Week 31 - CVA/AMS Flashcards
What is often the cause of AMS in young people?
Secondary: Usually due to toxic ingestion or trauma.
What is often the cause of AMS in the elderly?
CVA, Infection, medication interactions, or alterations in living environment.
What are the metabolic causes of LOC?
Hypoxia and hypoglycemia.
What are the structural causes of LOC?
Tumors, space occupying lesions (neoplasms, hematomas, abscess, vasc malformations.
What effect does the structural causes of LOC have on CPP?
deprive the brain of tissue substrates needed for neuronal function
HX questions for the ALOC patient?
SAMPLE, ingestion?, recent trauma or head injury?, symptoms?, ned meds?, substance use?
What does AEIOUTIPS stand for?
A- Alcohol, acidosis
E- Epilepsy, electrolytes
I- Infection
O- OD
U- Uremia (AKI), underdose
T- Trauma/temp
I- Insulin
P- Psychogenic
S- Stroke, shock, seizure
ECG findings to look for in the AMS patient?
Tall R wave
Long QT
Wide QRS
What could a TIA be considered as?
Brain Angina: a temp disturbance in focal cerebral blood flow causing neuro deficits with no infarction
Hypoxic causes of CVA
decreased blood flow causing decreased o2 reaching the tissues: cardiac arrest, shock, resp failure
Embolic causes of CVA
Cardio-Embolic: AF, LV aneurysm, mechanical valve
Paradoxical Embolus: Patent foramen ovale
Thrombotic causes of stroke?
Plaque formation, small/large vessel thrombus
ICH patho?
Blood accumulates within the parenchyma of brain tissue.
Causes of ICH
HTN, cerebral amyloid angiopathy, coagulopathy, trauma, malignancy, ischemic converting into a hemorrhage
What is SAH?
blood rupturing and accumulating in the sub arachnoid space
What is an AVM?
Arteriovenous malformation - abnormal formation at the arterioles and venules that can rupture (?no capillary bed due to malformation)
SAH Causes?
Cerebral: connective tissue diseases, cva that ruptures, sacular.
AVM
Trauma - blunt/penetrating
ICH clinical features?
Headache, increased ICP (cushings), N/V. Aphasia, Deviated gaze, Focal neuro deficits
SAH clinical features?
Thunderclap H/A, meningeal signs, brudzinski and kernigs signs, signs of increased ICP (cushings, N/V). Neuro deficits, unequal pupils, CN deficits. HTN and arrhythmias common resulting from released of catecholamines due to SAH
S/S of ischemic CVA?
FAST +, symptoms plateau they will not increase or get worse
What is another word for the brain?
Cerebrum
What are the 4 lobes of the brain?
frontal, parietal, occipital, temporal
What is the brain comprised of?
Cerebrum, cerebellum and brainstem
What does the frontal lobe of the brain control?
Movement, executive functions
What does the parietal lobe of the brain control?
Sensory Info
What does the temporal lobe of the brain control?
Hearing, smell, memory, facial recognition, and language.
What does the occipital lobe of the brain control?
Vision
What does the Cerebellum control?
Muscle coordination and balance
What does the brain stem control?
HR, BP, RR, GI Function, Consciousness
What is the circle of willis?
Ring of arteries in the brain, allowing blood to circulate from one side to the other in cases of blockage - it is an alternative way for blood to get around an obstructed vessel
2 main causes of ischemic stroke?
Endothelial cell dysfunction: irritants damage endothelium and the damaged area becomes a site for atherosclerosis and plaque formation leading to an obstruction of blood flow
Embolism: AF due to stagnant blood flow causing clots to form and shooting into the LA -> LV -> Aorta -> into the brain
What is a lacunar stroke?
involves deep branches of the MCA that feed the basal ganglia, the damaged tissue develops cysts or fluid filled pockets and there is where the name lacunar comes from
What is the ischemic core?
brain tissue that will likely die around the infarct
What is ischemic penumbra?
area of brain tissue that is preserved by collateral circulation during an infarct and may survive if blood flow is restored quick enough
What is another name for a lacunar stroke?
Watershed infarct
Stroke findings?
FAST +, visual field problems, neglect ( unable to observe and react to L sided stimula ie wont reach to effected side), transient blindness, unilateral numbness, loss of coordination, new colourblind, wernicke aphasia (inability to comprehend speech of others or written material), anomic aphasia (difficulty finding singular words)
What are signs of increased ICP?
N/V, decreased LOC, AMS, lethargy, CN deficits, posturing, cushings triad.
What is cushings triad?
HTN, Bradycardia, Irregular RR
What causes AVM’s to rupture?
Increased pressures
What does the blood brain barrier do?
Controls things leaving the blood and entering the neuro tissues
What does a hemorrhagic stroke do?
bleeding in cranial space puts pressure on the brain and compresses it
Causes of hemorrhagic stroke?
Aneurysm rupture (htn, genetic, trauma), AVM, Coagulopathy, Cirrhosis
