CVA Knowledge
What is the Pathophysiology behind a CVA? Think simplistically here.
Interruption of blood flow to the brain
What is the pathology behind a hemorrhagic CVA?
Blood gets into cranial space from vascular space
What typically precedes an Ischemic CVA?
Often preceded by TIA (Transient Ischemic Attack). Stroke like symptoms that last <24 hours.
This is a type of aphasia where the patient can understand what they hear in a conversation, but they struggle or are unable to express what they want to say.
Broca's Aphasia, AKA Expressive Aphasia
What can we do to treat a Hemorrhagic CVA? Name one option. (there's 2 items listed)
1. Surgery to repair the blood loss
2. Treat blood pressure with HTN drugs
What are the two types of CVA's?
1. Hemorrhagic
2. Ischemic (Thrombotic or Embolic)
There is a risk of "this" from a hemorrhagic stroke after it has concluded.
Rebleeding
Quick! What does BE FAST stand for?
B: Balance, loss of balance, h/a, dizziness
E: Eyes, blurry vision
F: Face, one side is droopy
A: Arms, Arm OR LEG weakness
S: Speech, speech difficulty
T: Time, time to call and ambulance
What degree should the head of bed be elevated to for a CVA patient?
30 degrees, or semi-fowlers
Within 2 weeks from the hemorrhagic CVA.
In a Left sided CVA, there's damage on the Left side of the brain. This results in hemiparesis on what side of the body?
The right side.
Name two risk factors for hemorrhagic CVA. (there's 4 listed)
1. Uncontrolled HTN
2. Cerebral Aneurysm
3. Use of anticoagulants
4. Coagulopathies from other diseases
What is the pathology behind an Ischemic CVA? Hint: there's two types (embolic & thrombotic).
1. Blood flow interrupted by occlusion like a blood clot (embolus)
2. Interrupted by atherosclerotic vessels (thrombotic)
This type of Aphasia is when the patient struggles to understand verbal or written speech. Their speech is normal, but they'll misuse a few words.
Wernicke's Aphasia, AKA Receptive Aphasia.
There's two options for treatment of Ischemic CVAs listed that are not drug related. One is surgical and the other is an MD allowance. Can you name one of these items?
1. Carotid Endartectomy
2. Permissive HTN (MD may allow this higher SBP to guarantee perfusion)
In a Left sided CVA, what are three main deficits that can result from the CVA? (there's 6 listed)
1. Right sided hemiparesis
2. Dysphagia
3. Speech & language struggles (happens in 95% of pts)
4. Memory deficits
5. Slow & cautious behavior
6. Distress & depression regarding relation to disability
Things you don't want to hear from a patient who might be having a hemorrhagic stroke.
1. "This is the worst headache of my life."
2. "I think I heard something pop."
What is the one diagnostic imaging exam that can be used for Ischemic CVAs and not for Hemorrhagic CVAs?
Carotid Doppler. Both Ischemic and Hemorrhagic CVAs can be diagnosed using CT, MRI, Angiography, Coags, and CBCs.
What is the window for being able to give a patient with an ischemic CVA TPA treatment?
0-3 hours.
What should we give a CVA patient to make sure that they don't bear down and give us more concern for a risk of rebleeding?
Stool softener. This is more common in Hemorrhagic CVAs.
In a Right sided CVA, what are three main deficits that can result from a CVA? (there's 6 listed)
1. Left hemiparesis
2. Left sided neglect
3. spatial perceptual defects
4. Fall risk d/t impulsiveness, impatience, & poor judgement.
5. Memory deficit
6. Indifference to disability (ignorance is bliss)
Name three signs and symptoms commonly seen in hemorrhagic CVAs. (there's 8 listed)
1. LOC Changes
2. Nuchal rigidity (stiff neck)
3. Photophobia (light intolerance)
4. Irritable
5. N/V
6. Pupil changes (esp. in size)
7. Eye deviations
8. Numbness in limbs
Name three signs and symptoms commonly seen in Ischemic CVAs. (there's 8 listed)
1. Hx of: HTN, MI, CAD, A-Fib
2. Heart Disease
3. Stress
4. Smoking
5. HLD
6. Coagulopathies
7. Polycythemia
8. Diabetes
This is a type of visual impairment that stems from Lesion 4 & 7 on the right side of the brain.
Left Homonymous Hemianopia
Hemorrhagic strokes can have a risk of vasospasms after recovery. What class of drug can you treat these vasospasm with?
Calcium Channel Blockers, "-pine"