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Neuro 1 > Intro & Pathophysiology of CVA > Flashcards

Intro & Pathophysiology of CVA Flashcards

1
Q

stroke

A

sudden cessation of cerebral blood flow leading to oxygen-glucose deprivation through blockage or hemorrhage

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2
Q

what is the leading cause of serious long-term neurological disability

A

stroke

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3
Q

modifiable risks

A
  • things we can change
  • HTN, diabetes, CV disease, obestiy, obstructive sleep apnea, physical inactivity, diet, blood disorders, arrhythmias, hyperglycemia, smoking, alcohol, drugs
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4
Q

non-modifiable risk

A
  • things we cant change
  • women > men
  • 55 years old
  • black/hispanic, american indian, alaskan natives
  • prior stroke, TIA and/or MI
  • genetics
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5
Q

women > men

A
  • 55,000 more females have a stroke than males

- higher lifetime risk

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6
Q

when you’re older..

A

incidence doubles >55 years old

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7
Q

race risk factors

A
  • black/hispanic:white - 2:1 ratio –> increases to 4:1 btw ages 45-54
  • american indian and alaskan natives are at high risk too
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8
Q

prior stroke, TIA, and/or MI

A

23% of people will have a second stroke

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9
Q

HTN risk factor

A

1 most common and most modifiable risk factor for stroke

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10
Q

arrhythmias risk factor

A

increases CVA risk 5x

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11
Q

ischemic strokes (cerebral infarct) cause

A

diminished volume of perfusion

cause: gradual worsening of fatty deposits lining arterial walls (atherosclerosis)

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12
Q

thrombotic

A

blockage caused by clot form within involved artery - occur anywhere

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13
Q

embolic

A

blockage caused by clot that travels from elsewhere in circulatory
smaller arteries

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14
Q

hemorrhagic strokes cause

A

rupture of artery due to weakening of vessel wall

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15
Q

intracerebral hemorrhage (ICH)

A

most common

cause: HTN

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16
Q

subarachnoid hemorrhage (SAH) cause

A
  • aneurysm and arteriovenous malformation (AVM)
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17
Q

aneurysm

A

enlargement/ballooning of weakened vessel wall

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18
Q

AVM

A

tangle of abnormal blood vessels connecting arteries and veins

19
Q

transient ischemic attack TIA

A
  • transiet episode of neurological dysfunction caused by focal brain, spinal cord or retinal ischemia without infarction
  • mini stroke, warning stroke
  • symptoms last < 24 hrs
20
Q

in the ischemic cascade, the infarct core experiences

A

necrosis

21
Q

in the ischemic cascade, the penumbra experiences

A

apoptosis

22
Q

in the ischemic cascade, what happens within minutes

A

neuronal death in core

23
Q

in the ischemic cascade, what happens within hours

A

surrounding tissue (penumbra) death

24
Q

onset of symptoms for a thrombotic event

A
  • gradual onset
  • days to weeks
  • most common in late PM or first thing AM, may see “wake up strokes”
25
Q

onset of symptoms for a embolic event

A

more abrupt than thrombotic

minutes to hours

26
Q

onset of symptoms for a hemorrhagic event

  • aneurysm
  • AVM
A
  • immediate, severe
  • asymptomatic until rupture
  • may have preceding symptoms (seizures, etc)
26
Q

onset of symptoms for a hemorrhagic event

  • aneurysm
  • AVM
A
  • immediate, severe
  • asymptomatic until rupture
  • may have preceding symptoms (seizures, etc)
27
Q

common complaints of CVA

A
  • imbalance
  • paraesthesias
  • weakness
  • blurry or double vision
  • “worse HA of my life”
28
Q

national institutes of health stroke scale (NIHSS)

A
  • quantitative measure of symptoms associated with cerebral infarcts
  • 15 items –> consciousness, vision, motor & coordination, sensory & perception, language & fluency, behavior
29
Q

cut off scores for NIHSS

A

> 25: very severe –> frequently require long term skilled care
15-24: severe –> frequently require long term skilled care
5-14: mild to moderatly severe –> typically require acute pt rehab
1-5: mild –> 80% will be discharge home from acute hospital

30
Q

when should a pt get a CT

A
  • head trauma
  • financial concerns
  • acute hemorrhage
  • speed needed
  • skull fx
  • calcified lesion
  • claustrophobic pt
  • pacemaker or other metallic implant
31
Q

when should a pt get a MRI

A
  • subtle areas of tumor, infarct, demyelination, etc.
  • brainstem lesion
  • ischemia
  • subacute or chronic hemorrhage
  • anatomy detail needed
32
Q

ischemia stroke major goal

A

revascularization

33
Q

management of an ischemia stroke

A
  • tPA –> 3-8 hr window
  • permissive HTN –> <220/110
  • antiplatelets for first 24-48 hours –> aspirin
34
Q

major goal for hemorrhagic stroke

A

reduce intracranial pressure (ICP)

sedation, hyperosmolar agents, hyperventilation

35
Q

management for hemorrhagic stroke

A
  • anti-hypertensive for BP control –> strict BP parameters, <130/80
  • vasospasm prevention and management (SAH)
  • antiseizure prophylaxis (ICH)
36
Q

if a pt has increased intracranial pressure, what are the PT considerations

A
  • monitor for S&S of increase ICP
  • avoid activity that may exacerbate
  • mobility contraindicated if >20mmHg
37
Q

if pt has a midline shift, what are PT considerations

A
  • evaluate bilateral symptoms

- monitor closely for neurological decline

38
Q

if pt has brain herniation, what are PT considerations

A

PT usually not indicated

39
Q

what is a vasospasm

A

persistent vasoconstriction and dilation of the blood vessels

40
Q

PT considerations for vasospasm

A

mobility contraindicated with moderate to severe vasospasm - consult MD prior to mobility

41
Q

seizures PT considerations

A

mobility usually deferred until > 24 hr after quiet EEG, monitor closely for seizure activity

42
Q

what are additional acute CVA complications

A
  • HTN
  • fever
  • pressure ulcers
  • infection
  • pneumonia
  • hyperglycemia

Neuro 1 (21 decks)

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