CVA/TIA Flashcards
CVA
this is a functional abnormality of the central nervous system due to disruption of blood supply to the brain
the umbrella term - stroke falls underneath it
stroke
primary CVA disorder in the US
- 2 categories: ischemic, and hemorrhagic stroke
Types of Ischemic Stroke: (5)
- Large artery thrombotic stroke
- Small penetrating artery thrombotic stroke
- Cardiogenic embolic stroke
- Cryptogenic stroke
- Others (illicit drugs; coagulopathies; migraine; spontaneous dissection of the carotid arteries
hemorrhagic stroke
extravasation or blood in the brain and the subarachnoid space
- burst aneurysm
ischemic stroke
vascular occlusion, a clot blocking off an artery
what is the worst ischemic stroke?
large artery thrombotic stroke
pathophysiology of a stroke (8 steps)
- disruption of blood flow
- Ischemic Cascade
- neurons unable to maintain aerobic respiration
- mitochondria utilizes un-aerobic metabolism
- lactic acid production
- neurons not capable of producing adequate ATP
- less ATP = less energy produced for depolarization
- cells cease to function
within pathophysiology of a stroke, what is the penumbra region?
an area of low cerebral blood flow that exists around the area of infarction (“dead” cells).
how can the body fix the penumbra region?
this can be salvaged through t-PA administration (tissue plasminogen activator)
what are the clinical manifestations (s/s) of a stroke? in general!!
- Numbness or weakness of the face, arm, leg (usually one side)
- Change in mental status
- Trouble speaking or difficulty understanding speech (of the affected person)
- Visual disturbances
- Difficulty walking, loss of balance or coordination
- Sudden severe headache
what are the clinical manifestations (s/s) of a stroke? SPECIFIC to motor loss
- Hemiplegia: paralysis of 1 part of the body
- Hemiparesis: weakness of one side of the body
- flaccid (typically during first 24-48hrs) vs. spastic
- Dysphagia (concern for aspiration pneumonia)
what are the clinical manifestations (s/s) of a stroke? SPECIFIC to communication loss
• Dysarthria: difficulty speaking
• Aphasia:
- expressive: inability to express yourself
- receptive: inability to understand
• Apraxia: inability to perform previously learned actions, make verbal substitutions
what are the clinical manifestations (s/s) of a stroke? SPECIFIC to perceptual disturbances
inability to interpret sensation
what are the clinical manifestations (s/s) of a stroke? SPECIFIC to sensory loss
Agnosia: loss of ability to recognize object by sensation; auditory, visual, tactile
what are the clinical manifestations (s/s) of a stroke? SPECIFIC to problem w/ cognition
- Frontal lobe damage: problem with learning, memory and other intellectual functions;
- Problem with comprehension, increased forgetfulness, issue with motivation (lack of)
what is a TIA
(Transient Ischemic Attack)
• This occurs as a result of temporary impairment of blood flow to the brain
• S/S are temporary that only last about 1-2 hours: sudden loss of motor, sensory or visual function
• Brain imaging will show NO evidence of ischemia, the impairment to blood flow was only for a few seconds
how do we diagnose a TIA
• CT head: usually non-contrast
- Determines whether the stroke is ischemic or hemorrhagic or no stroke at all (TIA) = PRIORITY
• ECG/EKG: electrocardiogram
• Carotid ultrasound
• CT angio
• MRI/MRA (magnetic resonance imaging/magnetic resonance angiography)
• TEE (transesophageal echocardiogram)
how do we treat/manage a TIA w/ medications? (5)
- Those with Atrial Fibrillation (cardioembolic stroke)
• Coumadin (with target INR 2-3)
• Novel Anticoagulants (NOACs): dagitraban (Pradaxa), apixaban (Eliquis), rivaroxaban (Xarelto) - Platelet-inhibiting medications
• ASA (aspirin), clopidogrel, Aggrenox - Statins
• Recommended for LDL 70 mg/dl and above - Antihypertensive medications
- Thrombolytic therapy
• T-PA= used to dissolve clot
BUT side effect = BLEEDING! so have to make sure theres no infarction, only treats the penumbra
what is a hemorrhagic stroke?
caused by bleeding into the brain tissue, ventricles or subarachnoid space
this one is worse!!
what are the 4 possible etiologies of hemorrhagic strokes
- AV (arterio-venous) malformation
- intracranial aneurysms
- intracranial neoplasms
- medications (anticoagulants)
mortality rate of a hemorrhagic stroke
- mortality rate can be as high as 50%
- those who survive will have longer recovery phase
- more severe deficits
s/s of a hemorrhagic stroke (3)
- Severe headache (vs. ischemic: numbness on the face)
- Neurologic deficits: motor, sensory, cranial nerve, cognitive
- Rupture aneurysm or AVM: sudden severe headache; loss of consciousness; nuchal rigidity; visual disturbances (if aneurysm is adjacent to oculomotor nerve) = loss of vision, diplopia, ptosis; tinnitus
how do we diagnose a hemorrhagic stroke?
- CT
- MRI
- Cerebral angiography or CT angio: can confirm diagnosis of AVM or intracranial aneurysm
complications of hemorrhagic stroke
- Cerebral hypoxia
• Cerebral blood flow depends on blood pressure, cardiac output, and the integrity of cerebral blood vessels. - Vasospasm
• Leading cause of mortality and morbidity of those who survive the initial subarachnoid hemorrhage
• Usually happens 7- 10 days after initial hemorrhage when clot undergoes lysis (and an increased chance of rebleeding!)
• s/s: worsening headache, decreased LOC, new neurologic deficit - Increased intracranial pressure
- Seizures
