Lecture 4: CVA and TIA Pathology and Medical Management Flashcards
What is a CVA?
cerebral vascular accident, sudden loss or neurologic function due to lack of blood flow to the brain, symptoms persist for over 24 hours
What type is pathology is a CVA?
VASCULAR which is extremely important for risk factors
What is a TIA?
transient ischemic attack, same sx as VA but with resolve within 24 hours, often lasting only 5 minutes
Is TIA a medical emergency?
YES bc it is very hard to distinguish between a CVA and TIA in the moment
What percentage of TIA pts will have a stroke?
35%
What are symptoms of stroke?
FAST, face drooping, unable to lift one arm, slurred speech, time call right away 911
also, sensory changes, visual disturbance, confusion, loss of consciousness, loss of balance, decreased ability to walk
What is epidemiology of stroke?
incidence with increased age, 70% of strokes for people over 65, risk doubles every 10 years after 55
higher risk in minorities and males
What is greatest risk factor for CVA?
HTN as well as HLD, obesity, heavy ETOH use, cocaine use, smoking sedentary lifestyle
risk is 1/2 with BP under 120/80
also DM and CVD (afib)
What are non modifiable risk factors for stroke?
age, gender, race, previous TIA/CVA, family history, DM 1
What is etiology of an ischemic stroke?
blood flow is blocked to brain from either low perfusion (cardiac failure) thrombolic (atherosclrotic plaques), embolic (clot from outside cerebral arteries- AFib) or vasospasm (blood vessels contract could be SE of drugs), coagulopathy (clotting from sickle cell or oral contraceptives with high estrogen count)
What percentage of strokes are ischemic?
80%
What is pathological process of ischemic stroke?
- lack of blood flow = loss of oxygen and glucose
- neuronal death in ischemic core within minutes
- ischemic cascade- impaired energy production, further neural damage
- ischemic penumbra forms in areas adjacent to ischemic core
- cerebral edema and ICP (frequent cause of death in large strokes) sodium ions leave causing attraction of water to brain
What is etiology of a hemorhagic stroke?
rupture of blood vessel leads to bleeding into extravascular space and blood is toxic
less common but more life threatenting
What are two types of hemorrhagic strokes?
- intracerebal hemorrhage (ICH)- rupture of vessel within brain
- subarachnoid hemorrhage (SAH)- rupture of vessel on brain surface and beelds into SAS, which can cause whole pain to swell
What can cause a hemorrhagic stroke?
trauma, HTN (36%), aneurysm (36%), ateriovenous malformation (congential) 11%
What are sx of ICH stroke?
elevated ICP, seevre HA, difficulty speaking, confusion, impaired vision, large pupils, NV, LOC
What are sx of SAH stroke?
elevated ICP, thunderclap HA, facial pain, diplopia, impaired peripheral vision, confused, restless, stiff neck and low back, D/V
What is difference in recovery time table between hemorrhagic and ischemic?
H- slower first 6 months followed by rapid recovery
I- steady rate early on then plateau
What is key for medical diagnosis?
time how fast they receive initial care so type can be diagnosed earlier
CT scan preferred over MRI
Why is CT preferred over MRI?
CT- can distinguish between I or H, quicker, ;ess expensive
MRI- more contraindications, however is more helpful when extent or location is unknown, should be done but maybe not right away
What is gold standard for outcome measures of stroke?
NIH stroke scale done acutely by trained RN or MD
What is NIH stroke scale?
0-7 mild
8-16 moderate
over 16 is severe
predictive of outcome measures
What is medical management of ischemic stroke?
clot breaking drug like tissue plasminogen activator, effective if given with 3 hours
surgical removal of clot
What is medical management of hemorrhagic stroke?
decreased ICP with shunt, drain or craiectomy, promote clotting with vitamin K, neurosurgery
What is medical management for TIA?
treat risk factors with ASA, anticoagulants, BP meds, statins, lifestyle mods
What are other areas for medical management of stroke?
siezure prevention, bowel/bladder function, skin integrity, DVT prevention, infxn control, nutritional needs
