Lecture 4: CVA and TIA Pathology and Medical Management

Question 1

What is a CVA?

Answer 1

cerebral vascular accident, sudden loss or neurologic function due to lack of blood flow to the brain, symptoms persist for over 24 hours

Question 2

What type is pathology is a CVA?

Answer 2

VASCULAR which is extremely important for risk factors

Question 3

What is a TIA?

Answer 3

transient ischemic attack, same sx as VA but with resolve within 24 hours, often lasting only 5 minutes

Question 4

Is TIA a medical emergency?

Answer 4

YES bc it is very hard to distinguish between a CVA and TIA in the moment

Question 5

What percentage of TIA pts will have a stroke?

Answer 5

35%

Question 6

What are symptoms of stroke?

Answer 6

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

Question 7

What is epidemiology of stroke?

Answer 7

incidence with increased age, 70% of strokes for people over 65, risk doubles every 10 years after 55

higher risk in minorities and males

Question 8

What is greatest risk factor for CVA?

Answer 8

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)

Question 9

What are non modifiable risk factors for stroke?

Answer 9

age, gender, race, previous TIA/CVA, family history, DM 1

Question 10

What is etiology of an ischemic stroke?

Answer 10

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)

Question 11

What percentage of strokes are ischemic?

Answer 11

80%

Question 12

What is pathological process of ischemic stroke?

Answer 12

1. lack of blood flow = loss of oxygen and glucose
2. neuronal death in ischemic core within minutes
3. ischemic cascade- impaired energy production, further neural damage
4. ischemic penumbra forms in areas adjacent to ischemic core
5. cerebral edema and ICP (frequent cause of death in large strokes) sodium ions leave causing attraction of water to brain

Question 13

What is etiology of a hemorhagic stroke?

Answer 13

rupture of blood vessel leads to bleeding into extravascular space and blood is toxic

less common but more life threatenting

Question 14

What are two types of hemorrhagic strokes?

Answer 14

1. intracerebal hemorrhage (ICH)- rupture of vessel within brain
2. subarachnoid hemorrhage (SAH)- rupture of vessel on brain surface and beelds into SAS, which can cause whole pain to swell

Question 15

What can cause a hemorrhagic stroke?

Answer 15

trauma, HTN (36%), aneurysm (36%), ateriovenous malformation (congential) 11%

Question 16

What are sx of ICH stroke?

Answer 16

elevated ICP, seevre HA, difficulty speaking, confusion, impaired vision, large pupils, NV, LOC

Question 17

What are sx of SAH stroke?

Answer 17

elevated ICP, thunderclap HA, facial pain, diplopia, impaired peripheral vision, confused, restless, stiff neck and low back, D/V

Question 18

What is difference in recovery time table between hemorrhagic and ischemic?

Answer 18

H- slower first 6 months followed by rapid recovery

I- steady rate early on then plateau

Question 19

What is key for medical diagnosis?

Answer 19

time how fast they receive initial care so type can be diagnosed earlier

CT scan preferred over MRI

Question 20

Why is CT preferred over MRI?

Answer 20

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

Question 21

What is gold standard for outcome measures of stroke?

Answer 21

NIH stroke scale done acutely by trained RN or MD

Question 22

What is NIH stroke scale?

Answer 22

0-7 mild
8-16 moderate
over 16 is severe

predictive of outcome measures

Question 23

What is medical management of ischemic stroke?

Answer 23

clot breaking drug like tissue plasminogen activator, effective if given with 3 hours

surgical removal of clot

Question 24

What is medical management of hemorrhagic stroke?

Answer 24

decreased ICP with shunt, drain or craiectomy, promote clotting with vitamin K, neurosurgery

Question 25

What is medical management for TIA?

Answer 25

treat risk factors with ASA, anticoagulants, BP meds, statins, lifestyle mods

Question 26

What are other areas for medical management of stroke?

Answer 26

siezure prevention, bowel/bladder function, skin integrity, DVT prevention, infxn control, nutritional needs