Transient Ischemic Attack and Cerebral Vascular Accident

Question 1

Cerebral Circulation

Answer 1

blood supplied to the brain in internal carotid arteries and vertebral arteries which needs to be 750 to 1000mL/min for normal brain function

Question 2

Ischemic Cascade

Answer 2

inadequate adenosine triphosphate production leads to loss of ion homeostasis, the release of excitatory amino acids, free radical formation and cell death

Question 3

Stroke

Answer 3

lack of blood flow to the brain with multiple causes results in cell death within the brain

Question 4

Ischemic Stroke

Answer 4

stroke from partial or complete occlusion of the artery. Most common stroke that can cause thrombotic and embolic effects

Question 5

Affect of Brain

Answer 5

If the stroke is on the left side of the brain, the right side of the body is affected and vice versa

Question 6

Transient Ischemic Stroke

Answer 6

temp neurological dysfunction from the focal brain, spinal cord, or retinal ischemia without acute infarction of the brain, essentially a mini-stroke. It May develop into a full stroke if not treated

Question 7

Thrombotic Stroke

Answer 7

cerebral thrombosis or narrowing of the lumen on the arteries in the brain from fatty plaque or trauma to the artery wall that causes a blood clot formation. 30-50% of all strokes. Typically no changes to LOC unless it is severe. Risk factors are hypertension and DM

Question 8

Lactunar Stroke

Answer 8

stroke form occlusion of a small penetrating artery that supplies blood to the deep tissues of the brain.

Question 9

S&S of Lactunar Stroke

Answer 9

Typically more severe
paralysis of one side of the brain
purse sensory stroke
loss of consciousness 
decrease in vascular functioning

Question 10

Embolic Stroke

Answer 10

embolus or blood clot or other debris causing a blockage in a narrow artery that blocks blood flow resulting in infarction and edema of the area with severe rapid progression, 24% of stroke and typically ends with cardiovascular complications as well

Question 11

Embolic Stroke S&S

Answer 11

headache that typically does not cause a LOC

Question 12

Hemorrhage Stroke

Answer 12

burst blood vessel or vessels that causes internal bleeding to occur in the brain and damage to the tissues until coagulation occurs, 15% of all strokes

Question 13

Intracerebral Hemorrhage Stroke

Answer 13

10% of all strokes, occurs in the brain due to some type of trauma with sudden onset of symptoms that is typically caused by hypertension

Question 14

Subarachnoid Stroke

Answer 14

intracranial bleeding into the cerebral spinal fluid space between the arachnoid space and pia mater that is commonly caused by a brain aneurysm. Mortality rates are 25% and 1/2 of survivors have severe permanent neurological damage. SILENT BUT DEADLY

Question 15

Risk Factors of Strokes

Answer 15

Hypertension, which is also the most common cause
DM due to the systemic inflammation, atrial fibrillation, endothelial dysfunction
CAD and other cardiovascular diseases
heavy alcohol consumption
oral contraceptives
smoking
physical inactivity
obesity
older age
ethnicity
hereditary so familial history of
low birth weight

Question 16

S&S of Strokes

Answer 16

decreased mobility
decreases senses, numbness or paralysis
loss of speech and swallowing
decreased rep
loss of voluntary movement
drooping face
amnesia of movements
lack of or decreased reflexes
monotone voice and inability/difficulty expressing emotions
decreased judgement and intellectual status
poor perception of self
poor elimination
headache
LOC depending on the type of stroke
fixed pupils or pupils unequally reactive
Homonymous Hemianospice - blindness equal on both sides in a specific area of vision that can lead to double vision, loss of corneal reflex and ptosis (drooping eyelid) 
dysphagia
dysarthria
altered spatial perception

Question 17

Left Side Stroke S&S

Answer 17

communication problems
hemiplegia
hyperaware of deficits causing depression and anxiety
impaired wrath
language impairment
facial drooping

Question 18

Right Side Stroke S&S

Answer 18

vision problems
Left side neglect
tend to minimize or deny effects of stroke
rapid performance
decreased attention span
impulsive or posing safety concerns to self
impaired time concepts

Question 19

Ischemic Stroke S&S

Answer 19

loss of sight in one eye
vertigo
dysphagia
double vision or blurriness
unilateral control of movement
problems speaking

Question 20

Intracerebral Hemorrhage Stroke S&S

Answer 20

hemiplegia
internal bleeding and bruising
balance off
abnormal body posture
paralysis

Question 21

Gender Differences in Strokes

Answer 21

1/3 more women die from strokes, with worse outcomes and less likely to be admitted into a rehab program. 85 women a day have a stroke and 18 of them will die

Question 22

Diagnosis of Stroke

Answer 22

CT
CAT
MRI
MRA
Carotid angiography
carotid duplex scanning
cerebral angiography
digital subtraction angiography
transcranial doppler
ultrasonography
cardiac markers and other cardiac diagnostics if cardiovascular involvement is suspected
coagulation studies
CSF analysis
CBC
aPTT
Renal and hepatic studies

Question 23

TX of Strokes

Answer 23

CABs
IV with NS
NPO and NG tube
ASA, Plavix, apixaban, dabigatran, rivaroxaban
surgery
physio and movement rehab
monitoring neuro exam results, elimination, skin integrity, and nutritional status
focus on emotions and coping tPA

Question 24

tPA Recombinant Tissue Plasminogen Activator

Answer 24

naturally occurring endothelial protein that activated conversion of plasminogen to plasmin that breakdown clots and is used to re-establish blood flow to the brain. Need to be within 3.5-4 hours of onset and cannot have blood thinners prior. Requires foley catheter,, NG tube and multiple IVs

Question 25

Rehab for Strokes

Answer 25

stabilized for 12-72 h is the beginning

attaining optimal functioning with physio may be transported to outpatient neuro wards and neuro exam is KEY