CVA/TBI Flashcards
(49 cards)
1
Q
Stroke
A
Nontraumatic brain injury caused by occlusion or rupture of cerebral blood vessels that result in sudden neurologic deficit
2
Q
TIA
A
- Reversible neurologic deficit within a few, up to 24, hours
- Brain injury likely if beyond 1 hour
3
Q
Types of Ischemia
A
Thrombotic
Embolic
Vasculitic, hypercoaguable
4
Q
Types of Hemorrhage Stroke
A
Intracerebral
Subarachnoid
5
Q
Ischemia- Thrombosis
A
*At the site –Atherosclerotic Plaque –Vessel Narrowing –Small or Large Vessel –Could become embolic
6
Q
Ischemic- Embolism
A
- Particles Travel
- Cardiac: a-fib, cardiomyopathy, valve disease
- Cardiac anomalies: patent foramen ovale
- Infectious endocarditis
- “break-off” part of thrombus
7
Q
Clinical Presentation of Thrombotic Stroke
A
Slower
Stuttering
8
Q
Clinical Presentation of Embolic Stroke
A
Sudden
9
Q
Hemorrhagic Stroke- Intracerebral
A
• Directly into brain tissue
• Causes: HTN, amyloid angiopathy, vascular malformations, bleeding
disorders, drugs (cocaine, amphetamines)
10
Q
Subarachnoid Stroke Causes
A
aneurysms, ateriovenous malformations
11
Q
Presentation of Hemorrhagic Stroke
A
- “Worst headache of my life”
* Sudden
12
Q
Nonmodifiable Risk Factors of Stroke
A
- Age (risk double every decade after age 55)
- Sex: female/older age
- Race
- Previous stroke
- Family history
- Coronary artery disease?
13
Q
Modifiable Risk Factors of Stroke
A
- Hypertension
- Hyperlipidemia
- Atrial Fibrillation
- Diabetes Mellitus
- Smoking
- Oral contraceptives
- Physical inactivity
- Diet
- Sleep apnea
14
Q
CVA Medical Treatment
A
- Primary - Reverse or limit impact
* Secondary - Prevent recurrence of stroke
15
Q
CVA Signs
A
- Balance
- Eyes
- Face
- Arm
- Speech
- Time
16
Q
Possible Stroke Impairments
A
- Weakness
- Sensory impairments
- Apraxia
- Aphasia
- Dysphagia
- Depression
- Cognition
- Ataxia
- Neglect
- Hemianopsia
- Balance
- Emotional lability
- Bladder/bowel
17
Q
Post Stroke Complications
A
- Pneumonia
- DVT/PE
- Pressure ulcers
- Deconditioning
- Contractures
- UTI
- Dehydration
- MI
18
Q
Should you use an MRI or a CT to diagnose a stroke?
A
Immediately –> CT (it will detect hemorrhage)
Then –> MRI
19
Q
Stroke Outcome Scale
A
NIH 42 point scale Normal: 0 Moderate: 9-15 Severe: > 16
20
Q
Items NIH evaluates
A
- Level of consciousness
- Visual gaze
- Vision
- Facial palsy
- Motor arm
- Motor leg
- Coordination
- Sensation
- Language
- Speech slurring
21
Q
ICA Stroke
A
- Combined ACA and MCA
- Ipsilateral monocular visual loss
22
Q
Left ACA stroke
A
- R leg numbers and weakness
- Transcortical motor aphasia
- Ideomotor apraxia
23
Q
Right ACA Stroke
A
- L leg numbness and weakness
- Motor Neglect
- Possible ideomotor apraxia
24
Q
Left MCA Stroke
A
- Right face/arm > leg numbness and weakness
- APHASIA
- Left gaze preference
25
Right MCA Stroke
- Left face/arm > leg numbness and weakness
- Left hemispatial neglect
- Right gaze preference
- Agraphesthesia/ astereognosia
26
PCA Stroke
Diplopia
Dizziness
Dysphagia
Dysarthria
27
What is the #1 goal of patients after a stroke?
Gait
28
Who is at risk for TBI?
* More common in men
| * Peak incidence teens and elderly
29
Most common causes of TBI
* Most common causes
* Falls : most common under age 17 and over 55
* MVA: most common between 18 and 55
* Sports
* Violence
30
TBI Classification Scale
Glascow Coma Scale
| Assesses eyes, verbal, motor functioning
31
Mild GCS Score
> 12
32
Moderate GCS Score
9-12
33
Severe GCS Score
8 or less
34
TBI Pathophysiology: Primary Injury
```
Direct Trauma
Skull Fractures
Hemorrhages
Diffuse Axonal Injury
Penetrating Injuries
```
35
Types of Hemorrhage
- Epidural hematoma
- Subdural hematoma
- Intracerebral hemorrhage
- Subarachnoid hemorrhage
36
TBI- Secondary Injury
* Increased intracranial pressure
* Cerebral Edema
* Hydrocephalus
* Brain Herniation
* Free Radicals
37
Brain Injury Classification
* Closed vs. Open
* Blunt vs. Penetrating
* Focal vs. Diffuse
* Hemorrhagic vs. Non-hemorrhagic
38
Non-traumatic Brain Injury
* Anoxic
* Aneurysms
* AVM’s
* Brain tumors
* Infectious (abscess, meningitis)
39
Epidural Hematoma
•Results from a blow to the side of the head leading to a fracture of the temporal bone tearing the middle meningeal artery (high pressure →bleed quickly)
40
Subdural Hematoma
• Caused by head injury where velocity changes within the skull
may stretch and tear small bridging veins (low pressure →slow bleeds)
• Common in the elderly and alcoholic due to cerebral atrophy
• “Crescent shaped”
• Shaken Baby Syndrome
41
Subarachnoid Hemorrhage
* Cause by traumatic and nontraumatic brain injury (ruptured aneurysm)
* Thunderclap headache- “Worst headache in my life.”
42
AVM
* Congenital disorder of the connections between veins and arteries in the vascular system
* “Tangle of Spaghetti” on arteriogram
* Can bleed with devastating- stroke-like effects
43
Complications of TBI
* DVT/PE
* Pneumonia
* Skin breakdown
* Pain
* Bowel/Bladder dysfunction
* Spasticity
* Contractures
* Deconditioning
44
Post acute TBI Evaluation:
Rancho Los Amigos Cognitive Scale
45
Rancho Los Amigos Cognitive Scale
```
I. No Response
II. Generalized Response
III. Localized Response
IV. Agitated Confused
V. Confused Inappropriate
VI. Confused Appropriate
VII. Automatic Appropriate
VIII. Purposeful Appropriate
```
46
Spasticity Management
* Cold
* Prevent noxious stimuli
* Manual techniques
* Splinting/ serial casting
* Botulinum Toxin and Phenol Injections
* Baclofen Pump
* Medications: Baclofen, Zanaflex, dantrium, clonidine, valium
47
Botulinum Toxin
* Different types
* Best for focal spasticity
* Indications:
* Medication failure
* Improve function
* Improve hygiene
* Prevent Pain
48
Baclofen Pump Indications
* Lower extremity spasticity
* Improve function, hygiene
* Lessen pain
49
What is the best predictor of stroke outcome
the presentation of the patient when they are evaluated
