CVA Flashcards
1
Q
most frequently occurring neurologic disorder?
A
CV disorders
2
Q
a red stroke is a…
A
hemorrhagic stroke
3
Q
a white stroke is a…
A
ischemic stroke
4
Q
a lacunar stroke is a…
A
microvascular stroke
5
Q
CVA is also called…
A
brain attack and stroke
6
Q
cell damage in a CVA results from what
A
inadequate perfusion
7
Q
Greatest risk factor for cva
A
HTN
8
Q
2 types of CVA?
A
ischemic and hemorrhagic
9
Q
2 types of ischemic strokes?
A
thrombotic and embolic
10
Q
this type of stroke is from a local source
A
thrombotic
11
Q
what causes a hemorrhagic stroke
A
ruptured BV
12
Q
what does a hemorrhagic stroke cause
A
downstream ischemia, localized edema, and mass effect
13
Q
def of ischemia?
A
inadequate blood supply to the tissue
14
Q
def of hypoxia?
A
inadequate oxygen supply to the tissue
15
Q
damage from a stroke depends on what
A
where event occurs and the size of the area affected
16
Q
what is infarction
A
tissue death
17
Q
what is anoxic brain injury
A
cell death from hypoxia/anoxia
18
Q
where do emboli come from
A
large arteries, small arteries, major source cardiogenic, unsual, cryptogenic
19
Q
patent foramen ovale
A
hole in heart that causes right to left shunt; when blood goes from right to left atrium
20
Q
what is DVT provoked by
A
reduced mobility, dehydration, hypercoagulable state
21
Q
how much cardiac output flows to the brain
A
25%
22
Q
are there more hemorrhagic strokes or ischemic
A
ischemic
23
Q
what did franklin D roosevelt die from
A
malignant HTN
24
Q
why has there been a reduction in CVA since 1950
A
dec incidence of CAD and uncontrolled HTN, better trmt from HTN, CAD,AFib
25
what causes CVA?
HTN, atrial fibrillation, diabetes, smoking, hyperlipidemia, hypercoagulable states, oral contraceptives, CHF, coronary atherosclerosis, structural heart disease, hypokalemia, genetic
26
what are some hypercoagulable states
cancer, factor 5
27
what can increase plaque formation
diabetes, smoking, hyperlipidemia
28
what type of CVA do atrial fibrillations cause
embolic ischemic strokes
29
2 types of strokes?
TIA and CVA
30
what is a stroke in evolution
stroke is still going on
31
what is a complete stroke
stroke is over
32
what are the 4 arteries the circle of willis is fed by
internal carotid artery, external carotid artery, and 2 vertebral arteries
33
what is a TIA
Episode of focal/localized cerebral ischemia that resolves fully and rapidly, usually within 1-24 hours, without evidence of cerebral infarction
34
if someone has a TIA, its a blinking red light that what...
a CVA is prob gonna come soon
35
mechanism of TIA
Transient embolus versus impending vascular occlusion
36
mechanism in a hemorrhagic CVA
disruption of the blood brain barrier; blood toxicity
37
mass lesion?
hematoma compresses underlying brain
38
4 categories of a hemorrhagic stroke
epidural, subdural, subarachnoid, intracranial
39
what type of blood is in an subdural hematoma
venous
40
is an epidural hematoma rapid onset or slow onset
rapid
41
is a subdural hematoma rapid onset or slow onset
slow
42
which type of hematoma comes in contact with the brain
subdural hematoma
43
which hematoma is the dura pushed away from the skull
epidural hematoma
44
mechanism of an epidural hemorrhage
Skull fracture lacerates an artery
45
epidural hemorrhage symptoms
headache, nausea, vomiting, seizures, focal neurologic deficits (eg, visual field cuts, aphasia, weakness, numbness)
46
what type of hemorrhage is seen on a CT without contrast
epidural hematoma
47
what is a subdural hematoma
Tearing of bridging veins connecting cerebral hemispheres with dural vessels and superior sagittal sinus.
48
what does cerebral atrophy lead to in elderly or pts with Hx EtOH
elongation of the distance the bridging veins must cross
49
when do symptoms come on for a subdural hematoma
may be none for hours to days
50
what are the symptoms of a subdural hematoma
headaches, confusion, behavioral changes, dizziness, nausea, vomiting, lethargy, weakness, apathy, seizures, loss of consciousness
51
MCC of Subarachnoid Hemorrhage
trauma
52
MC nontraumatic cause of a Subarachnoid Hemorrhage
ruptured saccular/berry aneurysm
53
what is an aneurysm
excessive localized enlargement of an artery caused by a weakening of the artery wall
54
what does an aneurysm look like
Protruding bubble or sac on a blood vessel that balloons out over time
55
3 types of aneurysms
saccular, fusiform, dissecting
56
3 arterial layer from deep to superficial
tunica intima, media, and adventitia
57
which arterial layer is the string muscular layer
tunica media
58
what aneurysm is AKA a berry aneurysm
saccular aneurysm
59
where does a saccular aneurysm bulge out
only one side of the artery wall
60
where are saccular aneurysms more common in and near
circle of willis
61
where does a fusiform aneurysm bulge out
all sides of BV
62
which aneurysm type has a “neck” that connects the aneurysm to its main (“parent”) artery and a larger, rounded area called the dome
saccular aneurysm
63
what are dissecting aneurysms formed thru?
accumulation of blood with a false lumen caused by a break in the intima of the blood vessel
64
where are intracranial aneurysms located
bifurcations in/near circle of Willis
65
MC intracranial aneurysms?
saccular
66
more common overall aneurysm?
fusiform
67
what can dissecting aneurysms be provoked by
trauma
68
what type of intracranial aneurysm is from a congenital abnormality and degenerative changes
saccular/berry
69
what are Mycotic aneurysms?
Arteritis caused by bacterial emboli/infection
70
what is a giant aneurysm
form of saccular aneurysm >2.5 cm
71
pseudoaneurysm/false aneurysm
External hematoma with a persistent communication to a leaking artery. Occurs when the vessel wall is injured and leaking blood collects in the surrounding tissue
72
what layers of a BV does an aneurysm invove?
all of them
73
MC CVA?
ischemic CVA
74
what is an ischemic stroke caused by
thrombus or embolism
75
what is the outcome of an ischemic CVA influenced by?
rate of onset and duration, collateral circulation, systemic circulation health, hypercoagulable state, high temp, glucose methanism
76
an ischemic CVA better if the duration is _____ and the onset is _____
short duration, slow onset
77
what does collateral circulation do to an ischemic CVA
helps
78
how does systemic circulation health impact ischemic CVA
Hypotension can result in global cerebral ischemia
79
how does hypercoagulable state impact ischemic CVA
increases microscopic thrombi, exacerbating vascular occlusion
80
how does elevated temp impact ischemic CVA
makes it worse
81
how does glucose mechanism impact ischemic CVA
hyper-, hypoglycemia worse
82
what do ischemic neurons do
release enzymes that increase microemboli and cause further damage
83
what is exotoxicity
during an ischemic stroke when damaged neurons cause an overreaction of certain NT such as glutamate and aspartate
84
when neurons surround the ischemic or infarcted areas, what gets disrupted
plasma membranes
85
what does Cellular edema cause compression of
capillaries
86
compression of an artery on the left side of the brain will affect what side of the body
right (contralateral)
87
compression of a nerve on the left side of the brain above the brainstem will affect what side of the body
right (contralateral)
88
compression of a nerve on the left side of the brain below the brainstem will affect what side of the body
left (ipsilateral)
89
penumbra?
cells at risk for damage if an ischemic stroke goes on for too long
90
why can Cells in the penumbra remain viable for up to several hours
collateral flow
91
what is the ischemic core
severe ischemia that leads to neuronal necrosis and glial cell damage
92
do older or younger ppl have better collateral flow
older
93
what are some ischemic CVAs accompanied by
spontaneous hemorrhage
94
which type of ischemic CVAs are usually accompanied by spontaneous hemorrhage
embolic
95
does conversion of an ischemic stroke worsen prognosis
no but it can change therapeutic options
96
trmt for ischemic CVA without hemorrhage
give clot buster
97
trmt for ischemic CVA with hemorrhage
do NOT give clot buster
98
what are lacunar strokes usually related to
HTN, DM, HLD (hypertensive lung disease)
99
what do lacunar strokes result from?
Microvascular atherosclerosis and small thrombi
100
what can lacunar strokes lead to
vacular dementia
101
symptoms of lacunar stroke
Pure motor hemiplegia, pure sensory stroke, clumsy hand (dysarthria), ataxia
102
when would a person develop an Arterovenous malformation
they have them at birth but dont usually get Sx until 10-30yo
103
what is an Arterovenous malformation
when arteries feed directly into veins through a tangle of malformed vessels
104
what are ppl with arterovenous malformations at risk for
hemorrhage or compression
105
symptoms of av malformations
cerebral hemorrhage, seizures, headache
106
what type of cerebral hemorrhage is common in ppl with av malformations
subarachnoid
107
what is a cavernous angioma
type of av malformation where clusters of abnormally formed capillaries with little or no interspersed brain tissue
108
how are cavernous angiomas typically found
incidentally by imaging or workup for headache, seizures, stroke, or recurrent focal or multifocal neurologic signs
109
these types of AV malformations used to be thought of as low risk but now it now appears that many are from genetic mutations and can form during life
cavernous angiomas
110
what is capillary telangiectasis
Sinusoidal collections of abnormally dilated capillaries with interspersed normal brain tissue
111
how is capillary telangiectasis diff from cavernous angiomas
capillary telangiectasis have interspersed normal brain tissue
112
what sx do ppl with capillary telangiectasis have
most are asymptomatic and are accidentally discovered on MRI
113
MC cerebral vascular malformation
venous angioma
114
when do ppl with venous angiomas get diagnosed
at birth bc its a congential condition
115
when is venous circulation developed
fetal development
116
what are venous angiomas AKA
Developmental Venous Anomalies
117
how are venous angiomas treated
they are not treated
118
what is a venous angioma
An unusual cerebral drainage bc venous circulation is not developed with the central vein
119
trmt for cva
Determine when patient was last “normal”
Rapid transport to a stroke center
CT w/o contrast to rule-out hemorrhagic stroke
Determine if to be treated by: Thrombolytic or Endovascular procedure
Management of blood pressure
Avoiding repeat events
Physical therapy.
120
a ct without contrast rules out what type of stroke
hemorrhagic
121
what is the typical thrombolytic trmt for someone who had an an acute ischemic stroke less than 4.5 hrs ago
tPA (tissue plasminogen activator)
122
what is the typical thrombolytic trmt for someone who had an an acute ischemic stroke less than 24 hrs ago
mechanical thrombectomy
123
what does tPA do
activates plasminogen to activate plasmin which helps restore blood flow to the brain
124
why may someone not be able to receive tPA
high bp, concern for hemorrhagic stroke or hemorrhagic conversion, recent intracranial/spinal surgery, CVA, head trauma, History of cerebral aneurysm, Recent active internal bleeding,Low platelets, elevated INR (from blood thinners or liver malfunction).
125
what are some typical tPA warnings
Advanced age
Hyper/hypoglycemia
Comorbidities (bacterial endocarditis, renal/hepatic dz, etc)
Pregnancy
126
2 types of CVA trmt?
thrombolytic or endovascular procedure
127
thromoblytic CVA trmt?
tPA
128
endovascular trmt for CVA?
mechanical thrombectomy
129
if blood pressure is too low during a stroke, what is that bad for
collateral circulation
