CVA

Question 1

sudden onset of a focal deficit resulting from either infarction or hemorrhage within the brain

Answer 1

CVA

Question 2

major cause of death within the first 5 years of a CVA is what?

Answer 2

cardiac disease

Question 3

ischemia etiology:

Answer 3

carotid atherosclerotic dx with artery-to-artery thromboembolism

Question 4

other etiologies include?

Answer 4

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

Question 5

anterior cerebral:

Answer 5

frontal and parietal, hemiparesis affecting leg>arm

Question 6

middle cerebral:

Answer 6

frontal, temporal and parietal, hemiparesis arm/face> leg

Question 7

posterior cerebral:

Answer 7

occipital, homonymous hemianopsia

Question 8

carotid:

Answer 8

amaurosis Fugax, loss of vision (curtain over eye!!! emergency!!!!!)

Question 9

signs and symptoms:

carotid circulation:

Answer 9

hemiplegia, hemianesthesia, neglect, aphasia, visual field defects (less often HA, seizures, amensia, confusion)

Question 10

Vertebrobasilar (brainstem or cerebellar): s/s

Answer 10

diplopia, vertigo, ataxia, facial paresis, Horner syndrome, dysphagia, dysarthia, impaired level of consciousness

Question 11

cerebellar lesions would show what sign?

Answer 11

HA! N/V

Question 12

some tests we can do?

Answer 12

duplex carotid US
ECG
EEG
transthroacic echocardiogram
holter monitor
PT, PTT, B12, homocysteine
cardiac enzymes
antiphospholipid ABs

Question 13

best test for CVA?

Answer 13

MRI! usually wont get it first, will get an CT f

Question 14

surgical therapy: medically fit pts with >70% stenosis, what surgery and side?

Answer 14

carotid endarterectomy on ipsilateral side

Question 15

tx: we want to maintin what and monitor what for 48 hours?

Answer 15

oxygenation

cardiac rhythm

Question 16

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)

Answer 16

elevated BP

Question 17

other tx we can use?

Answer 17

heparin
statins
SSRIs

Question 18

what do we want to use in highly selected cases within 3 hours of ischemia stroke?

Answer 18

IV tissue plasminogen

Question 19

when do we want to give Warfarin?

Answer 19

pts a fib or cardioembolic stroke

Question 20

occurs when supply of O2 is cut off to an area of the brain, less than 24 hours symptoms

Answer 20

TIA

Question 21

anyone with a TIA is at a greater risk for what?

Answer 21

developing a stroke in the future

Question 22

TIA (carotid) s/s:

Answer 22

loss of vision in 1 eye

clumsiness or weakness on 1 side of body

problems with speech

Question 23

TIA (vertebro-basilar system s/s):

Answer 23

vision problems with both eyes

vertigo

ataxia

double vision

LOC or temporary amnesia

Question 24

TIA workup and tx?

Answer 24

same workup as CVA

ASA if not on ASA prior to TIA

clopidogrel or dipyridamole