CVA Flashcards
___ leading cause of death
5th
After the scalp is the ___ ___
dura mater
After dura mater is the
arachnoid mater
After arachnoid mater is the
pia mater
Circle of willis is located where
subarachnoid space
Anterior cerebral artery comes off of what and goes where
internal carotid artery and goes up to the front of the brain
Anterior cerebral artery feeds into
the inside - it gets the frontal lobes but mostly runs along the inside of the brain
Middle cerebral artery feeds where
up the outside of the brain
Posterior cerebral artery feeds where
the back of the brain
impacts the posterior cranial nerves - gagging, swallowing
If there is an injury to the right side of the brain where does the patient exhibit symptoms
the left - everything crosses at the thalamus
The majority of people are which brain dominant
left
Spending money on shoes and brain deviation
left - math side
right - creative, the story you make up
Brain injury - it is really all about
blood flow AND the Kreb cycle!
Need oxygen and glucose
Kreb cycle
1 molecule of glucose and a lot of oxygen goes through Kreb and result is 32 ATP - leads to happy productive cells
If can’t get oxygen to cell we default to what
anaerobic metabolism - get 2 ATP and lactic acid - leads to cellular swelling and then death and K comes out and other bad things now out of the cell
Brain needs constant supply of
O2 and glucose and the only way to get it is from blood
Volume and pressure concept
Brain, Blood, CSF
Brain tissue 80%, others 10% each
If something extra comes in, something has to get kicked out
Autoregulation can
Optimize blood flow to brain tissues by manipulating pressures - can shunt blood and CSF out of the skull
What if all of the CSF and blood that can be shunted is out but still not enough space>
brain tissue will get shunted out (CSF first and then venous blood)
Called herniation syndrome and is not compatible with life
What if brain tissue becomes ischemic -
inflammatory response kicks in - dying tissue will get bigger
Two ways for a stroke to occur
Ichemic
Hemorrhagic
Ischemic stroke
something is in the way of the vessel and cuts flow
Hemorrhagic stroke
hole in the vessel and blood comes out
Most common type of strok
Ischemic! then hemorrhagic and then subarachnoid
Ischemic stroke can be
thrombotic
embolic
Thrombotic ischemic stroke
grow a plaque and a clot around the plaque
Embolic ischemic stroke
flick off a piece of the clot or plaque and goes into arterial system
Risk factors for CVA
High cholesterol, smoking, sedentary, age, diet, genetics, sex, obesity, ethnicity, A fib, atherosclerosis, HPTN, diabetes, valvular heart disease, sickle cell disease
Common symptoms of CVA
Speech, facial droop, one side weaker than other, sensation loss on one side, confusion, trouble talking, thinking, walking
Headache as a symptom of CVA
not for ischemic but yes for hemorrhagic
Blood on brain tissue =
BAD
PAIN
Anterior cerebral artery - calling 911
Can’t walk to phone, but can call 911
Anterior cerebral artery - what will you see
LE weakness
Incontinence
Middle cerebral artery - calling 911
Can walk to the phone but can’t speak to 911
Middle cerebral artery - what will you see
Facial and arm weakness
Aphasia
Aphasias can be __ or __
Brocas - expressive
Wernickes - receptive
Brocas motor or expressive aphasia - where is brocas
back of frontal lobe
Brocas motor or expressive aphasia - what do you see
Words come out but broken speech, they can understand you and they know what they want to say but they can’t say it correctly
Often they are frustrated patients because they can’t get their words out
Wernickes or fluent aphasia or receptive aphasia - where is it
front of temporal
Wernickes or fluent aphasia or receptive aphasia - what do you see
speech is good and they can get words out but they don’t have meaning or make sense
Posterior circulation CVA - calling 911
too dizzy to walk to the phone and can’t see all of the numbers on the phone to call 911
Posterior circulation CVA s/s
5Ds Dizzy, diplopia, dysarthria, dysphagia, dystaxia
Dysarthria is what
the muscles don’t work
Hemianopsia is what
Part of the visual field is cut
Neglect is what
Don’t recognize a part of their body as their own
Apraxia is what
Give them an object that they would normally use and they don’t know how to use it - like meal with spoon and fork
Treating an acute CVA - first need to figure out if
hemorrhagic or ischemic
Treating acute CVA - CT scan - if normal think
ischemic
Treating an acute CVA - after determine if ischemic or hemorrhagic then what
Consider their symptoms
FAST
Face
Arms
Speech
Time
NIHSS stroke scale includes what additionally
vision, language
How is the NIHSS scored
serially
Initially to determine if candidate for fibrinolytics
and then serially to see if worked
Inclusion criteria for tPA
Onset of sx 3 hrs (up to 4.5) prior
Ischemic stroke
Measureable neuro deficit
18 yrs or older
Absolute exclusion criteria for tPA
Intracranial hemorrhage, hx of it
Uncontrolled HPTN (185, 110)
Head trauma or CVA within 3 months
Coagulopathy
Relative exclusion criteria for tPA
OVer 75 yrs Mild sx or very severe like coma Recent surgery Recent GI bleed Seizure
What can be done if the patient can’t be given the drugs
Intra-arterial fibrinolysis
Embelectomy
Coiling of aneurysm
What can be done post acutely for CVAs
Control comorbidities like HPTN, Diabetes, Heart Disease
THERAPY! PT, OT, Speech
Prognosis
Depends Ischemic better than hem NIHSS less than 10 is better after 1 yr 25% left with disability 25% stroke again within 5 yrs
Where does the circle of willis live
in the subarachnoid space
Which is NOT a risk factor for stroke A fib Oral contraceptives Smoking Hx of bleeding ulcer
Hx of bleeding ulcer
Stroke patient has Wernickes aphasia - you would expect all of the following except
They dont always follow directions
Speech is halting and garbled
Confident that they are understood by you
Fluent speech but doesnt make sense
Speech is halting and garbled
You received consult to work with left sided MCA stroke - what symptoms do you expect
Right sided arm weakness
Aphasia
Which is an absolute contraindication for tPA Hx of peptic ulcer BP 170/100 Last time seen normal over 12 hrs prior Age 65
Last time seen normal over 12 hours prior
