CVA Flashcards
If a CVA is suspected, what diagnostic tool is used to
determine whether the stroke is hemorrhagic or
ischemic in nature?
A noncontrast CT
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 234.
Why is it vital to determine whether a stroke is
hemorrhagic or ischemic?
The treatment modalities are completely different.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 234-236.
Is CT sensitive to ischemic changes?
No. Although the CT reliably detects intracranial bleeding, it is
insensitive to ischemic changes during the first few hours
following a stroke.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 234.
Are most strokes ischemic or hemorrhagic?
Most CVAs are ischemic in nature. Only about 20% are
hemorrhagic.
Butterworth JF, Mackey DC, Wasnick JD. Morgan & Mikhail’s
Clinical Anesthesiology. 5th ed. New York, NY: McGraw-Hill;
2013: 481.
What is the most significant risk factor for an acute
ischemic stroke?
Systemic HTN
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 234.
List some risk factors associated with acute ischemic
strokes.
Systolic and diastolic HTN, hyperlipidemia, increased serum
homocysteine concentrations, smoking, alcohol abuse, and DM.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 235.
A patient has been diagnosed with an ischemic
stroke. If IV TPA (tissue plasminogen activator) is
used, how soon must this treatment be initiated?
Within 3 hours from the onset of the symptoms
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 234-235.
What type of CVA is more likely to result in death?
Intracerebral hemorrhage or Ischemic stoke?
Intracerebral hemorrhages. They are four times more likely to
result in death.
Stoelting RK, Dierdorf SF. Anesthesia & Co-Existing Diseases.
5th ed. New York, NY: Churchill-Livingston; 2008: 216.
What are the two types of hemorrhage that result in
an acute hemorrhagic stroke?
Acute hemorrhagic strokes are caused from a subarachnoid
bleed or an intracerebral bleed.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 235.
What are the two most accurate predictors of
outcome following an intracerebral hemorrhage?
The patient’s level of consciousness and the estimated volume
of blood
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 235.
List symptoms associated with a subarachnoid
hemorrhage?
Severe headache, stiff neck, photophobia that is of rapid onset,
focal neurologic changes, decreased level of consciousness
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 236.
What is the main goal following a subarachnoid
hemorrhage? (with or without radiographic treatment
or surgical involvement)
The main goal is to prevent vasospasm. Vasospasms usually
occur 3 to 15 days post bleed. Transcranial doppler
sonographic exams are performed daily to find vasospasm.
Once found, triple H therapy is initiated. (Hypertension,
Hypervolemia, passive Hemodilution)
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 236.
What is the most common cause of a spontanoeus
subarachnoid hemorrhage?
Rupture of an intracranial aneurysm
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 236.
What electrocardiogram changes are often seen
following a subarachnoid hemorrhage?
ST-segment depression, and inverted T waves.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 236.
