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Clin Med III Disease Key Notes > CVA (Exam #3) > Flashcards

CVA (Exam #3) Flashcards

1
Q

In what age group are CVA more common (2), and in what area of the U.S.?

A
  • Younger males
  • Older females (75+ years)

SE U.S.

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2
Q

Define Ischemic Stroke. What are the there possible etiologies?

A

TOO LITTLE blood

  • Thrombosis
  • Embolism
  • Hypoperfusion
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3
Q

Define Hemorrhagic Stroke. What are the there possible etiologies?

A

TOO MUCH blood

  • Intracerebral hemorrhage
  • SAH
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4
Q

What is the most common CVA?

A

Middle Cerebral a. (MCA)

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5
Q

What is the main blood supply for the ANTERIOR large vessel? What three arteries are involved?

A

CAROTID A.

  • Middle Cerebral a. (MCA)
  • Anterior Cerebral a. (ACA)
  • Anterior Communicating a. (AComm)
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6
Q

What is the main blood supply for the POSTERIOR large vessel? What three arteries are involved?

A

VERTEBROBASILAR A.

  • Posterior Cerebral a. (PCA)
  • Posterior Inferior Cerebellar a. (PICA)
  • Basilar a.
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7
Q

What artery is affected if you experience contralateral hemiplegia/hemianesthesia of face and arm; ipsilateral gaze pref.?

A

Middle Cerebral a. (MCA)

- ANTERIOR large vessel

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8
Q

For a Middle Cerebral a. (MCA) lesion, what is seen if the dominant hemisphere is affected? NON-dominant hemisphere?

A
  • Dominant hemisphere = global aphasia

- NON-dominant hemisphere = hemineglect

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9
Q

What artery is affected if you experience contralateral hemiplegia/hemianesthesia of leg; abulia (sig. delay in verbal/motor response)?

A

Anterior Cerebral a. (ACA)

- ANTERIOR large vessel

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10
Q

What artery is affected if you experience CN impingement; visual field deficits?

A

Anterior Communicating a. (AComm)

- ANTERIOR large vessel

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11
Q

What artery is affected if you experience contralateral homonymous hemianopia; dec. light touch/pinprick sensation?

A

Posterior Cerebral a. (PCA)

- POSTERIOR large vessel

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12
Q

What is Wallenberg Syndrome (2), and what artery is it associated with?

A
  • Contralateral loss of pain/temp. over body
  • Ipsilateral loss of facial pain/temp.

Posterior Inferior Cerebellar a. (PICA)
- POSTERIOR large vessel

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13
Q

What artery is affected if you experience contralateral loss of pain/temp. over body; ipsilateral loss of facial pain/temp.? What is this called?

A

Posterior Inferior Cerebellar a. (PICA)
- POSTERIOR large vessel

Wallenberg Syndrome

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14
Q

What artery is affected if you experience quadriplegia and facial/mouth/tongue weakness?

A

Basilar a.

- POSTERIOR large vessel

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15
Q

What is “locked-in syndrome”, and what artery is it associated with?

A

Quadriplegia and facial/mouth/tongue weakness

Basilar a.
- POSTERIOR large vessel

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16
Q

What finding is seen on CT if small vessel stroke?

A

Lacunas

- Also called a Lacunar Stroke

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17
Q

What RF is associated with small vessel stroke?

A

Chronic HTN

18
Q

What is the dx test of choice for CVA (if needed)? What is seen with each type?

A

NON-Contrast CT of Brain

  • Ischemic: hyperdense/darker
  • Hemorrhagic: hypodense/lighter
19
Q

How is an Ischemic Stroke dx? How is a Hemorrhagic Stroke dx?

A
  • Ischemic = clinical

- Hemorrhagic = CT without contrast

20
Q

What is always the recommended disposition for CVA?

A

ADMIT TO ICU

21
Q

What is the recommended BP control for an ISCHEMIC Stroke?

A

Start BP tx if greater than 220/120

22
Q

What is the recommended BP control for an HEMORRHAGIC Stroke?

A

Start BP tx if greater than 160/90

23
Q

For acute Ischemic Stroke, what is the recommended tx? When should it be started?

A

ASA 325 mg +/- Clopidogrel (Plavix)

- Within 48 hours of sxs onset

24
Q

When might tPA be considered (3), and for what type of stroke?

A

Ischemic Stroke ONLY

  • CT NORMAL
  • <4.5 hours since sxs onset
  • Administer within <60 min.
25
Q

What two medications are NOT considered for Hemorrhagic stroke?

A
  • NO ASA

- NO tPA

26
Q

What is the recommended tx for a Hemorrhagic Stroke (3)?

A
  • IMMEDIATE neurosurg consult
  • STOP ALL anticoagulants and REVERSE
  • LOWER ICP (elevate head of bed, Mannitol, bolt, NM blockage, hyperventilation)
27
Q

What dx tests are often recommended for TIA (4)? What other test can assess for blockage

A
  • EKG
  • Carotid US
  • Lipid lowering meds
  • Anti-HTN meds

CTA of head AND neck for blockage

28
Q

What is always the recommended disposition for TIA?

A

ADMIT

29
Q

What tx is ALWAYS recommended for TIA? What other two meds might be considered?

A

DAILY ASA +/-…

  • Clopidogrel (Plavix)
  • Dipyridamole
30
Q

What is the primary RF associated with Subarachnoid Hemorrhage (SAH)?

A

Smoking

31
Q

What condition involves aneurysm rupture = blood into CSF → increased ICP?

A

Subarachnoid Hemorrhage (SAH)

32
Q

What two complaints might be seen with Subarachnoid Hemorrhage (SAH)?

A
  • “Worst HA of my life” (WHOL)

- “Thunderclap” HA = SUDDEN onset and severe

33
Q

What condition involves “thunderclap” HA?

A

Subarachnoid Hemorrhage (SAH)

34
Q

What condition involves “worst HA of my life” (WHOL)?

A

Subarachnoid Hemorrhage (SAH)

35
Q

What are the two primary complications associated with Subarachnoid Hemorrhage (SAH)?

A
  • Vasospasm (after day 3+)

- Re-bleeding

36
Q

What are the two recommended dx tests for Subarachnoid Hemorrhage (SAH)? What is seen with each (1, 2)?

A
  1. NON-Contrast CT of Brain = bleed in subarachnoid space

2. LP = RBCs in CSF, xanthochromia

37
Q

What two findings will be seen on LP for Subarachnoid Hemorrhage (SAH)?

A
  • RBCs in CSF (# remains steady in all tubes)

- Xanthochromia

38
Q

What condition presents with xanthochromia?

A

Subarachnoid Hemorrhage (SAH)

39
Q

What is always the recommended disposition for Subarachnoid Hemorrhage (SAH)?

A

ADMIT to ICU

40
Q

What medication is recommended in tx of Subarachnoid Hemorrhage (SAH) to prevent re-bleeding? To prevent vasospasm (2)?

A
  • Prevent re-bleeding = analgesics

- Prevent vasospasm = IVF, Nimodipine

41
Q

What test is used to monitor for vasospasm in a patient with Subarachnoid Hemorrhage (SAH)?

A

TCD US (trasncranial doppler US)

42
Q

What non-pharm tx is recommended for Subarachnoid Hemorrhage (SAH) to prevent re-bleeding?

A

Surgery (clipping, coiling)

- STOPS another aneurysm from rupturing later

Clin Med III Disease Key Notes (18 decks)

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