CVA Part 1

Question 1

what is cerebrovascular disease

Answer 1

non traumatic sudden loss of neurological function d/t interruption of blood flow to brain

can have motor, sensory, cognition, perception, language and consciousness problems

Question 2

what is the golden period for early acute management

Answer 2

4-8 mins

Question 3

what is the golden period for stroke rehab

Answer 3

3-6 mo.

Question 4

stroke is _____ leading cause of death

Answer 4

4th

Question 5

stroke is most common cause of _____ in adults/elderly

Answer 5

disability

Question 6

weight of adult brain

Answer 6

1500 grams or 1 kg or 2% of BW

Question 7

normal cerebral BF

Answer 7

50 or 60 mL / 100g grams of brain tisuee

Question 8

the brain can produce _____ every 24 hrs

Answer 8

150g glucose and 72L oxygen

Question 9

upon interruption of cerebral blood flow irreversible damage occurs after ____

Answer 9

4-8 mins

Question 10

what is ischemic penumbra

Answer 10

lethargic cells that are reversible

they surround the irreversible damage

Question 11

what is the significance of ischemic penumbra

Answer 11

after 8 mins the penumbra dies = irreversible damage grows

need to treat in 4-8 mins to reverse the damage

Question 12

normal range BF

Answer 12

100% or 50 gm-min

Question 13

metabolic changes BF

Answer 13

80% or 40 gm-min

Question 14

mild ischemia BF

Answer 14

60% or 30 gm-min

Question 15

moderate ischemia or penumbra BF

Answer 15

40% or 20 gm-min

Question 16

severe ischemia BF

Answer 16

20% or 10 gm-min

Question 17

stroke risk factors: non-modifiable

Answer 17

> 65 yo

M>F but equal at menopause

AA>ASIAN>WHITES

genetics

hx of previous stroke or TIA

Question 18

why is TIA a risk factor for stroke

Answer 18

after 5 yrs of TIA - at risk of major stroke

Question 19

discuss TIA

Answer 19

temporary interruption of BF to brain

deficits last for few mins to hours but no more than 24 hrs c no residual sx

no blockage on MRI

Question 20

discuss RIND

Answer 20

focal neurologic deficits fully recover w/in a week

more than 24 hrs but less than 1 wk

after 1 wk no more deficits and findings on MRI

Question 21

discuss stroke in evolution

Answer 21

stepwise incremental inc in neurologic deficits

SD
SD + W
SD + W + D
SD + W + D + CoordProb

Question 22

discuss completed stroke

Answer 22

no further deterioration in neurologic status - stabilized na

no progression unless mag ka attack ule

Question 23

temporal classification of stroke

Answer 23

TIA
RIND
completed stroke

Question 24

etiologic classification of stroke

Answer 24

ischemic
hemorrhagic

Question 25

discuss ischemic stroke

Answer 25

90% most common type from dec pressure or BF endothelial injury theory lipid infiltration theory unified hypothesis

Question 26

what are the kinds of ischemic stroke

Answer 26

thrombotic embolic lacunar

Question 27

discuss thrombotic ischemic stroke

Answer 27

40% most common ischemic stroke blood clot blocks BF - atherosclerosis affects larger arteries insidious onset - during sleep - HA - weakness - sleep - ngiwi

Question 28

discuss embolic ischemic stroke

Answer 28

30% most common ischemic stroke dislodged clot - usually cardiac origins (CABG pts) from aorta sudden onset - occurs in morning p physical activity

Question 29

hallmark of embolic ischemic stroke

Answer 29

seizures, aphasia and unilateral neglect

Question 30

discuss lacunar ischemic stroke

Answer 30

10% most common ischemic stroke from uncontrolled HTN or DM affects lenticulostriate arteries insidious or sudden pure motor or pure sensory

Question 31

discuss hemorrhagic stroke

Answer 31

10% - rarest type of stroke over dilated vessels - rupture of aneurysm = loss of consciousness catastrophic - 50-70% mortality but if recovered - best prognosis

Question 32

discuss hemorrhagic intracerebral stroke

Answer 32

10-15% most common type of hemorrhagic stroke does not follow anatomic pattern - dissects through tissue planes = VERY MASSIVE assoc c charcot-bouchard - d/t long standing HTN younger pts and dramatic onset

Question 33

discuss hemorrhagic subarachnoid stroke

Answer 33

5-10% most common type of hemorrhagic stroke at dural space around brain can be: 1. saccular: degen of tunica adventitia = lose outside support 2. AVM: tangled arteries and veins = fusion of blood = burst d/t diff pressures worst HA of my life F > M

Question 34

management classification of stroke

Answer 34

TIA major stroke - stable and severe deficits deteriorating stroke - neuro status deteriorates p hospi young stroke - younger than 45 yo