TIA/CVA/Seizure Flashcards
S & S TIA
Ipsilateral monocular blindness ** transient aphasia paraesthesias of contralateral extremities ** vertigo nystagmus
What are the two types of TIA classifications?
Vertebrobasilar (more neuro presentations)
Carotid (presents more like a true stroke)
How does a patient present with a TIA d/t carotid stenosis?
aphasia, dysarthria, ALOC, numbnesss
How does a patient present with a TIA 2/2 vertebrobasilar reasons?
-vertigo, ataxia, dizziness, visual field deficits,
Labs and diagnostics for TIA
- CT: distinguishes between ischemia, hemorrhage and tumor
- MRI is superior to CT in detecting ischemic infarcts
- echo
- carotid doppler
- cerebral angiography
Management of TIA
- ASA along with plavix usually
- plavix
- ticlopidine (not well tolerated and requires labs, thrombocytopenia)
- assess for HTN
- carotid endarectomy if has > 70-80% stenosis of vessels
Common causes of CVA
- atherosclerotic changes
- chronic htn
- trauma
- aneurysm
- av malformation
- tumor
Hemorrhagic CVA S&S
-sudden increased ICP including altered mentation, headache and vomiting when hemorrhage is extensive
What do you expect to see with left dominant hemisphere involvement
-right hemiparesis, aphasia, dysarthria, difficulty reading/writing
What do you expect to see with right dominant hemisphere involvement?
-left hemiparesis, spatial disorientation and RIGHT visual field changes
Why is LP contraindicated with large bleeds?
brain stem herniation can be induced with rapid decompression of the subarachnoid space. ALWAYS do CT before LP
when is a lumbar puncture indicated with hemorrhagic CVA?
if grade 1 or 2 aneurysm to detect blood in csf
when is fibrinolytic therapy indicated?
Thrombotic strokes within less than 3-4.5 hours of onset of symptoms
What are supportive measure to prevent increase in ICP prior to surgery?
- HOB elevated to promote venous drainage
- sedation
- adequate oxygenation
- analgesics
- laxatives
What should the MAP be maintained at with CVA patient?
110-130 to tx cerebral vasospasm
What is the utility of Nimodipine ** in a CVA patient
a calcium channel antagonist that helps to counter vasospasm by preventing calcium from entering smooth muscle cells and causing contraction
prevents cerebral vasospasm**
what are other measures taken to maintain cerebral profusion pressure?
Intravascular volume expansion and hypertensive therapy to increase cerebral profusion pressure (CPP = MAP-ICP), blood flow and oxygen delivery
what do you want to limit the ICP to
< 20
characteristics of simple partial seizures?
focal or local
- no loss of consciousness **
- motro symptoms start in single muscle group and spread to entire side of body
- paresthesias, flashing lights, vocalizations
characteristics of complex partial seizures
- any simple partial seizure followed by impaired level of consciousness **
- may have aura, lip smacking, picking at clothing
characteristics of absence seizure
petite mal
- sudden arrest of motor activity with blank stare
- common with adolescence
- begin and end suddenly
characteristics of grand mal seizure (tonic-clonic)
- begins with tonic contraction (repetitive involuntary contraction of muscle)
- loss of consciousness then clonic contractions (maintained involuntary contraction of muscle)
- lasts 2-5 minutes
- incontinence may occur
- postictal period
status spileticus
series of grandmal seizures of > 10 minutes duration
- med emergency
- may occur when patient is awake or asleep but pt never gains consciousness between attacks
seizure assessment includes what:
presence of aura, onset, spread, type of movement, body parts involved, pupil changes and reactivity, duration, loss/LOC, incontinence, neurological changes after cessation of seizure activity
- EEG: most important test in determining seizure classification
- CT of head indicated for all new onset seizures
