CVA

Question 1

What is a CVA?

Answer 1

A CVA is a Cerebrovascular Accident (stroke). This is where there has been a disruption of blood supply to the brain.

A stroke is characterised by rapidly developing clinical signs or symptoms of focal or global loss of cerebral function lasting more than 24 hours.

Question 2

What are the two types of CVA?

Answer 2

Ischaemic - A blockage/occlusion in a blood vessel in the brain

Haemorrhagic - A burst/ruptured blood vessel in the brain

Question 3

Name the types of ischaemic CVA

Answer 3

Embolic - where a clot has travelled from elsewhere in the body and blocked in the smaller blood vessels in the brain (sudden onset).

Thrombotic - where a clot has formed inside the brain blood vessel (usually develops overnight).

Question 4

Name the types of haemorrhagic CVA

Answer 4

Intracerebral haemorrhage - bleeding into the deeper parts of the brain. Associated with hypertension. Severe headache and vomiting.

Subarachnoid haemorrhage - bleeding into the subarachnoid space due to ruptured aneurysm, arteriovenous malformation or trauma. Intense vomiting and loss of consciousness.

Subdural haemorrhage - bleeding into the subdural space usually caused by trauma. Headache, drowsiness, hemiparesis, coma.

Extradural haemorrhage - bleeding into the extradural space. Associated with severe trauma.

Question 5

How is the brain supplied?

Answer 5

By two vertebral arteries and two internal carotid arteries.

Question 6

Brain arteries and what they supply.

Answer 6

Anterior Cerebral Artery - frontal lobe, medial part of the sensorimotor cortex

Middle Cerebral Artery - most of the outer surface, sensorimotor cortex, basal ganglia, Broca’s Area (ONLY ON LEFT, production of speech)

Posterior Cerebral Artery - occipital lobe, medial aspect of temporal lobe, thalamus

Basilar Artery - brainstem, cerebellum

Question 7

Scale to measure ischaemic CVA

Answer 7

Bamford Classification Scale

TACS - Total anterior circulation stroke
PACS - Partial anterior circulation stroke
POCS - Posterior circulation stroke
LACS - Lacuna stroke (deep arteries)

Question 8

Medical Management of a CVA

Answer 8

• MRI/CT scan
• Aspirin, anticoagulants - ISCHAEMIC. Blood pressure tablets, blood clotting tablets - HAEMORRHAGIC.
• Blood tests, angiography, echocardiology
• Thrombectomy

Question 9

Clinical Features of a CVA - Motor symptoms

Answer 9

• Alterations in tone - spasticity/flaccidity
• Ataxia
• Weakness
• Asymmetry

Motor cortex in the frontal lobe, corticospinal tract

Question 10

Clinical Features of a CVA - Sensory symptoms

Answer 10

Sensory impairment:

• Impaired sensation
• Stereognosis
• Proprioceptive impairment

Visual problems:

• Visual field loss
• Homonymous Hemianopia

Sensory receptors (touch, pressure, temp, pain). Sensory cortex in the parietal lobe. Dorsal column tracts (cuneatus and gracilis).

Question 11

Clinical Features of a CVA - Speech symptoms

Answer 11

• Dysarthria (slurred speech)
• Expressive dysphasia (lose the ability to produce speech - damage to Broca’s area)
• Receptive dysphasia (lose the ability to understand speech - Wernicke’s area).

Motor cortex in the frontal lobe - Broca’s area. Auditory cortex in the temporal lobe - Wernicke’s area.

Question 12

Clinical Features of a CVA - Cognitive symptoms

Answer 12

• Perceptual problems - Visual/auditory agnosia (unable to recognise things with a specific sense)
• Apraxia
• Neglect