CVA Pathophysiology

Question 1

Statistics of stroke

Answer 1

Costs $74 billion/year in US.

795000 strokes a year.
1/3 will die.
#4 cause of death.

25-35% recurrance of acute.
40% within 5 years, men>women.

Question 2

s&s of stroke

Answer 2

weakness, sensation deficits, facial droop, visual disturbances, difficulty talking, confusion

Cerebellar stroke: loss of balance

Question 3

stroke risk factors

Answer 3

Black>hispanic>white.
HTN.
High cholesterol.
Obesity.
ETOH abuse.
Cocaine use.
Cmoking.
DM.
Heart disease.

Question 4

Types of stroke

Answer 4

Thrombotic: clot in brain.

Embolic: clot elsewhere travels to brain.

Hemorrhage: bleed (from aneurysm) in brain–>heels better once the blood is absorbed.

Question 5

Thrombotic CVA

Answer 5

Caused by HTN and ASCHD (atherosclerotic coronary heart disease).

“stroke in progress”

Question 6

TIA

Answer 6

Indicative of throbolytic disease.

Possible vasospasm.

Transient systemic arterial hypotension.

Question 7

Thrombotic/TIA management

Answer 7

PREVENTION

Goal: improve circulation ASAP.

Meds: T-PA (tissue plasminogen activator) (w/in 3 hours).
anticoagulents.
antiplatelets (ASA, persantine,).

sx: thromboendarerectomy (carotid and subclavian).

Question 8

Embolic CVA

Answer 8

Sign of cardiac disease.

From: heart, ICA, carotid sinus.

Branches of MCA most common affected, with poorer outcomes.

Question 9

Embolic CVA management

Answer 9

PREVENTION

Anticoagulants (long term).

sx

Question 10

Hemorrhagic CVA

Answer 10

Causes: HTN, ruptured saccular aneurysm, AV malformation.

Bleeding displaces midling structures.

Blood re-absorbed over 6-8 mo.

Question 11

Hemorrhagic CVA management

Answer 11

HTN: prevention.

Ruptured aneurysm: sx: post op restrictions: HOB >30*, 4-6 wks limited activity, anti-seizure med (kepra).

Question 12

CVA movement dysfunction

Answer 12

Decreased force production.
Abnormal synergistic movement=later on in stroke.
Altered timing.
Decreased force regulation.
Delayed responses (toe tapping).
Abnormal tone.
Associated reactions: arm curls with difficult task.

Question 13

CVA 2* impairments

Answer 13

Alignment issues.
Changes in mobility.
Contracture.
Pain.
Edema.

Question 14

Orpington Prognostic Scale

Answer 14

Not for acute.
Used when neurologically stable.
Optimal predictive power at 2 weeks post stroke.
Scores: 1.6-6.8.

Question 15

OPS scores

Answer 15

5.2 generally require long term care

Question 16

Predictors of CVA recovery

Answer 16

only having 1 CVA=good.

UE movement in 2 weeks=possible full arm recovery.

no grip by 24 days=no UE at 3 mo.
30% have no arm recovery.

82% learn to walk again.