CVA

Question 0

FAST

Answer 0

Face Arms Speech Time

Question 1

What is a stroke?

Answer 1

Supply of blood to brain is suddenly disrupted. Two types haemorrhagic (bleed in or around brain). Ischemic (blocked bf to the brain)

Question 2

Signs & Symptoms of Stroke

Answer 2

Hemiparesis,mono paresis, or quadriparesis. Hemisensory deficits, visual field deficits, dysarthria, ataxia, facial droop, vertigo,aphasia, sudden decrease in level of consciousness

Question 3

Sub arachnoid hemorrhage presentation

Answer 3

Sudden onset headache, nausea,vomiting, signs of meningitis (neck stiffness, photophobia) decrease level of consciousness.

Question 4

Intracerebral hemorrhage presentations

Answer 4

More insidious, focal neurological signs, fluctuating levels of consciousness

Question 5

Describe ischaemic stroke

Answer 5

Obstruction of an artery leading to or in the brain preventing oxygenated blood and nutrients from reaching parts of the brain that the artery feeds

Question 6

Name the 2 the types of ischemic strokes

Answer 6

Large vessel thrombosis (most common, occurs in large arteries). Small vessel disease (lacunar infarction -deep brain infarct). Occurs when BF is blocked to a very small arterial vessel.

Question 7

Embolic ischaemic stroke

Answer 7

A blood clot that forms in one area of the body and travels through the bloods stream where it may lodge. Can be fat globules, air bubbles, or bits and pieces of atherosclerotic plaque such as lipid debris that have detached from an artery wall or cardiac source.

Question 8

Nurses role in stroke management

Answer 8

Neuro obs, assistance with mobility, falls prevention,info & support, do, trachy management, pt centred care, continence,skin integrity, pain control, incontinence, swallowing hydration

Question 9

Ischemic stroke

Answer 9

Main mechanisms= thrombosis, embolism, and systemic hypo perfusion. The underlying mechanism can often be deduced by the size of the artery affected. Large arteries = carotid, vertebral and basilar. Small arteries =perforator arteries from MCA, verterbral and basilar - ischemia in these vessels give rise to lacunar strokes.

Question 10

Borderzone Infarcts

Answer 10

Ischemic- sometimes known as watershed infarcts. Typically occur at boundaries of arterial territories. Occur due to hypo perfusion either following a period of systemi hypotension (cardiac arrest or intraoperative) or from complete occlusion of a large artery with minimal compensatory collateral flow

Question 11

Primary and secondary prevention in TIA and stroke

Answer 11

Anti platelet meds -aspirin, copied ogres, or comb of aspirin and dipyrimade, anti coags- warfarin. BP management -ACE inhibitors in comb with diuretics. Lifestyle changes- diet and exercise. Cholesterol lowering therapy

Question 12

Cerebral oedema

Answer 12

Common complication of large multi lobe strokes. Peaks 3-5 days and is only a problem in the first 24 hours in young stroke pts. Young people have no cerebral atrophy and thus no room to accommodate a swelling brain. Clinical signs= change in consciousness, worsening neurological deficits! new pupillary changes or changes in respiratory patterns .

Question 13

Midline shift

Answer 13

Shift of the brain past it’s centre line. Commonly associated with a distortion in the brain stem, failure of the pupils to constrict in response to light. Often associated with a high ICP that can be deadly.

Question 14

Herniation

Answer 14

Coning. When pt has a neurological injury or a space occupying mass within the skill (such as a tumour, swelling, excess CSF or bleed ) the pressure in the cranium may rise= brain tissue displaced to an area of low pressure. When the pressure increases the brain tissue herniates (get pushed down). This can cause alterations in the functions of neurons. Clinical symptoms = hemiplegia, dilated pupils and restlessness. If pressure persists brain may be pushed down through foramen ovale, which may lead to a basic loss of cardio respiratory function,

Question 15

TIA

Answer 15

Transient obstruction to BF where no significant damage is detected on CT or MRI. Symptoms may resolve in 24 hours. Direct warning for a major stroke.

Question 16

Complications of stroke

Answer 16

Dysphagia - damage interrupts normal swallowing reflex making aspiration possible leading to infection (pneumonia). Pneumonia- most common complication. Others include cardiac complications, venous thrombo embolism, fever, pain , incontinence and depression.

Question 17

Symptoms of subarachnoid hemmorhage

Answer 17

Sudden sever headache, photophobia, pain with eye movements, nausea and vomiting, syncope. Signs of meningitis with uncalled rigidity

Question 18

Routine investigations for CVA

Answer 18

ct, MRI, blood test (cardiac, lipids, pregnancy, toxicology, Doppler us, angiography, coagulation blood tests.

Question 19

Clinical assessment for CVA

Answer 19

1. Distinguish strokes a from mimics (seizures, infections, brain tumour). 2. Determine and document for future comparison. 3. Localise the lesion. 4. Identify comorbidities 5. Identify conditions influencing treatment decisions ( active bleeding,infection). Careful head and neck exam, physical exam (ABC + vitals). Neurological exam.

Question 20

Risk factor for ischemic stroke

Answer 20

Non-modifiable: age,race,sex,history of migraines, fibromuscular dysplasia, hereditary . Modifiable: HTN, DM, valvular disease, HF, MS, structural anomalies that allow R to L shunting. TIAs , hypercholesterolemia, carotid stenosis, obesity, contraceptives, sickle cell disease

Question 21

Haemorrhagic stroke

Answer 21

Occurs when a BV suddenly ruptures or blood begins to leak directly into the tissue. Leading cause in HTN. Can originate from a weak spot on BV wall or other BV malformation in or around brain. Rupture can be caused by the force of high BP. Includes Intracerebral haemorrhage, subarachnoid and cerebral aneurysm.