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Patho Exam 3 > CVA/TIA > Flashcards

CVA/TIA Flashcards

1
Q

CVA

A

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

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2
Q

stroke

A

primary CVA disorder in the US

- 2 categories: ischemic, and hemorrhagic stroke

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3
Q

Types of Ischemic Stroke: (5)

A
  1. Large artery thrombotic stroke
  2. Small penetrating artery thrombotic stroke
  3. Cardiogenic embolic stroke
  4. Cryptogenic stroke
  5. Others (illicit drugs; coagulopathies; migraine; spontaneous dissection of the carotid arteries
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4
Q

hemorrhagic stroke

A

extravasation or blood in the brain and the subarachnoid space
- burst aneurysm

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5
Q

ischemic stroke

A

vascular occlusion, a clot blocking off an artery

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6
Q

what is the worst ischemic stroke?

A

large artery thrombotic stroke

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7
Q

pathophysiology of a stroke (8 steps)

A
  1. disruption of blood flow
  2. Ischemic Cascade
  3. neurons unable to maintain aerobic respiration
  4. mitochondria utilizes un-aerobic metabolism
  5. lactic acid production
  6. neurons not capable of producing adequate ATP
  7. less ATP = less energy produced for depolarization
  8. cells cease to function
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8
Q

within pathophysiology of a stroke, what is the penumbra region?

A

an area of low cerebral blood flow that exists around the area of infarction (“dead” cells).

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9
Q

how can the body fix the penumbra region?

A

this can be salvaged through t-PA administration (tissue plasminogen activator)

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10
Q

what are the clinical manifestations (s/s) of a stroke? in general!!

A
  • 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
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11
Q

what are the clinical manifestations (s/s) of a stroke? SPECIFIC to motor loss

A
  • 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)
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12
Q

what are the clinical manifestations (s/s) of a stroke? SPECIFIC to communication loss

A

• Dysarthria: difficulty speaking
• Aphasia:
- expressive: inability to express yourself
- receptive: inability to understand
• Apraxia: inability to perform previously learned actions, make verbal substitutions

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13
Q

what are the clinical manifestations (s/s) of a stroke? SPECIFIC to perceptual disturbances

A

inability to interpret sensation

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14
Q

what are the clinical manifestations (s/s) of a stroke? SPECIFIC to sensory loss

A

Agnosia: loss of ability to recognize object by sensation; auditory, visual, tactile

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15
Q

what are the clinical manifestations (s/s) of a stroke? SPECIFIC to problem w/ cognition

A
  • Frontal lobe damage: problem with learning, memory and other intellectual functions;
  • Problem with comprehension, increased forgetfulness, issue with motivation (lack of)
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16
Q

what is a TIA

A

(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

17
Q

how do we diagnose a TIA

A

• 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)

18
Q

how do we treat/manage a TIA w/ medications? (5)

A
  1. Those with Atrial Fibrillation (cardioembolic stroke)
    • Coumadin (with target INR 2-3)
    • Novel Anticoagulants (NOACs): dagitraban (Pradaxa), apixaban (Eliquis), rivaroxaban (Xarelto)
  2. Platelet-inhibiting medications
    • ASA (aspirin), clopidogrel, Aggrenox
  3. Statins
    • Recommended for LDL 70 mg/dl and above
  4. Antihypertensive medications
  5. Thrombolytic therapy
    • T-PA= used to dissolve clot
    BUT side effect = BLEEDING! so have to make sure theres no infarction, only treats the penumbra
19
Q

what is a hemorrhagic stroke?

A

caused by bleeding into the brain tissue, ventricles or subarachnoid space

this one is worse!!

20
Q

what are the 4 possible etiologies of hemorrhagic strokes

A
  1. AV (arterio-venous) malformation
  2. intracranial aneurysms
  3. intracranial neoplasms
  4. medications (anticoagulants)
21
Q

mortality rate of a hemorrhagic stroke

A
  • mortality rate can be as high as 50%
  • those who survive will have longer recovery phase
  • more severe deficits
22
Q

s/s of a hemorrhagic stroke (3)

A
  • 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
23
Q

how do we diagnose a hemorrhagic stroke?

A
  1. CT
  2. MRI
  3. Cerebral angiography or CT angio: can confirm diagnosis of AVM or intracranial aneurysm
24
Q

complications of hemorrhagic stroke

A
  1. Cerebral hypoxia
    • Cerebral blood flow depends on blood pressure, cardiac output, and the integrity of cerebral blood vessels.
  2. 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
  3. Increased intracranial pressure
  4. Seizures

Patho Exam 3 (9 decks)

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