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Cerebrovascular Accident (CVA)
Terms in this set (88)
What is a sudden loss of neurological function caused an interruption of blood flow to the brain?
What is the more common name for a CVA?
if the neurological deficits persist for at least 24 hours then its a ______; if they resolve within 24 hours its a ______
what are the 2 major types of CVA (stroke)?
85% of all CVA are ______
Which type of CVA takes up 15% of all cases but leads to 40% of CVA deaths
What are some focal deficits (problems with nerve, spinal cord, or brain function) that occur due to a CVA?
- altered level of consciousness
- impairment of sensory, motor, cognitive, perceptual, and language function
What is paralysis of one side of the body?
What is weakness of one side of the body?
The outcome of the CVA will depend on what three factors?
- location & extent of brain injury
- amount of collateral blood flow
- early acute management
What is the fourth leading cause of death & the most common neurological disorder in the US?
Do you CVAs occur more in males or females?
(men have 1.25x greater risk than women, but women are more women die from them)
Do African-Americans or Caucasians have a higher risk for a CVA?
African-Americans (2x more likely)
At what age does a risk for CVA begin to double?
doubles every decade after 55 years old
2/3 of all strokes occur in people over the age of ______
Between the ages of 45 and 55, African-Americans have a __________x greater risk of death from strokes and whites.
(risk of death equalize is after the age of 55)
What is the mortality rate of a hemorrhagic CVA?
37-38% at 1 month
What is the mortality rate of an ischemic stroke?
14.7% at 1 month
What risk factors can decrease the survival rate of a CVA?
- heart disease
CVA patients take up 26% of all patients in what setting?
(also the largest percentage of rehab hospital admissions)
Which type of CVA is characterized by blood flow being blocked or decrease?
Which type of CVA is characterized by non-traumatic bleeding into or onto the brain?
what are 2 types of ischemic CVA?
- cerebral thrombosis
- cerebral embolus
what are 3 types of hemorrhagic CVA?
- Intracranial hemorrhage
- Subarachnoid hemorrhage
- Arteriovenous Malformation (AVM)
What type of hemorrhagic CVA involves an abnormal tangle of blood vessels connecting arteries and veins WITHOUT their interposing capillaries , which disrupts normal blood flow and oxygen circulation?
Arteriovenous Malformation (AVM)
(50% eventually bleed)
what is the major contributing factor in CVDs?
What is atherosclerosis?
hardening of the arteries
where are the most common sites for atherosclerosis in the brain?
- origin of common carotid artery
- transition of common carotid to MCA
- main bifurcation (division) of MCA
- junction of vertebral arteries with basilar artery
What is the circle of arteries at the base of the brain that supply blood to the brain?
Circle of Willis
Which type of ischemic stroke is caused by a blood clot in cerebral arteries or branches?
which type of ischemic stroke is caused by a blood clot that is formed elsewhere in the body and travels into the cerebral arteries?
In an ischemic CVA, the lack of blood flow deprives the brain of _____ and _____, this disrupts cellular metabolism resulting in tissue death
O2 and glucose
what is the narrowing of an artery?
What type of hemorrhagic stroke is caused by a rupture of cerebral vessels?
what type of hemorrhagic stroke is usually caused by a berry aneurysm?
What are some modifiable risk factors of a stroke?
- high fat/cholesterol diet
- sedentary lifestyle
- alcohol consumption
What are the 5 warning signs of a stroke?
1. Sudden, severe headache
2. Weakness or numbness in face, arm, or leg; especially if its one sided
3. sudden confusion & trouble speaking
4. Trouble seeing in one or both eyes
5. sudden trouble walking, dizziness, loss of balance, or coordination
What does BE FAST stand for?
Balance (LOB, HA, dizziness)
Eyes (blurred vision)
Face (drooping on one side)
Arms (weakness on one side)
Speech (difficulty speaking)
Time (call 911)
what can be used to differentiate between an atherothrombotic and a hemorrhagic stroke?
If a CT scan cannot see a blood clot, why is it the best way to identify which type of stroke the person is experiencing?
it can see blood, so if there is blood its a hemorrhagic stroke but if there isn't any blood its a ischemic stroke
If the stroke is thrombotic, what can be administered to break up the clot?
clot-dissolving enzymes (t-PA)
(DANGEROUS for pt's with hemorrhagic strokes)
In order for the t-PA injection to work properly on a thrombotic stroke, when must it be given?
within 3-4.5 hours of the stroke
If the t-PA is administered to a ischemic stroke within the first three hours of the initial stroke, The person is _____% more likely to recover from a CVA in ______ months with minimal or no long-term diability
33% ; 3 months
Why is a CT scan better to use in diagnosing a CVA?
CT without contrast is quicker & cheaper than an MRI without contrast & safer than a MRI with contrast
What is the treatment for a hemorrhagic stroke?
What imaging is most used and rules out tumors, abcesses and hemorrhagic strokes?
MRI allows and detects
allows greater resolution of the brain
detection of the cerebral infarction within 2-6 hours after the stroke
PET scan allows
imaging of the regional blood flow and is expensive
Transcranial and carotid doppler
noninvasive imaging of neck and chest vessels
invasive procedure with injection of dye
USED WHEN SURGERY IS CONSIDERED
Within minutes after an ischemic stroke, what is produced & how long does it last?
cerebral edema; 3-4 days
What can cerebral edema cause?
- increase ICP
- possible brainstem herniation
__________ is the most common cause of death in an acute stroke
what is the temporary interruption of blood supply to the brain?
transient ischemic attack (TIA)
How long do the symptoms of a TIA last?
few minutes or several hours but never longer than 24 hours
TIA may result from
occlusive episodes, emboli, arrhythmias, decreased cardiac output, or cerebrovascular spasm
TIA may be precursor to
cerebral or myocardial infarction
What artery is the first and smaller of the 2 terminal branches of the internal carotid artery?
anterior cerebral artery (ACA)
What does the anterior cerebral artery supply?
medial aspect of the cerebral hemisphere (which controls the fxn of LE) and basal ganglia
If a patient is experiencing contralateral hemiparesis, sensory loss with greater involvement in LE, and apraxia (loss of motor planning), what type of vascular syndrome might they have?
anterior cerebral artery syndrome
the more ________ the lesions are in anterior cerebral artery syndrome, the more significant the deficits will be
what is the most common type of vascular syndrome/site of occlusion?
middle cerebral artery syndrome
What does the middle cerebral artery supply?
entire lateral aspect of the cerebral hemisphere & subcortical structures
if a patient is experiencing contralateral hemiparesis, ataxia, & sensory loss of the face, UE, & LE, what type of vascular syndrome might they have?
middle cerebral artery syndrome
In a middle cerebral artery syndrome, if the lesion is in the non-dominant hemisphere (usually the right), what might this produce?
perceptual deficits (unilateral neglects, contralateral homonymous hemianopsia, anaosognosis)
in a middle cerebral artery syndrome, if the lesion is in the dominant hemisphere (usually the left), what might this produce?
aphasia (inability to speak)
What does the posterior cerebral artery supply?
occipital lobe, medial & inferior temporal lobe, brainstem, midbrain, & thalamus
With a posterior cerebral artery syndrome, if there is ischemic damage in the occipital lobe what conditions might this produce?
- contralateral homonymous hemianopsia
- visual agnosia (inability to recognize familiar objects)
- prosopagnosia (face blindness)
- cortical blindness if bilateral
If a posterior cerebral artery syndrome involves occlusion of the thalamic branches, what are some of the conditions that might be produced?
- hemianesthesia (lacking of feeling on one side of the body)
- central post-stroke thalamic pain
With a posterior cerebral artery syndrome, if there is a temporal ischemia, what condition might be a result ?
PCVA more ____ lesions produce more significant deficits
What is homonymous hemianopsia?
The loss of the right or left half of the field of vision in both eyes.
The occlusion of the internal carotid artery (ICA) typically produces massive infarction in the region of the brain supplied by the ______ & _______
ACA & MCA
If collateral circulation from the Circle of Willis is absent in Internal carotid artery syndrome,
extensive cerebral infarction in both area can occur
With internal carotid artery syndrome, significant edema is possible leading to _________, _______, & ________
brain herniation, coma, & death
where does vertebral arteries arise from?
Which vestibular syndrome can produce a wide variety of symptoms with both ipsilateral and contralateral signs, produces cerebellar & cranial nerve impairments, and can produce the Locked-in syndrome?
vertebrobasilar artery syndrome
what is a condition that is involved with vertebrobasilar artery syndrome in which a patient is aware and awake but cannot move or communicate verbally because of complete paralysis of nearly all voluntary muscles except the eyes? (Tetraplegia)
How does "Locked-In Syndrome" occur?
bilateral infarction of the pons
which cranial nerves are involved with locked-in syndrome?
What is the mortality rate of "locked-in" syndrome?
What type of stroke is caused by small vessel disease deep in the brain & ischemia will leave crescent shaped damage?
lacunar strokes (aka lacunar infarctions)
What 2 conditions are lacunar strokes strongly associated with?
- hypertensive hemorrhage
- diabetic microvascular disease
What are the common sites of a lacunar stroke?
- basal ganglia
- internal capsule
If a lacunar strokes is pure motor, it is associated with the involvement of what 3 areas?
- posterior limb of internal capsule
If a lacunar strokes is pure sensory, it is associated with the involvement of what 2 areas?
- ventrolateral thalamus
- thalamocortical projections
No deficits in ______,____, _______becauses these higher cortical levels are not affected. (Lacunar strokes)
consciousness, language, visual fields
primary of impairments of stroke
postural control and balance
speech, language, and swallowing
hemispheric behavioral differences
bowel and bladder functions
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