CVA Flashcards
sudden onset of a focal deficit resulting from either infarction or hemorrhage within the brain
CVA
major cause of death within the first 5 years of a CVA is what?
cardiac disease
ischemia etiology:
carotid atherosclerotic dx with artery-to-artery thromboembolism
other etiologies include?
hemorrhagic
HTN
Amyloid
cardioembolism 2ndary to valvular pathology
mural hypokinesias/akinesias thrombosis
cardiac arrhythmia
spontaenous/post traumatic artery dissection (chiropractic manipulation)
fibromuscular dysplasia
vasculitis
drugs (cocaine, amphetamines)
AV malformation, cavernous angioma, venous angioma, capillary angioma
anterior cerebral:
frontal and parietal, hemiparesis affecting leg>arm
middle cerebral:
frontal, temporal and parietal, hemiparesis arm/face> leg
posterior cerebral:
occipital, homonymous hemianopsia
carotid:
amaurosis Fugax, loss of vision (curtain over eye!!! emergency!!!!!)
signs and symptoms:
carotid circulation:
hemiplegia, hemianesthesia, neglect, aphasia, visual field defects (less often HA, seizures, amensia, confusion)
Vertebrobasilar (brainstem or cerebellar): s/s
diplopia, vertigo, ataxia, facial paresis, Horner syndrome, dysphagia, dysarthia, impaired level of consciousness
cerebellar lesions would show what sign?
HA! N/V
some tests we can do?
duplex carotid US ECG EEG transthroacic echocardiogram holter monitor PT, PTT, B12, homocysteine cardiac enzymes antiphospholipid ABs
best test for CVA?
MRI! usually wont get it first, will get an CT f
surgical therapy: medically fit pts with >70% stenosis, what surgery and side?
carotid endarterectomy on ipsilateral side
tx: we want to maintin what and monitor what for 48 hours?
oxygenation
cardiac rhythm
tx: Bp >185/110 if pt will be or has been treated with IV tissue plasminogen activator
do not tx this unless acute end organ dysfunction (enpephalopathy, MI, aortic dissection, ARF)
elevated BP
other tx we can use?
heparin
statins
SSRIs
what do we want to use in highly selected cases within 3 hours of ischemia stroke?
IV tissue plasminogen
when do we want to give Warfarin?
pts a fib or cardioembolic stroke
occurs when supply of O2 is cut off to an area of the brain, less than 24 hours symptoms
TIA
anyone with a TIA is at a greater risk for what?
developing a stroke in the future
TIA (carotid) s/s:
loss of vision in 1 eye
clumsiness or weakness on 1 side of body
problems with speech
TIA (vertebro-basilar system s/s):
vision problems with both eyes
vertigo
ataxia
double vision
LOC or temporary amnesia
TIA workup and tx?
same workup as CVA
ASA if not on ASA prior to TIA
clopidogrel or dipyridamole
