E3: CVA (Stroke)

Question 1

Define Stroke or cerebrovascular accident (CVA)

Answer 1

Syndrome resulting from impaired blood flow in blood vessels serving the brain

Brain attack: complex neurological damage results in peripheral symptoms/malfunction of body

Question 2

Cessation of flow lasts for more than a few minutes =

Answer 2

infarction or death of brain tissue

Question 3

transient ischemic attack (TIA)
Define
Warning sign of..
Symptoms:

Answer 3

-When blood flow is quickly restored, brain tissue can recover fully
-Often an early warning sign of full blow stroke to occur later
-Symptoms are:
–Often no recognized/ignored
–Last few minutes to < 1hr
–Ischemia w/o infarction; no permanent damage
–TIA requires that all neurologic signs/symptoms resolve w/in 24 hr

Question 4

CLINICAL PRESENTATION of STROKE Acronym

Answer 4

FAST
Face: one side of face is drooping down
Arm: can the person raise both arms or is one arm weak
Speech: is speech slurred or confusing Time: time is critical so call 911 immediately

Question 5

Clinical Presentation of Stroke: _________ numbness or weakness of _______, arm, _____

Answer 5

Sudden numbness or weakness of face, arm, leg

Question 6

Hemiparesis

Answer 6

often just one side of the body (nearly 85% of ischemic stroke patients experience), rarely in pain

Question 7

2 Main types of strokes

Answer 7

Hemorrhagic

Ischemic

Question 8

Intracerebral hemorrhage (ICH)
Stroke type:
Definition:
Results in:
More common in:

Answer 8

Hemorrhagic Stroke
-Blood vessels rupture within brain tissue itself
-Results in hematoma formation
-More common w/high blood pressures/HTN

Question 9

Subarachnoid hemorrhage (SAH)
Stroke type:
Definition:
Associated w/:

Answer 9

Subarachnoid hemorrhage (SAH)
-Bleeding into the spaces surrounding the brain, covering the brain
-Often associated w/trauma

Question 10

Atherothrombotic
Stroke type:
Definition:

Answer 10

Ischemic
Primary lipid buildup and occlusion in cerebral artery

Question 11

Cariogenic embolism/cardioembolic stroke
Stroke type:
Causes (4):

Answer 11

Ischemic
-Atrial fibrillation (15%): due to lack of coordinated atrial chamber contraction, blood stagnates in the atria and forms emboli to travel into the aorta and the arterial tree
-Valvular disease
-Rhematic heart disease
-Infective endocarditis

Question 12

Other causes of strokes (3)

Answer 12

Drug abuse (meth, cocaine)

Estrogens

Hormones

Question 13

Pathophysiology of Ischemic Stroke

__ ______ _____ _____ __ _______= death of brain tissue within 4-10 min

Answer 13

↓ cerebral blood flow to zero

Question 14

ischemic penumbra

Answer 14

Tissue surrounding the infarct is “ischemic” but reversibly dysfunction

Question 15

Blood brain tissues causes damage to surrounding tissue = Pathophysiology of _________ Stroke

Answer 15

Hemorrhagic

Question 16

Causes of hemorrhagic stroke

Answer 16

Volume ↑ intracranial pressures

Neurotoxicity of blood components

Question 17

What type of stroke needs surgical evacuation of blood within 8 hr

Answer 17

Hemorrhagic

Question 18

_________ stroke more lethal (50% of patients w/ICH die within 30 days)

Answer 18

Hemorrhagic

Question 19

Atherothrombotic
Prodromal signs:
Onset:
First symptom:
Associated disease:
Outcome:

Answer 19

Prodromal signs: transient ischemic attack
Onset: gradual (yrs to decades)
First symptom: variable
Associated disease: atherosclerosis, HTN
Outcome: minimal dysfunction to death

Question 20

Cardioembolic Stroke
Prodromal signs:
Onset:
First symptom:
Associated disease:
Outcome:

Answer 20

Prodromal signs: NONE
Onset: Instantaneous(sec)
First symptom: headache
Associated disease: A. Fib, valvular disease
Outcome: re-occurrence rate (w/out tx) = 75%

Question 21

Hemorrhagic Stroke
Prodromal signs:
Onset:
First symptom:
Associated disease:
Outcome:

Answer 21

Prodromal signs: None
Onset: Sudden (hrs)
First symptom: headache in over half
Associated disease: HTN, trauma
Outcome: HIGHEST mortality