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Clinical Conditions II > CVA/TBI > Flashcards

CVA/TBI Flashcards

1
Q

Stroke

A

Nontraumatic brain injury caused by occlusion or rupture of cerebral blood vessels that result in sudden neurologic deficit

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2
Q

TIA

A
  • Reversible neurologic deficit within a few, up to 24, hours
  • Brain injury likely if beyond 1 hour
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3
Q

Types of Ischemia

A

Thrombotic
Embolic
Vasculitic, hypercoaguable

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4
Q

Types of Hemorrhage Stroke

A

Intracerebral

Subarachnoid

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5
Q

Ischemia- Thrombosis

A 
*At the site
–Atherosclerotic Plaque
–Vessel Narrowing
–Small or Large Vessel
–Could become embolic
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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
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7
Q

Clinical Presentation of Thrombotic Stroke

A

Slower

Stuttering

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8
Q

Clinical Presentation of Embolic Stroke

A

Sudden

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9
Q

Hemorrhagic Stroke- Intracerebral

A

• Directly into brain tissue
• Causes: HTN, amyloid angiopathy, vascular malformations, bleeding
disorders, drugs (cocaine, amphetamines)

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10
Q

Subarachnoid Stroke Causes

A

aneurysms, ateriovenous malformations

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11
Q

Presentation of Hemorrhagic Stroke

A
  • “Worst headache of my life”

* Sudden

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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?
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13
Q

Modifiable Risk Factors of Stroke

A
  • Hypertension
  • Hyperlipidemia
  • Atrial Fibrillation
  • Diabetes Mellitus
  • Smoking
  • Oral contraceptives
  • Physical inactivity
  • Diet
  • Sleep apnea
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14
Q

CVA Medical Treatment

A
  • Primary - Reverse or limit impact

* Secondary - Prevent recurrence of stroke

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15
Q

CVA Signs

A
  • Balance
  • Eyes
  • Face
  • Arm
  • Speech
  • Time
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16
Q

Possible Stroke Impairments

A
  • Weakness
  • Sensory impairments
  • Apraxia
  • Aphasia
  • Dysphagia
  • Depression
  • Cognition
  • Ataxia
  • Neglect
  • Hemianopsia
  • Balance
  • Emotional lability
  • Bladder/bowel
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17
Q

Post Stroke Complications

A
  • Pneumonia
  • DVT/PE
  • Pressure ulcers
  • Deconditioning
  • Contractures
  • UTI
  • Dehydration
  • MI
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18
Q

Should you use an MRI or a CT to diagnose a stroke?

A

Immediately –> CT (it will detect hemorrhage)

Then –> MRI

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19
Q

Stroke Outcome Scale

A 
NIH
42 point scale
Normal: 0
Moderate: 9-15
Severe: > 16
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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
Q

Right MCA Stroke

A
  • Left face/arm > leg numbness and weakness
  • Left hemispatial neglect
  • Right gaze preference
  • Agraphesthesia/ astereognosia
26
Q

PCA Stroke

A

Diplopia
Dizziness
Dysphagia
Dysarthria

27
Q

What is the #1 goal of patients after a stroke?

A

Gait

28
Q

Who is at risk for TBI?

A
  • More common in men

* Peak incidence teens and elderly

29
Q

Most common causes of TBI

A
  • Most common causes
  • Falls : most common under age 17 and over 55
  • MVA: most common between 18 and 55
  • Sports
  • Violence
30
Q

TBI Classification Scale

A

Glascow Coma Scale

Assesses eyes, verbal, motor functioning

31
Q

Mild GCS Score

A

> 12

32
Q

Moderate GCS Score

A

9-12

33
Q

Severe GCS Score

A

8 or less

34
Q

TBI Pathophysiology: Primary Injury

A 
Direct Trauma
Skull Fractures
Hemorrhages
Diffuse Axonal Injury
Penetrating Injuries
35
Q

Types of Hemorrhage

A
  • Epidural hematoma
  • Subdural hematoma
  • Intracerebral hemorrhage
  • Subarachnoid hemorrhage
36
Q

TBI- Secondary Injury

A
  • Increased intracranial pressure
  • Cerebral Edema
  • Hydrocephalus
  • Brain Herniation
  • Free Radicals
37
Q

Brain Injury Classification

A
  • Closed vs. Open
  • Blunt vs. Penetrating
  • Focal vs. Diffuse
  • Hemorrhagic vs. Non-hemorrhagic
38
Q

Non-traumatic Brain Injury

A
  • Anoxic
  • Aneurysms
  • AVM’s
  • Brain tumors
  • Infectious (abscess, meningitis)
39
Q

Epidural Hematoma

A

•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
Q

Subdural Hematoma

A

• 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
Q

Subarachnoid Hemorrhage

A
  • Cause by traumatic and nontraumatic brain injury (ruptured aneurysm)
  • Thunderclap headache- “Worst headache in my life.”
42
Q

AVM

A
  • 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
Q

Complications of TBI

A
  • DVT/PE
  • Pneumonia
  • Skin breakdown
  • Pain
  • Bowel/Bladder dysfunction
  • Spasticity
  • Contractures
  • Deconditioning
44
Q

Post acute TBI Evaluation:

A

Rancho Los Amigos Cognitive Scale

45
Q

Rancho Los Amigos Cognitive Scale

A 
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
Q

Spasticity Management

A
  • Cold
  • Prevent noxious stimuli
  • Manual techniques
  • Splinting/ serial casting
  • Botulinum Toxin and Phenol Injections
  • Baclofen Pump
  • Medications: Baclofen, Zanaflex, dantrium, clonidine, valium
47
Q

Botulinum Toxin

A
  • Different types
  • Best for focal spasticity
  • Indications:
  • Medication failure
  • Improve function
  • Improve hygiene
  • Prevent Pain
48
Q

Baclofen Pump Indications

A
  • Lower extremity spasticity
  • Improve function, hygiene
  • Lessen pain
49
Q

What is the best predictor of stroke outcome

A

the presentation of the patient when they are evaluated

Clinical Conditions II (11 decks)

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