CVA (Exam #3) Flashcards
In what age group are CVA more common (2), and in what area of the U.S.?
- Younger males
- Older females (75+ years)
SE U.S.
Define Ischemic Stroke. What are the there possible etiologies?
TOO LITTLE blood
- Thrombosis
- Embolism
- Hypoperfusion
Define Hemorrhagic Stroke. What are the there possible etiologies?
TOO MUCH blood
- Intracerebral hemorrhage
- SAH
What is the most common CVA?
Middle Cerebral a. (MCA)
What is the main blood supply for the ANTERIOR large vessel? What three arteries are involved?
CAROTID A.
- Middle Cerebral a. (MCA)
- Anterior Cerebral a. (ACA)
- Anterior Communicating a. (AComm)
What is the main blood supply for the POSTERIOR large vessel? What three arteries are involved?
VERTEBROBASILAR A.
- Posterior Cerebral a. (PCA)
- Posterior Inferior Cerebellar a. (PICA)
- Basilar a.
What artery is affected if you experience contralateral hemiplegia/hemianesthesia of face and arm; ipsilateral gaze pref.?
Middle Cerebral a. (MCA)
- ANTERIOR large vessel
For a Middle Cerebral a. (MCA) lesion, what is seen if the dominant hemisphere is affected? NON-dominant hemisphere?
- Dominant hemisphere = global aphasia
- NON-dominant hemisphere = hemineglect
What artery is affected if you experience contralateral hemiplegia/hemianesthesia of leg; abulia (sig. delay in verbal/motor response)?
Anterior Cerebral a. (ACA)
- ANTERIOR large vessel
What artery is affected if you experience CN impingement; visual field deficits?
Anterior Communicating a. (AComm)
- ANTERIOR large vessel
What artery is affected if you experience contralateral homonymous hemianopia; dec. light touch/pinprick sensation?
Posterior Cerebral a. (PCA)
- POSTERIOR large vessel
What is Wallenberg Syndrome (2), and what artery is it associated with?
- Contralateral loss of pain/temp. over body
- Ipsilateral loss of facial pain/temp.
Posterior Inferior Cerebellar a. (PICA)
- POSTERIOR large vessel
What artery is affected if you experience contralateral loss of pain/temp. over body; ipsilateral loss of facial pain/temp.? What is this called?
Posterior Inferior Cerebellar a. (PICA)
- POSTERIOR large vessel
Wallenberg Syndrome
What artery is affected if you experience quadriplegia and facial/mouth/tongue weakness?
Basilar a.
- POSTERIOR large vessel
What is “locked-in syndrome”, and what artery is it associated with?
Quadriplegia and facial/mouth/tongue weakness
Basilar a.
- POSTERIOR large vessel
What finding is seen on CT if small vessel stroke?
Lacunas
- Also called a Lacunar Stroke
What RF is associated with small vessel stroke?
Chronic HTN
What is the dx test of choice for CVA (if needed)? What is seen with each type?
NON-Contrast CT of Brain
- Ischemic: hyperdense/darker
- Hemorrhagic: hypodense/lighter
How is an Ischemic Stroke dx? How is a Hemorrhagic Stroke dx?
- Ischemic = clinical
- Hemorrhagic = CT without contrast
What is always the recommended disposition for CVA?
ADMIT TO ICU
What is the recommended BP control for an ISCHEMIC Stroke?
Start BP tx if greater than 220/120
What is the recommended BP control for an HEMORRHAGIC Stroke?
Start BP tx if greater than 160/90
For acute Ischemic Stroke, what is the recommended tx? When should it be started?
ASA 325 mg +/- Clopidogrel (Plavix)
- Within 48 hours of sxs onset
When might tPA be considered (3), and for what type of stroke?
Ischemic Stroke ONLY
- CT NORMAL
- <4.5 hours since sxs onset
- Administer within <60 min.
What two medications are NOT considered for Hemorrhagic stroke?
- NO ASA
- NO tPA
What is the recommended tx for a Hemorrhagic Stroke (3)?
- IMMEDIATE neurosurg consult
- STOP ALL anticoagulants and REVERSE
- LOWER ICP (elevate head of bed, Mannitol, bolt, NM blockage, hyperventilation)
What dx tests are often recommended for TIA (4)? What other test can assess for blockage
- EKG
- Carotid US
- Lipid lowering meds
- Anti-HTN meds
CTA of head AND neck for blockage
What is always the recommended disposition for TIA?
ADMIT
What tx is ALWAYS recommended for TIA? What other two meds might be considered?
DAILY ASA +/-…
- Clopidogrel (Plavix)
- Dipyridamole
What is the primary RF associated with Subarachnoid Hemorrhage (SAH)?
Smoking
What condition involves aneurysm rupture = blood into CSF → increased ICP?
Subarachnoid Hemorrhage (SAH)
What two complaints might be seen with Subarachnoid Hemorrhage (SAH)?
- “Worst HA of my life” (WHOL)
- “Thunderclap” HA = SUDDEN onset and severe
What condition involves “thunderclap” HA?
Subarachnoid Hemorrhage (SAH)
What condition involves “worst HA of my life” (WHOL)?
Subarachnoid Hemorrhage (SAH)
What are the two primary complications associated with Subarachnoid Hemorrhage (SAH)?
- Vasospasm (after day 3+)
- Re-bleeding
What are the two recommended dx tests for Subarachnoid Hemorrhage (SAH)? What is seen with each (1, 2)?
- NON-Contrast CT of Brain = bleed in subarachnoid space
2. LP = RBCs in CSF, xanthochromia
What two findings will be seen on LP for Subarachnoid Hemorrhage (SAH)?
- RBCs in CSF (# remains steady in all tubes)
- Xanthochromia
What condition presents with xanthochromia?
Subarachnoid Hemorrhage (SAH)
What is always the recommended disposition for Subarachnoid Hemorrhage (SAH)?
ADMIT to ICU
What medication is recommended in tx of Subarachnoid Hemorrhage (SAH) to prevent re-bleeding? To prevent vasospasm (2)?
- Prevent re-bleeding = analgesics
- Prevent vasospasm = IVF, Nimodipine
What test is used to monitor for vasospasm in a patient with Subarachnoid Hemorrhage (SAH)?
TCD US (trasncranial doppler US)
What non-pharm tx is recommended for Subarachnoid Hemorrhage (SAH) to prevent re-bleeding?
Surgery (clipping, coiling)
- STOPS another aneurysm from rupturing later
