer 7

In Ischemic strokes: EMBOLIC = clot/obstruction travels from the heart or elsewhere in the body; THROMBOLITIC = clot/obstruction develops within the vessel or brain.

Question 8

TIA

Answer 8

Transient Ischemic Attacks: called “mini strokes;” caused by vascular disease of the brain; mild, isolated, or repetitive neurological symptoms that develop suddenly, last minutes to hours (not longer than 24), and clear completely. Can be sign of impending stroke. Most occur with artherosclerotic disease. 1/3 of TIAs eventually have full stroke. Surgical interventions to restore vascular flow may prevent stroke.

Question 9

Tissue Plasminogen Activator (t-PA)

Answer 9

Used in ischemic strokes to dissolve clot. CRITICAL to administer within 3 hours of onset of symptoms! Better outcome of returned function when t-PA is used.

Question 10

Hemorrhagic Stroke

Answer 10

Account for only 13% of all strokes. More severe stroke (worse outcomes). Has numerous causes; most common are: 1) deep hypertensive intracerebral hemorrhages, 2) ruptured saccular aneurysms, 3) bleeding from arteriovenous malformations, and 4) spontaneous lobar hemorrhages.

Question 11

Ischemic Stroke

Answer 11

Ischemia= insufficient blood flow to meet metabolic demand, particularly in carotid and basilar arteries. May be result of embolism to the brain from arterial or cardiac sources (like atrial fibrillation, sinoatrial disorders, acute myocardial infarction, endocarditis, cardiac tumors, and valvular disorders). Prognosis dependent on return of blood flow. Age, gender, race, ethnicity, heredity are nonmodifiable risk factors. But, modifiable risk factors are:

1) hypertension,
2) mgmt of cardiac diseases,
3) mgmt of diabetes,
4) stop smoking,
5) moderate alcohol may reduce incidence,
6) not using illegal drugs,
7) lifestyle factors (obesity, inactivity, diet, stress).

Question 12

Stats on US Strokes

Answer 12

• Leading cause of serious, long-term disability
• 795,000 strokes/year
• 3/4 occur in people over 65
• 140,000 deaths/year (1 out of 20 deaths)
• Stroke occurs every 40 seconds
• Stroke death every 4 min

Question 13

RIGHT CVA

Answer 13

Causes LEFT sided deficits!

• Hemiparesis
• Visual impairments
• Major cognitive deficits

Acute Phase:
• Left hemiparesis upper and lower body
• Typically flaccid or low tone initially
• Hypertonicity can develop quickly
• Joints must be supported and mobilized
• ROM and soft tissue length must be maintained

Visual Impairments:
• Homonymous Hemianopsia-complete disruption 
• Visual field loss-one or more areas
• Cognitive inattention to left side 
• Diploplia-double vision-initially

Cognitive Deficits:
• Poor or NO insight 
• Poor memory
• Poor safety awareness 
• Poor attention to tasks

Question 14

LEFT CVA

Answer 14

Causes RIGHT sided deficits!

• Hemiparesis
• Aphasia
• Dysphagia
• Depression

Acute Phase:
• Right hemiparesis upper and lower body
• Flaccid stage may last much longer which leads to edema
• More significant sensory impairment
• Joints must be supported
• ROM and soft tissue length MUST be maintained
• Aphasia-inability to speak
• Global Aphasia-inability to speak or comprehend
language (spoken or written)
- Words may come out automatically
- When patient concentrates-words jumble
- Patient IS aware that they are unable to speak the
way they are intending

Dysphagia-difficulty swallowing:
• Patient may cough with thin liquids or tough consistencies (meat)
• Silent aspiration-food/liquids go into lungs instead of stomach due to malfunctions in the throat
• VERY dangerous if left untreated
• Swallow study can diagnose

• Due to language deficits, motor impairments and swallowing impairments:

• Patients often become depressed
• Emotionally Labile
• Family members need support and education

Question 15

Treatment of Hemorrhagic CVA

Answer 15

1) Skull removal to allow expansion (burr holes, parts of skull removed)
2) EVD: External ventricular drain (drains into a bag that clamps if needed)
3) Monitoring intercranial pressure (bolt in brain, IVs that can measure)