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Pharm Block 4 Mod 4 (Neuro Stroke...) > CVA > Flashcards

CVA Flashcards

1
Q

CVA

A

Cerebral Vascular Accident (CVA)
-Brain Attack

Problem with blood supply to the brain

  1. ISCHEMIC 87%
    - Thrombotic/embolic event
    - Hemorrhagic conversion (must Inc BP to perfuse ischemia following stroke which causes a hemorrhage)
    - Area of the brain supplied by clogged vessel loses blood supply
  2. HEMORRHAGIC (13%)
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2
Q

Epidemiology

A

800,000 per year

  • > 600,000 1st stroke
  • 34% <65yo

4th leading cause of death
-130,000 Americans a year

Stroke every 40 seconds

Death every 4 minutes

Leading cause of disability

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3
Q

CVA: Risk Factors

A 
HTN
Hyperlipidemia
Tobacco
DM
Race (Black)
Oral Contraceptives
Age 
Gender (men)
Sickle cell anemia
History of TIA
A-fib (quivering)
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4
Q

Ischemic Stroke

A

Occlusion of cerebral artery

  1. Thrombus
  2. Embolus
    - Presentation and treatment similar
    - Etiology, prevention is different
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5
Q

Blood supply to Brain

A

Very Extensive
-Can be disrupted at any point

Steps of Ischemic Stroke

  1. Decrease blood supply
  2. Oxygen deprivation
  3. Neuro deficits within 1 minute of occlusion
  4. Continued loss of supply leads to irreversible damage
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6
Q

Ischemic Stroke: Thrombotic Cause

A

Thrombotic

  1. Atherosclerosis OR
  2. Hypercoagulable state

-Both can cause Ischemic stroke

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7
Q

Ischemic Stroke: Embolic Cause

A

Embolic

  1. Cardiac Source
    - Mural thrombus (ventral clot)
    - A-fib
    - Venous clot if atrial septal defect or pt. foramen ovale
    - Thrombus vegetation of valves
  2. Carotid Plaque
    - Carotid bruite
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8
Q

Ischemic Stroke

A

Penumbra: Viable living tissue surrounding where ischemia happens

Goal:
-Salvage penumbra < 3 hours (reestablish blood supply)

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9
Q

Hemorrhagic Stroke

A

Bleeding within the brain parenchyma

  • Associated with long standing, severe HTN
  • 38% mortality (minutes to hours)
  • Death in seconds if in brainstem

Aneurysm

  • Bulging of blood vessel
  • Can lead to Hemorrhagic stroke
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10
Q

First thing to do after stroke

A

CT Scan (after ABCs)

  • Ischemic: DARK colored area (Non-perfused)
  • Hemorrhagic: WHITE colored area (Blood)
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11
Q

Hemorrhagic Stroke

A

Large area effected

  1. Increased intracranial pressure with inflammation
  2. Herniation (collapses into ventricles)
  3. Death

The larger the worse

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12
Q

Hemorrhagic Stroke: Prognosis

A
  • Age (older, smaller brain, more room for swelling)
  • Location and size
  • How rapid the bleed causes brain distortion and shift on scan
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13
Q

Different Types of Intracranial Hemorrhages

A

There are other types of intracranial hemorrhages that are NOT strokes but brain bleeds instead.

Hemorrhagic Stroke is a bleed in the brain tissue itself

Epidural Bleed: Bleed above dura matter

Subdural Bleed: bleeding below the Dura matter

Subarachnoid Bleed: bleeding in the subarachnoid space where the CSF occurs

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14
Q

Intracranial Hemorrhage

A

Epidural:

  • Skull fractures
  • Arterial
  • Injury is usually less severe

Subdural:

  • Occurs in bridging veins
  • Brain moves within skull, vessels don’t
  • Rapid SEVERE injury
  • Can be slow (2-10 days later)
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15
Q

Subarachnoid Hemorrhage

A

Space between outer arachnoid membrane and pia matter

Area filled with CSF

Rupture of:

  • Cerebral aneurysm
  • Arterio-venous malformation (AVM)
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16
Q

Berry aneurysm

A

Most commonly ruptured aneurysm

-Location is often in brain stem and results in DEATH

17
Q

Hemorrhagic Stoke: Info

A
  • Age: 30-60
  • High morbidity and mortality
  • Serious disabilities
18
Q

Hemorrhagic Stoke: Presentation

A

Worst Headache of their life

Rapid change in level of consciousness (LOC)

Irritation of the meninges

  • Nuchal rigidity “stiff neck” (similar to meningitis)
  • Photophobia
19
Q

Subarachnoid Hemorrhage: presentation

A
  • Blood in CSF (lumbar puncture)

- Toss first tube (may be bloody due to insertion trauma)

20
Q

Subarachnoid Hemorrhage: Management

A
  1. Bedrest with sedation
  2. BP tightrope
  3. Surgery ASAP (Aneurysm clipping)
  4. Prophylactic anticonvulsant
  5. Nimodipine
  6. Triple H (treatment) elevates BP for brain profusion
    - Hypertension (pressors)
    - Hypervolemia (colloids)
    - Hemodilution (Hct 33)

*risk of re-bleeding especially in 1st 24hrs

21
Q

Symptoms of Stroke

A

BEFAST

B: balance (loss of)
E: Eyes (loss of vision, unequal pupils)
F: Face (uneven)
A: Arm (weakness)
S: Speech (difficulty)
T: time to call 911

3 hours is KEY

Pharm Block 4 Mod 4 (Neuro Stroke...) (6 decks)

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