GF4: Neuro Strokes and CVAs Flashcards
What are the two main types of strokes?
Transient Ischemic Attack (TIA)
Cerebral Vascular Accident (CVA)
Describe the components of a TIA.
- Transient: short time frame
- Ischemic: low O2
- Attack: happens suddenly
- TIAs come and go and often resolve themselves
Describe a CVA.
No O2 causing long-term damage
What are the two types of CVA? Describe each.
Ischemic CVA: clot = blocked O2 to tissues
Hemorrhagic CVA: Bleed = ↑ICP
What are the two types of ischemic stroke?
Trombotic: via fatty deposit and atherosclerosis
Embolic: dislodged clot that travels to smaller vessel in brain and blocks it
What are some causes of hemorrhagic stroke?
- HTN
- Aneurysms
- Blood thinners (overuse)
What is the patho of a CVA?
- CVA happens when the brain lacks oxygen resulting in long-term permanent damage.
- Typically resulting from a blood clot, narrowed blood vessels (arteriosclerosis) or a ruptured blood vessel (aneurysm).
What are the risk factors for a stroke?
- HTN : #1RF, take meds regularly (ex. 142/94)
- Smoking: scars the blood vessels making them weak
- Hyperlipidemia: high cholesterol creates narrowed blood vessels
- Uncontrolled diabetes: thick sugar in blood increases pressure on vessels
- Use of birth control pills or estrogen hormone therapies
What are the non-modifiable risk factors for stroke?
- Age >55
- Black
- Male
If a stroke pt presents w/ a BP over 200 systolic, how do we lower it and why?
- Admin meds as ordered
- Keep systolic BP over 170 for the first 24-48 hrs
- This is to bring the rate down slowly so the system doesn’t go into shock from a rapid change
A severe headache is a symptom of what type of CVA?
Hemorrhagic
Why would a stroke pt be prescribed antiplatelet meds such as Plavix, Persantine or aspirin?
To promote blood flow and prevent/reduce clotting
Which type of stroke is the most common?
80% of all strokes are thrombotic/ischemic
Describe a lacunar acute ischemic stroke.
Small vessel perforates
Typically caused by chronic HTN, DM, Hyperlipidemia
What are the first signs of a stroke?
FAST
- Facial/smile drip
- Arm drift – one sided weakness
- Speech impairment
- Time to call 911, CT scan immediately!
What is a Carotid Endarterectomy?
Carotid endarterectomy is a surgical procedure to remove a build-up of fatty deposits (plaque), which cause narrowing of a carotid artery
What dx test is done to confirm stroke?
CT scan
What is the pharmacological tx for a thrombolytic ischemic stroke?
Thrombolytics
TPA must be started w/in 3hrs of onset of symptoms
What is tPA?
- Tissue plasminogen activator
- Aka a “Clot buster”
- It catalyzes the conversion of plasminogen to plasmin, the major enzyme responsible for clot breakdown
- Ex. alteplASE, streptokinASE
What is the tPA calculation and how is it administered?
- Formula = 0.9 mg/kg, not to exceed 90mg total dose
- 10% of dose give IV bolus over 1min
- Rest infused over 1hr
What are common blood thinners that may be used to prevent further clotting in an ischemic stroke pt?
- Heparin
- Fragmin (no INR, PT, PTT needed)
- Lovenox (no INR, PT, PTT needed)
What do antifibriolytics do?
Help blood to clot
What is the antidote for tPA and what are its side fx?
- Amicar
- Chest tight/pain
After stabilization, what is the initial plan of care for a pt with suspected embolic stroke?
- Obtain CT of head stat
- Perform neuro assessment
- Admin tPA w/in 3hrs of symptom onset
