Stoke and CVA

Question 1

cerebrovascular accident

Answer 1

CVA

old term for stroke, may still be heard in hospitals

Question 2

penumbra

Answer 2

area around infarct that is not dead yet that clinicians are trying to save w/Tx

Question 3

causes of ischemic stroke

Answer 3

large a thrombosis
embolism
lacunar

Question 4

sources of embolic strokes

Answer 4

arterial (carotid, aorta)
heart (atrial, ventricular, valvular)
paradoxical emboli

Question 5

other causes of ischemic stroke

Answer 5

watershed infarcts
hypercoagulable disorders
vasculitis
vasospasm
moyamoya

Question 6

large artery thrombosis

Answer 6

bascially like a MI of brain
best type of stroke to treat w/tPA
plaques rupture -> platelets -> WBC -> block aa

Question 7

atrial sources of emboli

Answer 7

A fib/flutter (most common)
atrial septal aneurysm (congenital)
atrial tumors/myoxoma

Question 8

ventricular sources of emboli

Answer 8

cardiomyopathy
MI (most common)
ventricular aneurysms (most common post MI)

Question 9

cardiomyopathy

Answer 9

weak and dilated ventricle isn’t pumping efficiently -> blood stasis and thrombus formation
hypertrophic usually forms the clot

Question 10

MI

Answer 10

part of wall is not moving, creating stasis -> mural thrombosis

Question 11

valvular cardiac emboli

Answer 11

rheumatic mitral stenosis
prosthetic valves 
infective and non-infective endocarditis
nonbacterial thrombotic endocarditis (CA)
calcific valves
bicuspid aortic valves
inflammatory valvulitis

Question 12

carotid a artherosclerosis/stenosis

Answer 12

may cause embolic or thrombotic strokes

Question 13

lacunar infarct

Answer 13

-forms in subCx areas of brain supplied by small deep penetrating aa arising from big aa
-BP does not decrease in smaller vessels of brain like it does elsewhere in body, therefore HTN can be devastating to the small vessels of the brain
-may be d/t atheroemboli or lipohyalinosis
frequently asymptomatic

Question 14

watershed infarcts

Answer 14

when MAP <60

Question 15

disorders which are more likely to cause arterial clotting

Answer 15

antiphospholipid Ab syndrome
anticardiolipid Abs
lupus anticoagulants
hperhomocysteinemia

Question 16

other hypercoagulable states

Answer 16

CA
prego (increased E)
hormone replacement therapy 
prolonged bedrest/immobility, MI, stroke
myeloproliferative disorders (polycythemia vera or essential throbocytosis)

Question 17

vasospasm

Answer 17

usually caused by cocaine

subarachnoid bleed

Question 18

myoyamoya disease

Answer 18

poorly understood occlusive disease involving large intracranial aa

Question 19

hemiparesis

Answer 19

weakness on one side of body

Question 20

hemiplegia

Answer 20

complete paralysis of one side of body

Question 21

homonymous hemianopsia

Answer 21

aka hemianopia

loss of vision in same visual field of both eyes

Question 22

aclculia

Answer 22

cannot form simple math task

Question 23

agnosia

Answer 23

inabiliyt to recognize objects, persons, shapes, smells

Question 24

alexia

Answer 24

inability to read

Question 25

agraphia

Answer 25

inability to write

Question 26

dyarthria

Answer 26

slurred speech

Question 27

apraxia

Answer 27

inability to perform simple task

Question 28

anosognosia

Answer 28

unawareness or denial of diability

Question 29

anomia

Answer 29

difficulty w/recalling words or names

Question 30

middle cerebral a syndrome

Answer 30

-most common ischemic stroke syndrome b/c MCA supplies a major area of Cx -c/l hemiplegia and sensation loss c/l homonymous hemianopsia

Question 31

middle cerebral a syndrome on dominant side

Answer 31

most common | aphasia, alexia, agraphia, acalcula, finger agnoisa, R/L confusion

Question 32

middle cerebral a syndrome on non-dominant side

Answer 32

u/l neglect dressing apraxia anosognosia constructional apraxia

Question 33

anterior a syndrome

Answer 33

c/l sensory and motor loss of lower extremity | loss of bladder control

Question 34

posterior cerebral a syndrome

Answer 34

homocymous hemianopsia alexia w/o agraphia visual or color anomia

Question 35

lateral pontine syndrome

Answer 35

AICA ataxia weakness hemisensory loss (pain and temp)

Question 36

lateral medullary syndrome

Answer 36

``` aka wallenberg syndrome PICA facial sensory and pain loss ataxia nystagmus vertigo hoarseness dysphagia horner syndrome hemisensory loss hiccups ```

Question 37

basilar a strokes

Answer 37

``` locked in syndrome lateral potine syndrome ventral pontine syndrome ventral potine syndrome ataxic hemiparesis cortical blindess ```

Question 38

amaurosis fugax

Answer 38

transient mono-ocular blindness loss of vision in 1 eye for a few hours often sign of ischemic stroke from carotid

Question 39

TIA

Answer 39

same symptoms and etiology of stoke, but lasts <24 hrs

Question 40

rtPA Tx

Answer 40

must be given w/in 3hrs of onset intravenous or intra-arterial have to have a thrombus for this to work must do CT to rule our hemorrhage

Question 41

race risk for stroke

Answer 41

african americans and hispanics higher risk of stroke, and have higher mortality

Question 42

stroke and gender

Answer 42

more men have strokes | more women die from strokes