CVA Flashcards
-refers to a functional abnormality of the CNS that occurs when the blood supply to the brain is disrupted
Cerebrovascular Disorders
-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
lack of blood supply
ischemia
temporary focal loss of neurologic function caused by ischemia (analogous to angina in CAD)
Transient Ischemic Attacks (TIA)
-may be due to micro-emboli that temporarily block blood flow
• most resolve within 3 hours
Transient Ischemic Attacks (TIA)
warning sign of progressive cerebrovascular disease
Transient Ischemic Attacks (TIA)
neurologic metabolism is altered
> 30
metabolism stops
2 minutes
brain cell death
<5 mins
brain dead
10-15 mins
how many percentage of cardiac output goes to the brain
20% (approximately 750-1000ml per minute)
cell death
infarction
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
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
thrombotic - plaque
•embolic
-occlusion
ischemic 87%
most common CVA
ischemic
-intracerebral hemorrhage
•subarachnoid hemorrhage
-bleeding
Hemorrhagic
13%
hemorrhagic
• inadequate blood flow to the brain from partial or complete occlusions of an artery
Ischemic
extent of ischemic stroke depends on?
-rapidity of onset
-size of the lesion
-presence of collateral circulation
-mechanism of brain wherein it will find a new route or new artery for blood supple if there is blockage
collateral circulation
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
-lumen of the blood vessels narrow → then becomes occluded → infarction
thrombotic
common type of ischemic stroke
thrombotic
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
