TIA/CVA/Seizure

Question 1

S & S TIA

Answer 1

Ipsilateral monocular blindness **
transient aphasia
paraesthesias of contralateral extremities **
vertigo
nystagmus

Question 2

What are the two types of TIA classifications?

Answer 2

Vertebrobasilar (more neuro presentations)

Carotid (presents more like a true stroke)

Question 3

How does a patient present with a TIA d/t carotid stenosis?

Answer 3

aphasia, dysarthria, ALOC, numbnesss

Question 4

How does a patient present with a TIA 2/2 vertebrobasilar reasons?

Answer 4

-vertigo, ataxia, dizziness, visual field deficits,

Question 5

Labs and diagnostics for TIA

Answer 5

• CT: distinguishes between ischemia, hemorrhage and tumor
• MRI is superior to CT in detecting ischemic infarcts
• echo
• carotid doppler
• cerebral angiography

Question 6

Management of TIA

Answer 6

• 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

Question 7

Common causes of CVA

Answer 7

• atherosclerotic changes
• chronic htn
• trauma
• aneurysm
• av malformation
• tumor

Question 8

Hemorrhagic CVA S&S

Answer 8

-sudden increased ICP including altered mentation, headache and vomiting when hemorrhage is extensive

Question 9

What do you expect to see with left dominant hemisphere involvement

Answer 9

-right hemiparesis, aphasia, dysarthria, difficulty reading/writing

Question 10

What do you expect to see with right dominant hemisphere involvement?

Answer 10

-left hemiparesis, spatial disorientation and RIGHT visual field changes

Question 11

Why is LP contraindicated with large bleeds?

Answer 11

brain stem herniation can be induced with rapid decompression of the subarachnoid space. ALWAYS do CT before LP

Question 12

when is a lumbar puncture indicated with hemorrhagic CVA?

Answer 12

if grade 1 or 2 aneurysm to detect blood in csf

Question 13

when is fibrinolytic therapy indicated?

Answer 13

Thrombotic strokes within less than 3-4.5 hours of onset of symptoms

Question 14

What are supportive measure to prevent increase in ICP prior to surgery?

Answer 14

• HOB elevated to promote venous drainage
• sedation
• adequate oxygenation
• analgesics
• laxatives

Question 15

What should the MAP be maintained at with CVA patient?

Answer 15

110-130 to tx cerebral vasospasm

Question 16

What is the utility of Nimodipine ** in a CVA patient

Answer 16

a calcium channel antagonist that helps to counter vasospasm by preventing calcium from entering smooth muscle cells and causing contraction
prevents cerebral vasospasm**

Question 17

what are other measures taken to maintain cerebral profusion pressure?

Answer 17

Intravascular volume expansion and hypertensive therapy to increase cerebral profusion pressure (CPP = MAP-ICP), blood flow and oxygen delivery

Question 18

what do you want to limit the ICP to

Answer 18

< 20

Question 19

characteristics of simple partial seizures?

focal or local

Answer 19

• no loss of consciousness **
• motro symptoms start in single muscle group and spread to entire side of body
• paresthesias, flashing lights, vocalizations

Question 20

characteristics of complex partial seizures

Answer 20

• any simple partial seizure followed by impaired level of consciousness **
• may have aura, lip smacking, picking at clothing

Question 21

characteristics of absence seizure

petite mal

Answer 21

• sudden arrest of motor activity with blank stare
• common with adolescence
• begin and end suddenly

Question 22

characteristics of grand mal seizure (tonic-clonic)

Answer 22

• 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

Question 23

status spileticus

Answer 23

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

Question 24

seizure assessment includes what:

Answer 24

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

Question 25

subsequent seizure prevention

Answer 25

• tegretol
• phenytoin
• phenobarbital
• valporic acid
• primidone
• clonazepan

Question 26

Name the 3 Hs of Increased ICP

Answer 26

• hypotension
• hypoxia
• hypercapnia

hyperventilate patients to keep co2 less than normal to keep the three Hs in line. co2 kept at 35

Question 27

new onset: seizure, HA, personality changes, vertigo

Answer 27

ned to r/o brain tumor first

Question 28

what seizure med is used to break status seizure?

Answer 28

valium because longer acting

Question 29

Hemorrhagic & Ischemic strokes. How is the onset different usually?

Answer 29

H: sudden onset of focal neuro deficits
I: more gradual in onset

Question 30

what seizure med is used to break non status epilepticus seizures

Answer 30

usually ativan

Question 31

when is a carotid endarectomy indicated?

Answer 31

> 70% to 80% stenosis of vessels for symptomatic** patients

Question 32

A pt with 90% stenosis in both carotids but left hand is tingling. what do you do

Answer 32

• fix right carotid first