Stroke

Question 1

What is CVA stand for?

Answer 1

CVA: Cerebral Vascular Accidents aka stroke

Question 2

What is the official definition of a CVA?

Answer 2

Neurological deficit attributed to acute focal injury of the CNS by a vascular cause

Question 3

Difference between TIA and a stroke?

Answer 3

A transient ischemic attack (TIA) happens when blood flow to part of the brain is blocked or reduced , often by a blood clot. After a short time, blood flows again and the symptoms go away.

With a stroke, the blood flow stays blocked, and the brain has permanent damage.

Question 4

What are the 5 main types of stroke?

Answer 4

Ischemic stroke ~85% of strokes
Intracerebral hemorrhage
Subarachnoid hemorrhage
Cerebral venous thrombosis
Not otherwise specified (NOS)

Question 5

Stroke is the ____ leading cause of death.

Answer 5

Fourth

Question 6

Morbidity

Answer 6

refers to the unhealthy state of an individual

Question 7

Stroke is the most__________cause of morbidity

Answer 7

prevalent

Question 8

1 out of ___ deaths in the U.S. are from a stroke

Answer 8

19

Question 9

Ischemia

Answer 9

an inadequate blood supply to an organ or part of the body, especially the heart muscles.

Question 10

What does Ischemia cause?

5 steps

Answer 10

Deprivation of oxygen and glucose
Causes depletion of ATP
Loss of membrane potential
Cytoplasmic Calcium Levels
Enzymatic Processes and cellular injury

Question 11

What is infarction?

Answer 11

tissue necrosis (CELL death)

Question 12

What are two types of Ischemic Stroke?

What % of strokes are Ischemic?

Answer 12

Embolus and Thrombus Ischemic Strokes

85% of strokes

Question 13

What is an Embolic Ischemic Stroke?

What is most frequently affected?

Answer 13

These are caused by a blood clot or plaque debris that develops elsewhere in the body and then travels to 1 of the blood vessels in the brain via the bloodstream.

Middle cerebral artery most frequently affected

Question 14

What is a Thrombotic Ischemic Stroke?

What is effected?

Answer 14

These are caused by a blood clot that develops in the blood vessels inside the brain.

carotid bifurcation, origin of the middle cerebral artery, end of basilar artery

Question 15

What are common sources for Embolic Ischemic Stroke?

Answer 15

Cardiac: MI, valvular disease, atrial fibrillation

Carotid artery: atherometous plaques

Question 16

What are symptoms associated with Stroke?

9

Answer 16

• Hemiparesis, monoparesis: paralysis of half or one part of the body
• Hemisensory deficits: Loss of sensation
• Visual field deficits: Decreased and or double vision
• Facial droop: Face literally droops
• Ataxia: Loss of coordination
• Vertigo: Dizziness
• Aphasia: Loss of speech
• Headache: Sudden and Severe
• Decrease in level of consciousness

Question 17

What are early management guidelines?

5

Answer 17

• 911, EMS protocols, stroke assessment*
• Non-contrast-enhanced CT or MRI
• Blood glucose: Checked because hypoglycemia can mimic some symptoms of a stroke
• Stroke rating scale (NIHSS)
• ECG and other tests, but should not delay treatment

Question 18

What is the best way to treat an Ischemic Stroke?

Answer 18

Tissue plasminogen activator (tPA)

Enzyme that binds to fibrin in a thrombus
Converts plasminogen to plasmin
fibrinolysis (CLOT BUSTER)

Question 19

What timing intervals are necessary for good treatment of Ischemic strokes?

Answer 19

• Imaging within 45 minutes of arrival
• tPA administration within 60 minutes of arrival
• tPA within 3 hours of stroke onset

Question 20

What is important to remember about TPA

Answer 20

Only use with Ischemic Stroke!!

Question 21

What are other strategies to treat Ischemic Stroke?

7

Answer 21

• Control blood pressure
• Control blood glucose
• Maintain oxygenation
• Avoid hyperthermia (fever)
• Thrombectomy - involves removal of thrombi (blood clots)
• Surgery – Besides Thrombectomy what is there?
• Aspirin 325 mg within 24 to 48 hours

Question 22

how can one recover from a Ischemic stroke?

Answer 22

• Physical therapy
• Occupational therapy
• Speech therapy
• Manage risk factors
• May take months, may not be complete

Question 23

What risk factors can be managed to help prevent Ischemic stroke?
Name 5

Answer 23

• Hypertension
• Diabetes
• Atherosclerosis
• Metabolic syndrome
• Atrial fibrillation
• Sleep apnea
• Carotid disease
• Cardiomyopathy
• MI, ventricular thrombus
• Mitral disease
• Not Smoking
• LimitingAlcohol use
• Not being Obesity
• Na intake

Question 24

What is important to note when using medication to help treat a Ischemic stroke?

Answer 24

Depends on nature of risk (intracranial atherosclerosis, a-fib, MI, LV thrombus, cardiomyopathy,etc)

Question 25

What are 4 types of medications that can be used to help prevent Ischemic stroke

Answer 25

- Antiplatelets - Vitamin K antagonists - Direct Thrombin Inhibitor - Factor Xa inhibitors

Question 26

What are examples of Antiplatelet drugs?

Answer 26

Aspirin Clopidogrel Dipyridamole

Question 27

What are examples of Vitamin K antagonist?

Answer 27

Warfarin

Question 28

What are examples of Direct Thrombin Inhibitor?

Answer 28

Dabigatrin

Question 29

What are examples of Factor Xa Inhibitors

Answer 29

Rivaroxiban | Apixiban

Question 30

Hemorrhagic stroke

Answer 30

a blood vessel ruptures and blood accumulates in the tissue around the rupture. This produces pressure on the brain and a loss of blood to certain areas.

Question 31

What % of strokes does Hemorrhagic make up?

Answer 31

-Approximately 8-18% of all strokes

Question 32

What are the fatality rates within 30 days of a hemorrhagic stroke?

Answer 32

-35-45% fatality rate within 30 days

Question 33

What are symptoms of a hemorrhagic stroke? | 5

Answer 33

- Headache - Altered mental status - Seizures - Nausea, vomiting - Depends on area involved – can be similar to ischemic presentation

Question 34

What are the two types of hemorrhagic stroke?

Answer 34

Intracerebral hemorrhages and Subarachnoid

Question 35

What are Intracerebral hemorrhages Where do they occurs? What could cause them?

Answer 35

- Focal bleeding within the brain parenchyma or ventricular system - Often occurs in putamen, thalamus, pons, cerebellum - Can be caused by AVN, Saccular Aneurysm

Question 36

What is AVN? | How much of population does it effect?

Answer 36

Arteriovenous malformation An abnormal connection between arteries and veins, usually in the brain or spine. AVM occurs in 1% of population

Question 37

What are Subarachnoid hemorrhages Where do they occur What could cause them?

Answer 37

bleeding in the area between the brain and the tissue covering the brain subarachnoid space AVN, medications, Saccular Aneurysm

Question 38

What is a Saccular aneurysm? | How much of population does it effect?

Answer 38

Rupture of saccular (“berry”) aneurysm in cerebral artery | Saccular aneurysm found in about 2% of population

Question 39

Things to do for a Hemorrhagic Stroke | 5

Answer 39

``` Non-contrast CT or MRI Other labs and diagnostics Control blood pressure Vitals and oxygenation Surgical and endovascular methods ```

Question 40

Thing to be mindful of after a Hemorrhagic Stroke | 4

Answer 40

Vasospasm (constriction) and delayed ischemia (clot) Intracranial pressure Seizures Complications

Question 41

Ways to prevent Hemorrhagic Stroke? | 4

Answer 41

Manage hypertension Avoid tobacco and alcohol misuse DASH diet Exercise

Question 42

Transient ischemic attacks

Answer 42

An episode of acute neurological dysfunction caused by focal brain, spinal cord, or retinal ischemia without acute infarction -Usually last under an hour

Question 43

What is the problem with Transient Ischemic Attacks?

Answer 43

Means risk of ischemic stroke

Question 44

How to prevent a Transient ischemic attack? | 3

Answer 44

- Similar to preventing a stroke - Manage risk factors - Antiplatelet or anticoagulant as appr

Question 45

What is the FAST Assesment?

Answer 45

Face: ask the person to smile. Does one side droop? Arms: ask the person to raise both arms. Does one arm drift downward? Speech: ask the person to repeat a single sentence. Is speech slurred or strange? Time: if you observe any of these signs, call 9-1-1

Question 46

What is the clinical presentation of a stroke? | 5

Answer 46

numbness or weakness of face, arm or leg - especially on one side of the body confusion, trouble speaking or understanding. trouble seeing in one or both eyes trouble walking, dizziness, loss of balance or coordination. severe headache with no known cause.