Week 31 - CVA/AMS

Question 1

What is often the cause of AMS in young people?

Answer 1

Secondary: Usually due to toxic ingestion or trauma.

Question 2

What is often the cause of AMS in the elderly?

Answer 2

CVA, Infection, medication interactions, or alterations in living environment.

Question 3

What are the metabolic causes of LOC?

Answer 3

Hypoxia and hypoglycemia.

Question 4

What are the structural causes of LOC?

Answer 4

Tumors, space occupying lesions (neoplasms, hematomas, abscess, vasc malformations.

Question 5

What effect does the structural causes of LOC have on CPP?

Answer 5

deprive the brain of tissue substrates needed for neuronal function

Question 6

HX questions for the ALOC patient?

Answer 6

SAMPLE, ingestion?, recent trauma or head injury?, symptoms?, ned meds?, substance use?

Question 7

What does AEIOUTIPS stand for?

Answer 7

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

Question 8

ECG findings to look for in the AMS patient?

Answer 8

Tall R wave
Long QT
Wide QRS

Question 9

What could a TIA be considered as?

Answer 9

Brain Angina: a temp disturbance in focal cerebral blood flow causing neuro deficits with no infarction

Question 10

Hypoxic causes of CVA

Answer 10

decreased blood flow causing decreased o2 reaching the tissues: cardiac arrest, shock, resp failure

Question 11

Embolic causes of CVA

Answer 11

Cardio-Embolic: AF, LV aneurysm, mechanical valve
Paradoxical Embolus: Patent foramen ovale

Question 12

Thrombotic causes of stroke?

Answer 12

Plaque formation, small/large vessel thrombus

Question 13

ICH patho?

Answer 13

Blood accumulates within the parenchyma of brain tissue.

Question 14

Causes of ICH

Answer 14

HTN, cerebral amyloid angiopathy, coagulopathy, trauma, malignancy, ischemic converting into a hemorrhage

Question 15

What is SAH?

Answer 15

blood rupturing and accumulating in the sub arachnoid space

Question 16

What is an AVM?

Answer 16

Arteriovenous malformation - abnormal formation at the arterioles and venules that can rupture (?no capillary bed due to malformation)

Question 17

SAH Causes?

Answer 17

Cerebral: connective tissue diseases, cva that ruptures, sacular.
AVM
Trauma - blunt/penetrating

Question 18

ICH clinical features?

Answer 18

Headache, increased ICP (cushings), N/V. Aphasia, Deviated gaze, Focal neuro deficits

Question 19

SAH clinical features?

Answer 19

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

Question 20

S/S of ischemic CVA?

Answer 20

FAST +, symptoms plateau they will not increase or get worse

Question 21

What is another word for the brain?

Answer 21

Cerebrum

Question 22

What are the 4 lobes of the brain?

Answer 22

frontal, parietal, occipital, temporal

Question 23

What is the brain comprised of?

Answer 23

Cerebrum, cerebellum and brainstem

Question 24

What does the frontal lobe of the brain control?

Answer 24

Movement, executive functions

Question 25

What does the parietal lobe of the brain control?

Answer 25

Sensory Info

Question 26

What does the temporal lobe of the brain control?

Answer 26

Hearing, smell, memory, facial recognition, and language.

Question 27

What does the occipital lobe of the brain control?

Answer 27

Vision

Question 28

What does the Cerebellum control?

Answer 28

Muscle coordination and balance

Question 29

What does the brain stem control?

Answer 29

HR, BP, RR, GI Function, Consciousness

Question 30

What is the circle of willis?

Answer 30

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

Question 31

2 main causes of ischemic stroke?

Answer 31

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

Question 32

What is a lacunar stroke?

Answer 32

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

Question 33

What is the ischemic core?

Answer 33

brain tissue that will likely die around the infarct

Question 34

What is ischemic penumbra?

Answer 34

area of brain tissue that is preserved by collateral circulation during an infarct and may survive if blood flow is restored quick enough

Question 35

What is another name for a lacunar stroke?

Answer 35

Watershed infarct

Question 36

Stroke findings?

Answer 36

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)

Question 37

What are signs of increased ICP?

Answer 37

N/V, decreased LOC, AMS, lethargy, CN deficits, posturing, cushings triad.

Question 38

What is cushings triad?

Answer 38

HTN, Bradycardia, Irregular RR

Question 39

What causes AVM's to rupture?

Answer 39

Increased pressures

Question 40

What does the blood brain barrier do?

Answer 40

Controls things leaving the blood and entering the neuro tissues

Question 41

What does a hemorrhagic stroke do?

Answer 41

bleeding in cranial space puts pressure on the brain and compresses it

Question 42

Causes of hemorrhagic stroke?

Answer 42

Aneurysm rupture (htn, genetic, trauma), AVM, Coagulopathy, Cirrhosis