CVA

Question 1

___ leading cause of death

Answer 1

5th

Question 2

After the scalp is the ___ ___

Answer 2

dura mater

Question 3

After dura mater is the

Answer 3

arachnoid mater

Question 4

After arachnoid mater is the

Answer 4

pia mater

Question 5

Circle of willis is located where

Answer 5

subarachnoid space

Question 6

Anterior cerebral artery comes off of what and goes where

Answer 6

internal carotid artery and goes up to the front of the brain

Question 7

Anterior cerebral artery feeds into

Answer 7

the inside - it gets the frontal lobes but mostly runs along the inside of the brain

Question 8

Middle cerebral artery feeds where

Answer 8

up the outside of the brain

Question 9

Posterior cerebral artery feeds where

Answer 9

the back of the brain

impacts the posterior cranial nerves - gagging, swallowing

Question 10

If there is an injury to the right side of the brain where does the patient exhibit symptoms

Answer 10

the left - everything crosses at the thalamus

Question 11

The majority of people are which brain dominant

Answer 11

left

Question 12

Spending money on shoes and brain deviation

Answer 12

left - math side

right - creative, the story you make up

Question 13

Brain injury - it is really all about

Answer 13

blood flow AND the Kreb cycle!

Need oxygen and glucose

Question 14

Kreb cycle

Answer 14

1 molecule of glucose and a lot of oxygen goes through Kreb and result is 32 ATP - leads to happy productive cells

Question 15

If can’t get oxygen to cell we default to what

Answer 15

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

Question 16

Brain needs constant supply of

Answer 16

O2 and glucose and the only way to get it is from blood

Question 17

Volume and pressure concept

Answer 17

Brain, Blood, CSF
Brain tissue 80%, others 10% each
If something extra comes in, something has to get kicked out

Question 18

Autoregulation can

Answer 18

Optimize blood flow to brain tissues by manipulating pressures - can shunt blood and CSF out of the skull

Question 19

What if all of the CSF and blood that can be shunted is out but still not enough space>

Answer 19

brain tissue will get shunted out (CSF first and then venous blood)
Called herniation syndrome and is not compatible with life

Question 20

What if brain tissue becomes ischemic -

Answer 20

inflammatory response kicks in - dying tissue will get bigger

Question 21

Two ways for a stroke to occur

Answer 21

Ichemic

Hemorrhagic

Question 22

Ischemic stroke

Answer 22

something is in the way of the vessel and cuts flow

Question 23

Hemorrhagic stroke

Answer 23

hole in the vessel and blood comes out

Question 24

Most common type of strok

Answer 24

Ischemic! then hemorrhagic and then subarachnoid

Question 25

Ischemic stroke can be

Answer 25

thrombotic | embolic

Question 26

Thrombotic ischemic stroke

Answer 26

grow a plaque and a clot around the plaque

Question 27

Embolic ischemic stroke

Answer 27

flick off a piece of the clot or plaque and goes into arterial system

Question 28

Risk factors for CVA

Answer 28

High cholesterol, smoking, sedentary, age, diet, genetics, sex, obesity, ethnicity, A fib, atherosclerosis, HPTN, diabetes, valvular heart disease, sickle cell disease

Question 29

Common symptoms of CVA

Answer 29

Speech, facial droop, one side weaker than other, sensation loss on one side, confusion, trouble talking, thinking, walking

Question 30

Headache as a symptom of CVA

Answer 30

not for ischemic but yes for hemorrhagic

Question 31

Blood on brain tissue =

Answer 31

BAD | PAIN

Question 32

Anterior cerebral artery - calling 911

Answer 32

Can't walk to phone, but can call 911

Question 33

Anterior cerebral artery - what will you see

Answer 33

LE weakness | Incontinence

Question 34

Middle cerebral artery - calling 911

Answer 34

Can walk to the phone but can't speak to 911

Question 35

Middle cerebral artery - what will you see

Answer 35

Facial and arm weakness | Aphasia

Question 36

Aphasias can be __ or __

Answer 36

Brocas - expressive | Wernickes - receptive

Question 37

Brocas motor or expressive aphasia - where is brocas

Answer 37

back of frontal lobe

Question 38

Brocas motor or expressive aphasia - what do you see

Answer 38

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

Question 39

Wernickes or fluent aphasia or receptive aphasia - where is it

Answer 39

front of temporal

Question 40

Wernickes or fluent aphasia or receptive aphasia - what do you see

Answer 40

speech is good and they can get words out but they don't have meaning or make sense

Question 41

Posterior circulation CVA - calling 911

Answer 41

too dizzy to walk to the phone and can't see all of the numbers on the phone to call 911

Question 42

Posterior circulation CVA s/s

Answer 42

5Ds Dizzy, diplopia, dysarthria, dysphagia, dystaxia

Question 43

Dysarthria is what

Answer 43

the muscles don't work

Question 44

Hemianopsia is what

Answer 44

Part of the visual field is cut

Question 45

Neglect is what

Answer 45

Don't recognize a part of their body as their own

Question 46

Apraxia is what

Answer 46

Give them an object that they would normally use and they don't know how to use it - like meal with spoon and fork

Question 47

Treating an acute CVA - first need to figure out if

Answer 47

hemorrhagic or ischemic

Question 48

Treating acute CVA - CT scan - if normal think

Answer 48

ischemic

Question 49

Treating an acute CVA - after determine if ischemic or hemorrhagic then what

Answer 49

Consider their symptoms

Question 50

FAST

Answer 50

Face Arms Speech Time

Question 51

NIHSS stroke scale includes what additionally

Answer 51

vision, language

Question 52

How is the NIHSS scored

Answer 52

serially Initially to determine if candidate for fibrinolytics and then serially to see if worked

Question 53

Inclusion criteria for tPA

Answer 53

Onset of sx 3 hrs (up to 4.5) prior Ischemic stroke Measureable neuro deficit 18 yrs or older

Question 54

Absolute exclusion criteria for tPA

Answer 54

Intracranial hemorrhage, hx of it Uncontrolled HPTN (185, 110) Head trauma or CVA within 3 months Coagulopathy

Question 55

Relative exclusion criteria for tPA

Answer 55

``` OVer 75 yrs Mild sx or very severe like coma Recent surgery Recent GI bleed Seizure ```

Question 56

What can be done if the patient can't be given the drugs

Answer 56

Intra-arterial fibrinolysis Embelectomy Coiling of aneurysm

Question 57

What can be done post acutely for CVAs

Answer 57

Control comorbidities like HPTN, Diabetes, Heart Disease | THERAPY! PT, OT, Speech

Question 58

Prognosis

Answer 58

``` Depends Ischemic better than hem NIHSS less than 10 is better after 1 yr 25% left with disability 25% stroke again within 5 yrs ```

Question 59

Where does the circle of willis live

Answer 59

in the subarachnoid space

Question 60

``` Which is NOT a risk factor for stroke A fib Oral contraceptives Smoking Hx of bleeding ulcer ```

Answer 60

Hx of bleeding ulcer

Question 61

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

Answer 61

Speech is halting and garbled

Question 62

You received consult to work with left sided MCA stroke - what symptoms do you expect

Answer 62

Right sided arm weakness | Aphasia

Question 63

``` Which is an absolute contraindication for tPA Hx of peptic ulcer BP 170/100 Last time seen normal over 12 hrs prior Age 65 ```

Answer 63

Last time seen normal over 12 hours prior