Exam 2: Stroke (aka: CVA/"Brain attack") Flashcards
What are the 2 types of Strokes ?
- Ischemic
- Hemmorrhagic
Ischemic strokes are due to what ?
Thrombolic or Embolic
What is a Thrombus ?
Is a blood clot that FORMS in a vein
What is an Embolus ?
A clot that MOVES through the blood vessels, until it reaches a vessel that is too small to let it pass.
What is an Ishemic stroke ?
Inadequate blood flow due to a clot
What are manifestations of an Ischemic stroke ?
- SUDDEN weakness or numbness on one side of the body
- SUDDEN confussion (change n LOC), trouble speaking or understanding
- SUDDEN vision changes in one or both eyes
- SUDDEN trouble walking, dizziness, or loss of balance
- SUDDEN severe headache
What is a Hemorrhagic stroke ?
- Bleeding in the space either between the brain & the tissue covering the brain (Subarachnoid bleed)
OR - A bleed in the brain tissue itself
Hemorrhagic strokes can be either _____________ or _______________ ?
- Intracerebral
- Subarachnoid
How do pt’s with hemorrhagic strokes appear ?
Appear more seriously ill
True or False: Pt’s with hemorrhagic strokes, deteriorate more rapidly ?
True
How do Hemorrhagic strokes present ?-
- More severe headaches
- Display more marked disturbances in consciousness
- Have more sever nausea & Vomiting
(vomiting = projectile)
What type of Stroke occurs when an obstruction blocks blood flow to a part of the brain ?
Ischemic Stroke
What type of stroke occurs when a weekend vessel wall ruptures causing bleeding in the brain ?
Hemorrhagic Stroke
What are the warning signs of a stroke ?
- Sudden numbness or weakness of the face, arm, or leg, especially on one side of the body
- Sudden confusion or trouble speaking, or understanding
- Sudden trouble seeing in one or both eyes
- Sudden trouble walking, dizziness, or loss of balance or coordination
- Sudden severe headache with no known cause
What is the Acronym used for the identification of a stroke ?
Act FAST
What does the acronym FAST stand for
F: Face, facial drooping
A: Arms, weakness, drift
S: Speech difficulties
T: Time, any of these things call 911
What are Non-modifiable risk factors for strokes ?
- Gender
- Age
- Race
- Heredity - sickle cell
What are potentially modifiable risk factors for strokes ?
- Cardiac disease
- Blood lipid abnormalities
- Lifestyle: smoking/obesity
- TIA
- HTN
- Diabetes
- A-fib
Which sex is at an increased risk for having a stroke ?
Males
True or False: The chances of having a stroke increase with age ?
True
Which race is 2x more likely of having a stroke ?
African Americans
Many of the modifiable risk factors for strokes can be controlled how ?
- Diet
- Exercise
- Medications
When trying to diagnose a stroke, what is the first thing we want to do ?
Want to try an establish a timeline !
- Determine when the pt. was last seen well/acting normal
What diagnostics are used to detect strokes ?
- CT scan (bleed vs. ischemic)
- MRI (size, location, etc)
- 12 lead EKG
- CXR
- Pulse Oximetry
- Labs: BMP with ionized calcium, CBC, INR, PTT
- Find etiology
What is the main thing were looking to do (treat) with ischemic strokes ?
Restore perfusion !
What is tPA ?
Tissue Plasminogen Activator
AKA: Clot buster
What is the immediate Tx for a stroke if the onset of symptoms is < 4.5hrs & there are no contraindications ?
IV tPA
What is intra-arterial tPA ?
They insert a thin catheter right up into the femoral artery and put it right against the area of the clot and actually inject tPA right into the clot
When can Intra-arterial tPA be given when a stroke is suspected ?
When the onset of the symptoms is between 3-6 hours
When can Mechanical clot removal be used with a suspected stroke?
Up to 8hrs post symptom onset
What are we monitoring very closely with Hemorrhagic strokes ?
ABCs
What other treatments used for Hemorrhagic strokes ?
- Reverse anticoagulants (give clotting factors via fresh frozen plasma)
- Correct bleeding
- Strict BP control
(want systolic kept below 160mmHg)
Injury to the right side of the brain from a stroke damages what side of the body ? which includes what type of things ?
Left side of body
- creativity
- Music
- Spatial Orientation
- Artistic awareness
Injury to the left side of the brain from a stroke damages what side of the body ? Which includes what types of things ?
Right side of the body
- Spoken language
- Reasoning
- Number skills
- Written language
What area of the brain is responsible for speech ?
Broca’s area
Which area of the brain is responsible for speech comprehension
Wernicke’s area
What are the 2 types of Aphasia ?
- Expressive
- Receptive
What is Expressive Aphasia ?
The pt can’t say what they want to say
When somebody has expressive aphasia, where in the brain, is the damage ?
Broca’s area (Motor)
What is Receptive Aphasia ?
The inability to understand what is being said to them
When somebody has receptive aphasia, where in the brain, is the damage ?
Wernicke’s area (sensory)
What is Dysarthria ?
Muscle control of speech
- The pt. may have slurring/unintelligible speech d/t dysarthria
Spatial Perceptual problems related to a stroke, are more common with what ?
Right hemisphere strokes
What are Manifestations of Spatial Perceptual problems associated with a stroke (most commonly R hemisphere) ?
- Deny illness or body parts
- Neglect all input from the affected side
- Homonymous hemianopsia
(loss of 1/2 of visual field, on the same side of both eyes) - Agnosia
- Apraxia
What is Agnosia ?
Inability to recognize objects by sight, touch, or hearing
What is Apraxia ?
Inability to carryout learned, sequential movements
- things they have done in the past
What is the Management for Ischemic strokes ?
- Anti-platelet therapy
- Aspirin*
- Clopidogrel (plavix)*
- Anticoagulants for A-fib
- Coumadin (warfarin)
- Eliquis
- Tx carotid artery stenosis/intracranial stenosis
- “Statin” therapy for LDL >70
- BP management
- Dysphagia screening
- DVT prophylaxis
- PT/OT/Speech
What is the management for Hemorrhagic strokes ?
- ABC’s
- Reverse anticoagulants
- Correct bleeding disorders
- Strict BP control
- Monitor of NIHSS (stroke scale) & VS
- Monitor for increased ICP
- Monitor for cerebral vasospasms
- Possible ventricular drain
- Elevate HOB 30 degrees
- Seizure prevention
- Temperature management
What things are used to reverse anticoagulants ?
- Vitamin K
- Fresh frozen plasma
(has clotting factors right in it)
What things are done for the prevention of strokes ? (collaborative management)
- Manage modifiable risk factors
- Platelet inhibitors
- Anticoagulants for A-fib
- Surgery
- Carotid angioplasty or endartectomy
- Acute care & Rehabilitation
- depends and area & extent of stroke
