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Pathophysiology > CVA > Flashcards

CVA Flashcards

1
Q

Definition of CVA

A

Interruption of blood flow to an area of the brain

robs brain cells of vital nutrients and supplies
results in loss of neuronal function
Sx’s last longer than 24 hours

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2
Q

Types of CVA

A

ischemia or hemorrhage

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3
Q

Ischemia

A

clot blocks or impairs blood flow
lack of blood flow deprives the neurons of oxygen and nourishment

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4
Q

Hemorrhage

A

vessel ruptures causing bleeding into the brain and leakage
extra-vascular release of blood causes damage by cutting off connecting pathways
results in local or generalized pressure injury

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5
Q

Modifiable Risk Factors

A

Lack of Exercise
Diet
Smoking

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6
Q

Non-Modifiable Risk Factors

A

HTN
HD-?
Increased Cholesterol
Cardiac Disorders
Cardiac arrhythmias
DM
CHF
Age
Family Hx
Sleep Apnea
Genetic Factors

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7
Q

Most vulnerable areas to ischemia

A

hippocampus - pyramidal cell layer
cerebral cortex - purkinje cell layer
cerebral cortex

These are areas that need glutamate and cannot receive it during an episode of ischemia

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8
Q

Significant reduction of death and disability if a person having an acute stroke arrives to ED within _______________ of symptoms

A

2 hours

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9
Q

Causes of Ischemia

A

thrombus (more common) and embolus

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10
Q

Influences on progression and extent of ischemia injury

A

rate and duration of ischemic event
collateral circulation in involved area of brain
systemic circulation and arterial blood pressure
coagulation abnormalities
temperature
glucose

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11
Q

CVA: Thrombus

A

formation or development of a blood clot within the cerebral arteries and their branches
often caused by atherosclerosis

typically gradual onset
progressive neurological decline x2-3 weeks
no loss of consciousness

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12
Q

Common sites of thrombus

A

carotid arteries at bifurcation
MCA

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13
Q

CVA: Embolus

A

matter formed elsewhere and released into the blood stream and travel into cerebral arteries and lodge in vessel

sudden onset
may induce hemorrhage

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14
Q

Common sites of embolus

A

L sided cardiac chambers
detachment from internal carotid arteries at site of plaque and lodges in another artery

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15
Q

Common sources of embolism

A

atrial fibrillation with cardiac disease - most common
bacterial endocarditis
atherosclerosis in carotid arteries

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16
Q

Pathogenesis of Ischemia

A

sudden cessation of cerebral blood flow causes O2 and glucose deprivation
loss of homeostasis
within minutes neuronal death begins (signs and symptoms result)
surrounding neurons at risk

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17
Q

What does loss of auto regulation secondary to lack of O2?

A

-vasodilation
-depletion of neurotransmitters
-lack of cerebral blood flow
-changes in ion balance

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18
Q

Ischemic Cascade

A

Release of excess neurotransmitters (glutamate and aspartate)
Brain can’t produce ATP
Excess influx of Ca and pump failure at neuronal cell membrane
Excess Ca causes increasing free radicals and stimulates other chemical imbalances
neuronal death and edema

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19
Q

Cerebral Edema

A

widespread cell death and failure of ion pumps causes cells to burst
fluids accumulate and occupy space in brain
causes increased permeability of blood-brain barrier causes increased fluid in the brain
starts within minutes and reaches max in 3-4 days

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20
Q

What is the most frequent cause of death in acute stroke?

A

cerebral edema

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21
Q

Results of Cerebral Edema

A

increased intracranial pressure
decreased level of consciousness
possible shifts in brain structures (herniation)

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22
Q

Signs of Increased InterCranial Pressure

A

decreased level of consciousness
increased HR
irregular respiration
vomiting
non-reactive pupils

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23
Q

Types of Hemorrhage

A

intracerebral
subarachnoid

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24
Q

Intracerebral hemorrhage (ICH)

A

bleeding from an arterial source into the brain parenchyma (bulk of brain)
worst type of CVA

25
Primary ICH
spontaneous bleeding in the absence of any readily identifiable precipitant often results from aging and/or HTN
26
Secondary ICH
from trauma, exposure to toxins or anatomic lesion
27
ICH Risk Factors
High BP** Arterial Aneurysm** AVM TBI secondary hemorrhage following ischemic stroke surgery (atherosclerosis) bleeding disorder/anticoagulation therapy excessive ETOH or substance abuse **most common
28
Common Sites of ICH
cuadate thalamus - most common lobar subcortical putamin pontine - VERY RARE cerebellum - RARE
29
Subarachnoid Hemorrhage
bleeding into subarachnoid space best confirmed with brain CT
30
Symptoms of Subarachnoid Hemorrhage
SUDDEN ONSET OF SEVERE HEADACHE stiff neck photophobia due to blood in CSF acute hydrocephalus increased ICP vomiting nausea Headache may occur after exertion and occurs in 40% of people with SAH
31
SAH Risk Factors
Aneurisms Atrial venous malformation (AVMs) Women over 70 can occur secondary to: trauma developmental defects neoplasm infection
32
Why does SAH have such a high mortality rate?
causes compression of brain stem where respiratory and cardiac centers are
33
Aneurysm
abnormal stretching in the wall of artery, vein or heart itself caused by trauma, HTN, atherosclerosis, heredity
34
What is the best way to detect an Aneurysm?
CT scan
35
Most common site of aneurysm
Men- anterior communicating artery or ACA Women- junction of IJA with posterior communicating
36
Signs and symptoms of aneurysm
sudden onset of unilateral focal deficits after activity often preceded by headache
37
AV Malformation
abnormal connection between arteries and veins, bypassing the capillary system Acute onset of headache followed by bleeding leading to neurologic deficits depending on location of malformation
38
Lacunar Infarcts
small subcortical infarcts in deep penetrating arteries (deep white matter) strongly associated with hypertensive hemorrhage or DM Typically have excellent outcomes- because a small artery is what was affected
39
Transient Ischemic Attack
acute episode of temporary focal loss of cerebral function rapid onset always lasts less than 24 hours FUNCTION RETURNS when blood flow is restored increased likelihood of CVA
40
ACA supply
frontal lobe parietal lobe basal ganglia corpus collosum branches of limbic system
41
ACA Symptoms
contralateral hemiplegia contralateral hemi-sensory impairments incontinence apraxia LE > UE collateral circulation in many areas
42
MCA Supply
most of temporal lobe frontal lobe parietal lobe internal capsule globus pallidus caudate putamen
43
MCA Dominant Symptoms
contralateral hemiplegia contralateral sensory loss aphasia- typically expressive facial involvement loss of conjugate eye movements (Area 8- frontal eye fields)
44
MCA Non Dominant Symptoms
contralateral hemiplegia contralateral sensory loss homonymous hemiplegia anosognosia- pt decides limb doesn't belong to them perceptual deficits- neglect, depth perception, spatial relations and agnosia limb apraxia
45
PCA supply
Occipital lobe parts of temporal lobe upper brainstem midbrain thalamus
46
PCA causes
embolism from heart, aortic arch, vertebral artery, basilar artery collateral circulation in many areas
47
PCA: Thalamic branch occlusions
contralateral hemiplegia contralateral sensory loss central thalamic pain syndrome
48
PCA: Occipital occlusions
homonymous hemianopsia visual agnosia-unable to recognize things paralysis of eye movements
49
PCA: temporal lobe
memory deficits
50
PCA: communicating arteries
minimal deficits
51
Pusher Syndrome
disorder of postural orientation actively push away from non paretic side perceptual issue not vestibular occurs with damage to L or R posterolateral thalamus
52
Vertebral-Basilar Artery Syndrome
very small number of CVAs due to collateral circulation Locked In Syndrome
53
Thrombolysis
treatment for ischemic CVA clot found in large vessel restores blow flow in acute stage with improvement or resolution of neurological deficits **can cause hemorrhagic conversion**
54
Thrombolysis Agents
t-PA - must be administered within 3 hours streptokinase fibrinolytic snake venom
55
Contraindications for t-PA
Seizures at onset Sx of SAH CVA or BI within 3 months prior major surgery or trauma within 2 weeks prior Hx of ICH, AVM/aneurism, neoplasms Oral anticoagulant improving neuro signs high BP GI bleed within 21 days prior
56
Ischemia Treatments
surgical catheterization - removal of clot anticoagulation- heperin, coumadin, aspirin
57
Hemorrhage Treatments
Treat HTN - to get bleeding under control surgical removal of hematoma ICU
58
Ischemic vs Hemorrhagic
Ischemic: at risk for other CVA/MI most return within 3 months Hemorrhagic: high mortality extend of bleed return can be slower both: often hand function does not return

Pathophysiology (10 decks)

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