CVA/TBI Flashcards
Stroke
Nontraumatic brain injury caused by occlusion or rupture of cerebral blood vessels that result in sudden neurologic deficit
TIA
- Reversible neurologic deficit within a few, up to 24, hours
- Brain injury likely if beyond 1 hour
Types of Ischemia
Thrombotic
Embolic
Vasculitic, hypercoaguable
Types of Hemorrhage Stroke
Intracerebral
Subarachnoid
Ischemia- Thrombosis
*At the site –Atherosclerotic Plaque –Vessel Narrowing –Small or Large Vessel –Could become embolic
Ischemic- Embolism
- Particles Travel
- Cardiac: a-fib, cardiomyopathy, valve disease
- Cardiac anomalies: patent foramen ovale
- Infectious endocarditis
- “break-off” part of thrombus
Clinical Presentation of Thrombotic Stroke
Slower
Stuttering
Clinical Presentation of Embolic Stroke
Sudden
Hemorrhagic Stroke- Intracerebral
• Directly into brain tissue
• Causes: HTN, amyloid angiopathy, vascular malformations, bleeding
disorders, drugs (cocaine, amphetamines)
Subarachnoid Stroke Causes
aneurysms, ateriovenous malformations
Presentation of Hemorrhagic Stroke
- “Worst headache of my life”
* Sudden
Nonmodifiable Risk Factors of Stroke
- Age (risk double every decade after age 55)
- Sex: female/older age
- Race
- Previous stroke
- Family history
- Coronary artery disease?
Modifiable Risk Factors of Stroke
- Hypertension
- Hyperlipidemia
- Atrial Fibrillation
- Diabetes Mellitus
- Smoking
- Oral contraceptives
- Physical inactivity
- Diet
- Sleep apnea
CVA Medical Treatment
- Primary - Reverse or limit impact
* Secondary - Prevent recurrence of stroke
CVA Signs
- Balance
- Eyes
- Face
- Arm
- Speech
- Time
Possible Stroke Impairments
- Weakness
- Sensory impairments
- Apraxia
- Aphasia
- Dysphagia
- Depression
- Cognition
- Ataxia
- Neglect
- Hemianopsia
- Balance
- Emotional lability
- Bladder/bowel
Post Stroke Complications
- Pneumonia
- DVT/PE
- Pressure ulcers
- Deconditioning
- Contractures
- UTI
- Dehydration
- MI
Should you use an MRI or a CT to diagnose a stroke?
Immediately –> CT (it will detect hemorrhage)
Then –> MRI
Stroke Outcome Scale
NIH 42 point scale Normal: 0 Moderate: 9-15 Severe: > 16
Items NIH evaluates
- Level of consciousness
- Visual gaze
- Vision
- Facial palsy
- Motor arm
- Motor leg
- Coordination
- Sensation
- Language
- Speech slurring
ICA Stroke
- Combined ACA and MCA
- Ipsilateral monocular visual loss
Left ACA stroke
- R leg numbers and weakness
- Transcortical motor aphasia
- Ideomotor apraxia
Right ACA Stroke
- L leg numbness and weakness
- Motor Neglect
- Possible ideomotor apraxia
Left MCA Stroke
- Right face/arm > leg numbness and weakness
- APHASIA
- Left gaze preference
Right MCA Stroke
- Left face/arm > leg numbness and weakness
- Left hemispatial neglect
- Right gaze preference
- Agraphesthesia/ astereognosia
PCA Stroke
Diplopia
Dizziness
Dysphagia
Dysarthria
What is the #1 goal of patients after a stroke?
Gait
Who is at risk for TBI?
- More common in men
* Peak incidence teens and elderly
Most common causes of TBI
- Most common causes
- Falls : most common under age 17 and over 55
- MVA: most common between 18 and 55
- Sports
- Violence
TBI Classification Scale
Glascow Coma Scale
Assesses eyes, verbal, motor functioning
Mild GCS Score
> 12
Moderate GCS Score
9-12
Severe GCS Score
8 or less
TBI Pathophysiology: Primary Injury
Direct Trauma Skull Fractures Hemorrhages Diffuse Axonal Injury Penetrating Injuries
Types of Hemorrhage
- Epidural hematoma
- Subdural hematoma
- Intracerebral hemorrhage
- Subarachnoid hemorrhage
TBI- Secondary Injury
- Increased intracranial pressure
- Cerebral Edema
- Hydrocephalus
- Brain Herniation
- Free Radicals
Brain Injury Classification
- Closed vs. Open
- Blunt vs. Penetrating
- Focal vs. Diffuse
- Hemorrhagic vs. Non-hemorrhagic
Non-traumatic Brain Injury
- Anoxic
- Aneurysms
- AVM’s
- Brain tumors
- Infectious (abscess, meningitis)
Epidural Hematoma
•Results from a blow to the side of the head leading to a fracture of the temporal bone tearing the middle meningeal artery (high pressure →bleed quickly)
Subdural Hematoma
• Caused by head injury where velocity changes within the skull
may stretch and tear small bridging veins (low pressure →slow bleeds)
• Common in the elderly and alcoholic due to cerebral atrophy
• “Crescent shaped”
• Shaken Baby Syndrome
Subarachnoid Hemorrhage
- Cause by traumatic and nontraumatic brain injury (ruptured aneurysm)
- Thunderclap headache- “Worst headache in my life.”
AVM
- Congenital disorder of the connections between veins and arteries in the vascular system
- “Tangle of Spaghetti” on arteriogram
- Can bleed with devastating- stroke-like effects
Complications of TBI
- DVT/PE
- Pneumonia
- Skin breakdown
- Pain
- Bowel/Bladder dysfunction
- Spasticity
- Contractures
- Deconditioning
Post acute TBI Evaluation:
Rancho Los Amigos Cognitive Scale
Rancho Los Amigos Cognitive Scale
I. No Response II. Generalized Response III. Localized Response IV. Agitated Confused V. Confused Inappropriate VI. Confused Appropriate VII. Automatic Appropriate VIII. Purposeful Appropriate
Spasticity Management
- Cold
- Prevent noxious stimuli
- Manual techniques
- Splinting/ serial casting
- Botulinum Toxin and Phenol Injections
- Baclofen Pump
- Medications: Baclofen, Zanaflex, dantrium, clonidine, valium
Botulinum Toxin
- Different types
- Best for focal spasticity
- Indications:
- Medication failure
- Improve function
- Improve hygiene
- Prevent Pain
Baclofen Pump Indications
- Lower extremity spasticity
- Improve function, hygiene
- Lessen pain
What is the best predictor of stroke outcome
the presentation of the patient when they are evaluated
