CVA

Question 1

What is a Cerebrovascular Disease? CVA

Answer 1

Stroke

Question 2

Define what a CVA is. What is it? What is it due to?

Answer 2

an acute neurological deficit d/t ischemia

Question 3

If a CVA is an acute neurological deficit d/t ischemia, what does this mean in regards to perfusion to the brain?

Answer 3

Lack of perfusion to the brain.

Question 4

There are 2 Types of CVAs. Name them and explain what it is.
1.
2.

Answer 4

1. Ischemic CVA
   - obstructed or occluded vessel causing lack of perfusion to the brain tissue
2. Hemorrhagic CVA
   - vessel severed in cranium –> hemorrhage –> brain compression

Question 5

Ischemic CVA: the vessel can be occluded why? (2)

Answer 5

1. Embolus

2. Thrombosis

Question 6

The risks for CVA

1. Modifiable (5)
2. Unmodifiable (4)

Answer 6

1. HTN, atherosclerosis, Hyperlipiedmia, DM, Smoking

2. Aging, males, prior strokes, familial history

Question 7

If the modifiable risk factors for CVA are managed, can a stroke be avoided?

Answer 7

Yes

Question 8

The patho for CVA involves the brain being sensitive to what two things?
Can the brain utilize anarerobic metabolism?

Answer 8

Oxygen and glucose

The brain relies on aerobic metabolism for ATP

Question 9

What are the two forms of stroke?

Answer 9

1. Ischemic CVA

2. Hemorrhagic CVA

Question 10

Explain the patho for Ischemic CVA:

Answer 10

Occlusion of the vessel –> focal ischemia –> necrotic core (dead tissue which will have loss of function) –> pneumbra around the necrotic core (tissue that is lacking perfusion but still alive) –> penumbra will become smaller and necrotic core bigger if there is not an intervention to increase the blood supply to the brain

Question 11

What does focal ischemia mean?

What does global ischemia mean?

Answer 11

1 hemisphere affected

Most of the brain is obstructed (BIG PROBLEM!)

Question 12

1. Explain the patho for Hemorrhagic CVA:
2. What usually causes this? (4)
3. What are the two complications from this?

Answer 12

1. severed vessel –> hemorrhaging –> compression
2. Htn and ageing (also aneurysms and tumors)
3. Coma and death

Question 13

Define TIA

is this a large or mini stroke?

Answer 13

Transient Ischemic Attack

Mini stroke

Question 14

Transient Ischemic Attack: what is occuring to the neurological deficit? d/t what?

Answer 14

acute, brief, neurological deficit d/t acute focal ischemia

Question 15

1. Is a TIA reversible?
2. Is the ET/Patho of TIA similar to CVA?
3. Does a TIA involve a necrotic core? Penumbra?

Answer 15

1. Yes
2. yes
3. No nectrotic core, yes penumbra

Question 16

Why would a TIA have a pneumbra?

Answer 16

The tissue is not being properly perfused, but there is no necrosis occuring.

Question 17

Does a TIA involve permanant damage?

Answer 17

No.

Question 18

If you have a TIA, what does this do for your risk of future TIA’s or strokes?

Answer 18

Increases the risk

Question 19

The manifestations for CVA depend on what?

Are the mnfts an acute onset?

Answer 19

the location, size of vessel, and area of brain distal to the vessel

Yes they are an acute onset

Question 20

The mnfts for a CVA in the left hempishere would present in the right side of a patient. Why?

Answer 20

D/t to the decaustation of the pyramids, the fibers cross over.

Question 21

What are the 3 main symptoms of a CVA?

Answer 21

1. Unilateral weakness or numbness in face, arm, and or leg (1 or more)
2. Speech alteration
3. Altered vision in 1 eye

Question 22

How is CVA Dx (3)

Answer 22

1. Labs
2. EEG
3. MRI/CT scans

Question 23

What labs are looked at for CVA? (3)

Expla

Answer 23

CBC, INR, lipids

Question 24

1. Why assess the INR?

2. Why assess the lipids?

Answer 24

1. Clotting time (for TPA)

2. Hyperlipedima can lead to atherosclerosis

Question 25

What is the electroencephogram looking at?

Answer 25

Conductivity of the brain tissue

Question 26

What is the MRI/CT scan looking for?

Answer 26

Differentiating between Ischemic and Hemorrhagic stroke

Question 27

The treatment for strokes main focus is to preserve AND salvage what?

Answer 27

Life! Penumbra!

Question 28

What is the Stat treatment for Ischemic stroke.

Answer 28

ASA (antiplatelet) 160 mg, then taper down

Question 29

What is the purpose of administering the antiplatelet?

Answer 29

Not allowing platelets to aggregate

Question 30

When would TPA be given to a patient?

Answer 30

When they meet the criteria and it is an ischemic stroke.

Question 31

The treatment for CV risk factors includes what? (2)

Answer 31

statins to decrease cholesterol | antihypertensives to decrease BP

Question 32

Sx for stenosis for patients with ischemic stroke. What is this procedure called? what is the time frame post stroke for it to be done?

Answer 32

Carotid endoarterectomy done within 2 weeks of CVA

Question 33

What would the stenosis be?

Answer 33

Narrowing of the blood vessel d/t atherosclerosis

Question 34

To prevent recurrence involves what? (2)

Answer 34

Reducing risk factors | Blood thinners to prevent thrombus reappearing

Question 35

Would a blood thinner ever be given to a patient experiencing a hemorrhagic stroke?

Answer 35

Nope you crazy lady.

Question 36

To prevent extension involves what?

Answer 36

preventing complications, be aware of aspirations