Flashcards in CVA Deck (36):
What is a Cerebrovascular Disease? CVA
Define what a CVA is. What is it? What is it due to?
an acute neurological deficit d/t ischemia
If a CVA is an acute neurological deficit d/t ischemia, what does this mean in regards to perfusion to the brain?
Lack of perfusion to the brain.
There are 2 Types of CVAs. Name them and explain what it is.
1. Ischemic CVA
- obstructed or occluded vessel causing lack of perfusion to the brain tissue
2. Hemorrhagic CVA
- vessel severed in cranium --> hemorrhage --> brain compression
Ischemic CVA: the vessel can be occluded why? (2)
The risks for CVA
1. Modifiable (5)
2. Unmodifiable (4)
1. HTN, atherosclerosis, Hyperlipiedmia, DM, Smoking
2. Aging, males, prior strokes, familial history
If the modifiable risk factors for CVA are managed, can a stroke be avoided?
The patho for CVA involves the brain being sensitive to what two things?
Can the brain utilize anarerobic metabolism?
Oxygen and glucose
The brain relies on aerobic metabolism for ATP
What are the two forms of stroke?
1. Ischemic CVA
2. Hemorrhagic CVA
Explain the patho for Ischemic CVA:
Occlusion of the vessel --> focal ischemia --> necrotic core (dead tissue which will have loss of function) --> pneumbra around the necrotic core (tissue that is lacking perfusion but still alive) --> penumbra will become smaller and necrotic core bigger if there is not an intervention to increase the blood supply to the brain
What does focal ischemia mean?
What does global ischemia mean?
1 hemisphere affected
Most of the brain is obstructed (BIG PROBLEM!)
1. Explain the patho for Hemorrhagic CVA:
2. What usually causes this? (4)
3. What are the two complications from this?
1. severed vessel --> hemorrhaging --> compression
2. Htn and ageing (also aneurysms and tumors)
3. Coma and death
is this a large or mini stroke?
Transient Ischemic Attack
Transient Ischemic Attack: what is occuring to the neurological deficit? d/t what?
acute, brief, neurological deficit d/t acute focal ischemia
1. Is a TIA reversible?
2. Is the ET/Patho of TIA similar to CVA?
3. Does a TIA involve a necrotic core? Penumbra?
3. No nectrotic core, yes penumbra
Why would a TIA have a pneumbra?
The tissue is not being properly perfused, but there is no necrosis occuring.
Does a TIA involve permanant damage?
If you have a TIA, what does this do for your risk of future TIA's or strokes?
Increases the risk
The manifestations for CVA depend on what?
Are the mnfts an acute onset?
the location, size of vessel, and area of brain distal to the vessel
Yes they are an acute onset
The mnfts for a CVA in the left hempishere would present in the right side of a patient. Why?
D/t to the decaustation of the pyramids, the fibers cross over.
What are the 3 main symptoms of a CVA?
1. Unilateral weakness or numbness in face, arm, and or leg (1 or more)
2. Speech alteration
3. Altered vision in 1 eye
How is CVA Dx (3)
3. MRI/CT scans
What labs are looked at for CVA? (3)
CBC, INR, lipids
1. Why assess the INR?
2. Why assess the lipids?
1. Clotting time (for TPA)
2. Hyperlipedima can lead to atherosclerosis
What is the electroencephogram looking at?
Conductivity of the brain tissue
What is the MRI/CT scan looking for?
Differentiating between Ischemic and Hemorrhagic stroke
The treatment for strokes main focus is to preserve AND salvage what?
What is the Stat treatment for Ischemic stroke.
ASA (antiplatelet) 160 mg, then taper down
What is the purpose of administering the antiplatelet?
Not allowing platelets to aggregate
When would TPA be given to a patient?
When they meet the criteria and it is an ischemic stroke.
The treatment for CV risk factors includes what? (2)
statins to decrease cholesterol
antihypertensives to decrease BP
Sx for stenosis for patients with ischemic stroke. What is this procedure called? what is the time frame post stroke for it to be done?
Carotid endoarterectomy done within 2 weeks of CVA
What would the stenosis be?
Narrowing of the blood vessel d/t atherosclerosis
To prevent recurrence involves what? (2)
Reducing risk factors
Blood thinners to prevent thrombus reappearing
Would a blood thinner ever be given to a patient experiencing a hemorrhagic stroke?
Nope you crazy lady.