CVA and TIA Flashcards
80% of embolic strokes are from ______________________
a fib
What are the risk factors for CVA (stroke) ?
- HTN
- DM
- Dislipidemia
- cigarette smoking
- cardiac disease
- recreational drugs/etoh
- family history
What is the NIH stroke scale?
it looks at level of consciousness, gaze, visual fields, motor, sensory, language. It allows for monitoring of symptoms over time
scale from 0-5
There are two types of CVA:
1.
2.
Ischemic stroke can be either ___________ or ___________
- ischemic
- hemorrhagic
can be either embolic (travels from another part of the body) or thrombotic (clot forms in an artery)
Lacunar infarcts are small lesions ( < 5mm) in ________________. They usually occur in the
1.
2.
3.
4.
It is associated with poorly controlled _______ and ________. The symptoms may progress for _________ to _________ hours. On the CT scan, it is seen as _______________________.
small arterioles
1. basal ganglia
2. pons
3. cerebellum
4. ant limb of internal capsule
HTN, DM
24 to 36
small, punched out hypodense areas
A thrombotic stroke is caused by a thrombus (blood clot) that develops in an artery supplying blood to the brain usually because of repeated build up of
1. ______________________
2. _______________________
3. ______________ such as __________ and ____________ carried in the blood.
The body perceives the buildup as an ______________ to the vessel wall and responds the way it would to a small wound - it forms ________________. The blood clots get caught on the plaque on the vessel walls, eventually stopping the blood flow.
- fatty deposits
- calcium
- clotting factors such as fibrinogen and cholesterol.
injury, blood clots
During an embolic infarct, the clot forms outside of the brain - usually in the ____________ or ______________ of the upper chest and neck and is transported through the blood stream to the brain. There, it eventually reaches a blood vessel small enough to block its passage. Emobli are most commonly bits and pieces of _________________.
heart, large arteries
atherosclerotic plaque
Hemmorhagic stroke occurs when _________________________ and blood begins to leak directly into _______________ and or into the clear ______________. The rupture can be caused by the force of ______________. It can also originate from a weak spot in a blood vessel wall (cerebral aneurysm) or other blood vessel malformation in or around the brain.
a vessel in the brain suddenly ruptures
brain/tissue and or into the clear CSF
high BP
The symptoms of a hemmorhagic stroke appear without warning. The sudden increase in blood volume = increase intracranial pressure that cannot be released. This may trigger severe
1. ________________ headache
2. _________________
3. __________________
4. ___________________
5. ___________________
or death.
- thunderclap
- neck pain
- double vision
- N/V
- Loss of consciousness
Which stroke has the higher fatality rate and overall poor prognosis?
hemorrhagic stroke
The imaging to quickly obtain in someone with a hemorrhagic CVA is a _________________ to discover the bleed.
CT
In cerebral circulation…..
opthalmic artery >
ACA >
MCA>
PCA >
- vision loss
- weakness and decreased sensation contralateral leg and arm, lack of initiative, confusion
- contralateral hemiplegia, hemisensory loss and homonymous hemianopia, eyes deviated towards lesion also can see global aphasia
- weakness, confusion, vision changes, difficulty swallowing, agitation
What is the acute treatment for CVA?
if the symptoms started within 3 hours (up to 4.5) may be a candidate for TPA. If within 3-6 hours may be a candidate for endovascular mechanical embolectomy
Corticosteroids if there is brain swelling
BP should ONLY be lowered if systolic is > 185 within the first two weeks of the CVA.
What is the treatment of ischemic CVA?
TPA given IDEALLY within 3 hours of symptom onset (can be used up to 4.5 hours)
screen for contraindications, bleeding risk.
Endovascular procedures
-Deliver TPA directly to clot
-Remove large clots
What other tests need to be ordered for ischemic CVA?
- Carotid doppler
- MRA (consider CEA in pts with stenosis > 80% )
- Cardiac echo
