TIA

Question 1

TIA

Answer 1

Periods of acute cerebral insufficiency lasting less than one hour without any residual deficit

Question 2

TIA Causes

Answer 2

Ischemia due to arthrosclerosis, thrombus, arterial occlusion, embolus, intracerebral hemorrhage
Cardio embolic events such as atrial fibrillation, acute MI, endocarditis, valve disease
TIA is indicated of impending stroke
Approximately 1/3 of patients with TIA will experience cerebral infarction within five years

Question 3

TIA signs/symptoms

Answer 3

Altered vision: ipsilateral mono ocular blindness (amaurosis fugax) homonymous hemianopia
Altered speech: transient aphasia
Motor impairment: paresthesia of contralateral arm, leg, or face
Sensory deficits
Cognitive and behavioral abnormalities
Dysphagia
Vertigo
Nystagmus

Question 4

TIA classifications

Vertebrobasilar

Answer 4

Occur as a result of inadequate blood flow from vertebral Arteries
Presentation includes: vertigo, ataxia, dizziness, visual field deficits, weakness, confusion

Question 5

TIA classifications

Carotid

Answer 5

Due to carotid stenosis

Presentations include: aphasia, dysarthria, altered level of consciousness, weakness, numbness

Question 6

TIA Lab/Diagnostics

Answer 6

CT is best in distinguishing between ischemia, hemorrhage and tumor
MRI is superior to see T in detecting ischemic infarct
ECG
Echocardiogram
Carotid Doppler and ultrasonography
Cerebral angiography

Question 7

TIA Management

Answer 7

Aspirin has been shown to reduce the incidence of stroke and death
Plavix 75 mg daily by mouth
Assessed for hypertension: the number one cause of heart failure
Carotid endarectomy decreases the risk of stroke and death in patients with recent TIAs
Indicated for > 70%-8% stenosis of vessels for symptomatic patients

Question 8

CVA

Answer 8

Rapid onset of neurological deficits lasting longer than 24 hours; the fifth leading cause of death in the United States

Question 9

CVA Common Causes

Answer 9

Arthrosclerosis of changes
Chronic hypertension
Trauma
Aneurysm
Arterial venous malformation
Tumor

Question 10

Ischemic CVA Signs/Symptoms

Answer 10

Can produce subtle, progressive, or sudden neurological deficits
Changes in LOC
Motor weakness or paralysis
Visual alterations
Changes in vital signs

Question 11

Hemorrhagic CVA Signs/Symptoms

Answer 11

Usually presents with acute onset of focal neurological deficit
Signs of sudden increased intracranial pressure including altered mentation, headache, and vomiting or present when the hemorrhaging is extension
Width left dominant hemisphere involvement, see right hemiparesis, aphasia, dysarthria, difficulty reading writing
With right non- dominant hemisphere involvement, see you left hemiparesis, right visual field changes, spatial disorientation

Question 12

CVA Lab/Diagnostics

Answer 12

Head CT
Cerebral angiography
Lumbar puncture may be performed to patient has a grade one or two aneurysm to detect blood in CSF
- Contraindicated with large bleeds as brain stem herniation can be induced with rapid decompression of the subarachnoid space

Question 13

CVA Management

Answer 13

Thrombotic strokes: fibrinolytic therapy is indicated within preferably less than 3 to 4.5 hours ago instead of symptoms
Surgical evacuation of bleeding may be required
Systemic blood pressure should be lowered if elevated with close observation for evidence of cerebral ischemia
Supportive measures to prevent sudden increases in ICP prior to surgery
MAP may be maintained at 110 -130 to treat cerebral vasospasm - Nimotop
Intravascular volume expansion in hypertensive therapy to increase cerebral perfusion pressure, blood flow, and oxygen delivery
The overall goal is to maintain cerebral perfusion pressure and limit increase in ICP less than 20