CVA (Exam 2) Flashcards by Isaiah Smith

Cerebral Vascular Accident: Two types

-Ischemic 87%

-Hemorrhagic 13%

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CVA: Epidemiology

-Almost 800,000 per year (most first time stroke)

-#1 Leading cause of serious disability

-#4 Leading cause of death

A-lot of people under 65 years of age

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CVA: Risk Factor

-Hypertension (largest)

-Hyperlipidemia (high cholesterol)

-Tobacco abuse

-Diabetes

-Obesity

-ETOH abuse

-African Americans

-Oral contraceptives

-Age (greater risk of stroke but better recovery)

-MEN

-Sickle Cell Anemia

-Physical inactivity

-Atrial fibrillation

-History of TIA

-Drug abuse (IV - Cocaine)

-Heart Failure EF <25

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CVA: Manifestations

Sudden Numbness or weakness on one side of body

Sudden confusion

Trouble speaking

Slurred speech (dysarthria)

Trouble seeing

Ataxia (poor muscle control)

Severe Headache (no known cause)

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After ABC’s, what is the first thing we do with a suspected CVA?

CT scan w/o contrast to see blood (shows up as white)

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On CAT scan hemorrhagic stroke will show up as

White because of blood

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On CAT scan ischemic stroke will show up as

Darker grey because lack of blood flow

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Ischemic Stroke: Definition

Occlusion of cerebral artery from thrombus or embolus

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Ischemic Stroke Types

THROMBUS

EMBOLUS

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Why is knowing the etiology of ischemic stroke important?

Helps us determine the best treatment

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Ischemic CVA: Patho

Thrombotic / embolism blocks blood supply to the brain

Oxygen deprivation

Neuro deficits within 1 minute

Continued loss of supply leads to irreversible damage

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Hemorrhagic Conversion

Can happened of ischemic stroke once blood supply is restored

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Will patient always have symptoms with ischemic CVA?

No, it depends on the size of the vessel that is being blocked

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Ischemic stroke: Thrombotic Cause

-Atherosclerosis

-Hypercoagulable state (cancer) (birth control pills)

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Ischemic Stroke: Embolic Causes

Cardiac source
-Mural thrombus
-Atrial fibrillation
-Venous clot if atrial septal defect or patent foramen ovale
-Thrombus of vegetation (mitral valve)
Carotid Plaque
-Carotid bruit (narrow blood flow)

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What is a mural thrombus

A clot in the bottom of the left ventricle. A piece can dislodge and travel to the brain causing a stroke

EMBOLIC STROKE

Patent Foramen Ovale

Birth defect that allows VTE from leg to bypass the left side of the heart and travel straight to the brain

Hole in atrial septum

EMBOLIC STROKE

Ischemic Stroke: What is Penumbra? What is our goal?

Extended area around the occlusion that is injured but still salvageable

GOAL:
-Salvage the penumbra in 3 hours
-Would want to maintain perfusion
-TPA - Keep BP below 180/105
W/out TPA - start lowering with BP of 220/120

Ischemic Stroke Goal

Salvage the penumbra within 3 hour of ischemic event

Establish blood flow and save pneumbra

Hemorrhagic Stroke: Defintion

Bleeding within the brain parenchyma

Major cause of Hemorrhagic Stroke

Long standing SEVERE hypertension (untreated)

Increase pressure weakens vessel

Mortality of Hemorrhagic Stroke

38%

Timing depends on where. If in brain system death can occur within seconds

Hemorrhagic Stroke: Large Area Affected

Increase intracranial pressure with inflammation and bleeding

Herniation (brain collapse on itself)
Results in
Death

Larger the area = more damage = less survivable

Hemorrhagic CVA: Charateristics

-Age 30-60 years

-High morbidity and mortality rate

-Serious disabilities

Hemorrhagic Stroke Prognosis Depends on

-Age (older people have atrophy so more space to accommodate blood and swelling) -Location and size (smaller = better prognosis) (In brain stem = poor prognosis) -How rapid the bleed causes brain distortion and shift on scan. (MIDLINE SHIFT = poorer prognosis)

Hemorrhagic CVA: Manifestation

-"Worse headache of my life" -Rapid change in LOC -Irritation of the meninges (subarachnoid bleed) (Nuchal Rigidity) Pain with chin to chest movement (photophobia)

Bleed under the pia mater in the brain tissue is a

Hemorrhagic Stroke

Types of Intracranial hemorrhage base on location

Epidural Hematoma (between skull and Dura) Subdural Hematoma (Below Dura) Subarachnoid Hemorrhage (Between arachnoid and pia mater) (CSF)

With what kind of bleed might you see blood in the cerebral spinal fluid

With a subarachnoid bleed. This type of hemorrhage is between the arachnoid and pia mater which is where our CSF is located)

Intracranial Hemorrhage: Epidural Hematoma

Above the DURA -Seen with skull fracture -Arterial (bleed a lot) -Injury is usually less severe

Intracranial Hemorrhage: Subdural Hematoma

Below the DURA -Tend to be veins -Brain moves within skull, vessels do not -Rapid decline w/ severe injury -Can be slow = 2-10 days (as venous blood accumulates over time)

What is treatment of epidural or subdural bleed?

Evacuate the blood collect to relieve pressure on the brain

Intracranial Hemorrhage: Subarachnoid Hemorrhage

-Space between outer arachnoid membrane and pia mater -Area filled with CSF

Subarachnoid Hemmorahge is usually due to

Cerebral Aneurysm Arteriovenous malformation (AVM) (malformation in artery or vein junction)

Arteriovenous Malformation (AVM)

Not normal venous / atrial junction Blood flow is going directly from artery to vein without decreasing pressure

How do we detect a subarachnoid hemorrhage?

Lumbar puncture 12 hours after onset of symptoms

Subarachnoid Hemorrhage: Management

-Bedrest (bp manage) -BP tight rope (do not let get high) -Surgical clipping as soon as possible (aneurysm) -Anti-convulsant (r/t brain irritation) -CCB after procedure (narrow vessels to slow blood flow) TRIPLE H Therapy -Hypertension (pressor) -Hypervolemia (corticoid) -Hemodilution

What is the most common aneurysm that ruptures in the brain? What is the problem with them?

Berry aneurysm Location is in brain stem which lead to death

CVA Pneumonic for recognition of stroke

Balance Eyes (vision loss) Face (asymmetry) Arm (weakness) Speech (difficulty) Time (call 911)