Cerebrovascular Accident (CVA)

Question 1

Primary risk factors for CVA

Answer 1

Hypertension, cardiac disease or arrhythmias, diabetes, smoking, transient ischemic attacks

Question 2

Secondary risk factors for CVA

Answer 2

Obesity, high cholesterol, behaviors related to hypertension (stress, excessive salt intake), physical inactivity, increased alcohol consumption

Question 3

Transient Ischemic Attack (TIA)

Answer 3

Usually linked to atherosclerotic thrombosis, which causes temporary interruption of blood supply to area of brain. Symptoms resolve quickly, typically within 24-48 hours. Usually occurs in carotid and vertebrobasilar arteries and may indicate future CVA.

Question 4

Complete Stroke

Answer 4

CVA with total neurological deficits at onset.

Question 5

Stroke in Evolution

Answer 5

Usually caused by a thrombus that gradually progresses. Total neurological deficits not seen for 1-2 days after onset.

Question 6

Ischemic stroke: Embolus

Answer 6

20% of ischemic CVAs 
Associated with cardiovascular disease. 
Embolus may be solid, liquid, or gas and can originate from any body part. 
MCA most commonly affected.
Often occurs with headache.

Question 7

Ischemic stroke: Thrombus

Answer 7

Athersclerotic plaque develops in artery and eventually occludes artery, causing infarct. Symptoms can appear in minutes or over several days. Often occurs during sleep or upon awakening after MI or post-surgical procedures.

Question 8

Hemorrhage stroke

Answer 8

10-15% of CVAs
Bleeding in brain due to rupture.
Hypertension usually a precipitating factor; trauma can also cause rupture.
Symptoms include severe headache, vomiting, high blood pressure, and abrupt onset of symptoms.

Question 9

National Institute of Health (NIH) Stroke Scale

Answer 9

Assessment of acute CVA relative to impairment

Question 10

Functional Independence Measure (FIM)

Answer 10

Provides level of burden through assessment of mobility and ADL management

Question 11

Stroke Impact Scale

Answer 11

Assessment of physical and social disability or level of impairment

Question 12

Fugl-Meyer Assessment of Physical Performance

Answer 12

Assessment of motor, sensory, and balance impairment, pain and ROM

Question 13

Pharmacological Intervention

Answer 13

Thrombolytic agents, anticoagulants (contraindicated for hemorrhagic CVA), diuretics, antihypertensives, and potential long-term use of aspirin.

Question 14

CVA Outcome

Answer 14

First 3 months of recovery typically reveals the most measurable neurologic recovery and is usually a good indicator of long-term outcome.
Pt can continue to improve control of movement and show progress for an average of 2-3 years post CVA.