CVA Flashcards by Rhea Donna Bagasin

-refers to a functional abnormality of the CNS that occurs when the blood supply to the brain is disrupted

Cerebrovascular Disorders

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-results from ischemiato a part of the brain or hemorrhage into the brain that results in death of brain cells.
-physical, cognitive, emotional, & financial impact
-stroke

Cerebrovascular Accident

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lack of blood supply

ischemia

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temporary focal loss of neurologic function caused by ischemia (analogous to angina in CAD)

Transient Ischemic Attacks (TIA)

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-may be due to micro-emboli that temporarily block blood flow
• most resolve within 3 hours

Transient Ischemic Attacks (TIA)

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warning sign of progressive cerebrovascular disease

Transient Ischemic Attacks (TIA)

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neurologic metabolism is altered

> 30

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metabolism stops

2 minutes

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brain cell death

<5 mins

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brain dead

10-15 mins

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how many percentage of cardiac output goes to the brain

20% (approximately 750-1000ml per minute)

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cell death

infarction

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Non modifiable risk factors for CVA

•age - occurrence doubles each decade >55 years
•gender - equal for men & women; women die more frequently than men
•race - African Americans, Hispanics, Native Americans,
Asian Americans – higher incidence
• heredity - family history, prior transient ischemic attack, or prior stroke increases risk

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Modifiable risk factors for CVA

*High blood pressure
* Diabetes
Cigarette smoking
TIA
* High blood cholesterol
Obesity
Heart disease
Atrial fibrillation
Oral contraceptive use
Physical inactivity - sedentary
Sickle cell disease.
Asymptomatic carotid stenosis
Hypercoagulability

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thrombotic - plaque
•embolic
-occlusion

ischemic 87%

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most common CVA

ischemic

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-intracerebral hemorrhage
•subarachnoid hemorrhage
-bleeding

Hemorrhagic

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13%

hemorrhagic

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• inadequate blood flow to the brain from partial or complete occlusions of an artery

Ischemic

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extent of ischemic stroke depends on?

-rapidity of onset
-size of the lesion
-presence of collateral circulation

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-mechanism of brain wherein it will find a new route or new artery for blood supple if there is blockage

collateral circulation

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TYPE OF ISCHEMIC

-formation of plaques in the large and small vessels of the brain
-starts with injury to a blood vessel wall and formation of blood clot then thrombosis develops from atherosclerotic plaque from narrowed blood vessels.

thrombotic

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-lumen of the blood vessels narrow → then becomes occluded → infarction

thrombotic

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common type of ischemic stroke

thrombotic

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what diseases do thrombotic associated with?

HPN and diabetes mellitus

->60% of strokes. -50% are preceded by TIA

thrombotic

development of cavity in place of infarcted brain tissue - results in considerable deficits - motor hemiplegia, contralateral loss of sensation or motor ability

lacunar stroke

left or right stroke

hemiplegia

upper or lower * for spinal cord injury only, hindi sa stroke

paraplegia

whole body weakness

tetraplagia

new term for tetraplegia

quadraplegia

-common sites of atherosclerosis in the brain (thrombotic)

• external carotid artery • left and right common carotid artery • left and right subclavian artery O innominate artery

-associated with cardiac disorders -embolus lodges in and occludes a cerebral artery

embolic

embolic results in?

infarction & cerebral edema of the area supplied by the vessel

second most common cause of stroke 24%

embolic

-emboli originate in endocardial layer of the heart

- atrial fibrillation, MI, infective endocarditis, rheumatic heart disease, valvular prostheses

-any age group -recurrence common if underlying cause not treated

embolic

•caused by bleeding into the tissues of the brain • account for approximately 15% of all strokes

hemorrhagic stroke

hemorrhagic stroke is result from?

• result from bleeding into the brain tissue itself or into the subarachnoid space or ventricles

-bleeding within the brain caused by a rupture of a vessel -commonly occurs during activity

intracerebral hemorrhage

important cause of intracerebral hemorrhage

hypertension

other causes of intracerebral hemorrhage

-other causes: vascular malformations, coagulation disorders, anticoagulation, trauma, brain tumor, ruptured aneurysms

-sudden onset of symptoms with progression

itracerebral hemorrhage

-neurological deficits, headache, nausea, vomiting, decreased LOC, and hypertension

intracerebral hemorrhage

prognosis for intracerebral hemorrhage

poor - 50% die within weeks

-often a sudden onset of symptoms that progress over minutes to hours because of ongoing bleeding

intracerebral hemorrhage

enumerate the manifestations for intracerebral hemorrhage

neurologic deficits, headache, nausea & vomiting, decreased levels of consciousness

- intracranial bleeding into the cerebrospinal fluid-filled space between the arachnoid and pia matermembranes on the surface of the brain

subarachnoid hemorrhage

-intracranial aneurysm → rupture of aneurysm

subarachnoid hemorrhage

common caused of subarachnoid hemorrhage

rupture of cerebral aneurysm (congenital or acquired)

where do subarachnoid hemorrhage majority occur?

the circle of willis

other causes of subarachnoid hemorrhage

arteriovenous malformation (AVM), trauma, illicit drug abuse

incidence of subarachnoid hemorrhage

- incidence: 6-16/100,000

increases with age and more common in women

subarachnoid hemorrhage

warning symptoms of subarachnoid hemorrhage

severe bursting headache “worst headache of one’s life “

symptoms of subarachnoid hemorrhage

-change of LOC, neurological deficits, nausea, vomiting, seizures, stiff neck

BE FAST

balance eyes face arms speech timing

symptoms of CVA

-sudden numbness or weakness of face, arm or leg -sudden confusion -sudden trouble with vision -sudden trouble with walking, dizziness -sudden severe headache

Symptoms of CVA Visual Deficits

-homonymous hemianopsia •loss of peripheral vision -diplopia

Symptoms of CVA Sensory deficits

paresthesia (peripheral neuropathy)

symptoms of cva verbal deficits

-expressive aphasia -receptive aphasia -global aphasia

symptoms of cva motor deficits

-hemiparesis - weakness of LorR -hemiplegia - paralysis -ataxia -uncoordinate movers -dysarthria- diff in forming words -dysphagia - diff in swallowing

-paralyzed left side: hemiplegia -left-side neglect

Right brain damage

-spatial-perceptual deficits •tends to deny or minimize problems •rapid performance, short attention span

right brain damage

•Impulsive, safety problems •impaired judgment • impaired time concepts

right brain damage

- paralyzed right side: hemiplegia • impaired speech/ language aphasias

left brain damage

* impaired right/left discrimination *slow performance, cautious

left brain damage

• aware of deficits, depression, anxiety • impaired comprehension related to language

left brain damage

enumerate the manifestations of right brain damage

*paralyzed left side: hemiplegia •left-side neglect "spatial-perceptual deficits •tends to deny or minimize problems •rapid performance, short attention span •Impulsive, safety problems •impaired judgment • impaired time concepts

enumerate the manifestations of left brain damage

- paralyzed right side: hemiplegia • impaired speech/ language aphasias * impaired right/left discrimination *slow performance, cautious • aware of deficits, depression, * anxiety • impaired comprehension related to language

Symptoms of cva affect

"difficulty controlling emotions "exaggerated or unpredictable emotional response "depression / feelings regarding changed body image and loss of function

symptoms of cva intellectual function

-memory and judgment -left-brain stroke: cautious in making judgments -right-brain stroke: impulsive & moves quickly to decisions -difficulties in learning new skills

Symptoms of CVA Spatial-Perceptual Alterations-4 Categories

•1. Incorrect perception of self and illness •2. Erroneous perception of self in space - may neglect all input from the affected side (worsened by homonymous hemianopsia) •3. Agnosia- inability to recognize an object by sight, touch or hearing •4. Apraxia- inability to carry out learned sequential movements on command

agnosia

inability to recognize an object by sight, touch or hearing

apraxia

inability to carry out learned sequential movements on command

Symptoms of CVA Elimination

Elimination -most problems with elimination occur initially and are temporary "prognosis for normal bladder function is excellent when only one hemisphere of brain is affected.

•a clinical grading system to predict prognosis and outcome in patients with subarachnoid hemorrhage

hunt and hess scale

h&h grade 1

Asymptomatic or mild headache, slight nuchal rigidity

h&h grade 2

Nuchal rigidity, moderate to severe headache

h&h grade 3

Drowsy, confused or mild focal defic

h&h grade 4

Stupor, moderate to severe hemiparesis, early decerebrate

h&h grade 5

Coma, decerebrate rigidity

diagnostic tests

cranial ct scan cerebral angiography mri

diagnostic test for ischemic stroke

cerebral angiography

is the primary diagnostic test used after a stroke

Cranial CT scan

•classifies the appearance of subarachnoid hemorrhage on CT scan and is used in predicting cerebral vasospasm

Fisher Grading Scale

Fisher grading scale Grade 1

none

Fisher grading scale Grade 2

Difuse, thin layer of blood

Fisher Grading scale grade 3

Localized clot or thick layer of blood

Fisher Grading scale grade 4

Intracerebral or intraventricular blood