Card Set Information
What is a CVA?
Stroke or brain attack
Neurologic deficits occur as a result of decreased blood flow to localized area of brain
Onset may be rapid or gradual
Etiology & patho
Ischemia followed by cell death
Result of severe and prolonged cerebral blood flow obstruction
Resulting deficits predict location of stroke
What are 4 types of brain attack?
Transient ischemic attack (TIA)
What is a TIA?
Brief period of neurological deficits that reslove within 24hrs
Frequently precursors to a permanent CVA
Causes- inflammatory arterial disorders, sickle cell anemia, atherosclerotic changes in cerebral vessels, thrombosis, emboli
What is a thrombotic CVA?
Caused by thrombus occluding a cerebral vessel
Tend to form atherosclerotic plaque in larger arteries wile BP is lower-sleep/rest
Thrombosis occurs quickly but deficits progress slowly
What is an embolic stroke?
Caused by traveling blood clot
Source of clot is elsewhere in body
Sudden onset eith immediate symptoms
If embolus not absorbed, deficits will be persistent
What is a hemmorhagic CVA?
Intracranial hemmorhage occurs when a blood vessel ruptures
Often occurs in presence of long-term, poorly controlled hypertension
Causes- ruptures intracranial aneurysm, embolic CVA, tumors, arteriovenous malformations, anticoagulant therapy, liver disease, DIC, thrombocytopenia
This form often fatal due to rapidly increasing ICP
Onset of symptoms is rapid
Loss of consciousness usually occurs
Vary according to cerebral vessel involved
Sudden weakness, numbness or paralysis in your face, arm, or leg-typically on one side of your body
Slurred or garbled speech or difficulty understanding others
Sudden blindness in one or both eyes, blurred, tunnel or double vision
Dizziness, loss of balance or coordination
Diagnostic & lab findings
CT/MRI- demonstrate hemorrhage, tumors, ischemia, edema, tissue necrosis
Cerebral angiography detects abnormal vessel structure, vasospasm, stenosis of carotid artery/loss of vessel wall integrity
Ultrasound evaluates blood flow
Blood tests- CBC, Chem 7, firenogen level, PT aPTT
Drug therapy-anti-platelet or anti-coagulant
to disrupt clot that has formed following hemmorhagic CVA
Surgery usually not indicated as treatment modality
Rehab is crucial to improve deficits
Neurochecks, lab work, ECG, CT
Stroke risk factors
HTN, obesity, sedentary lifestyle, atherosclerosis,A-fib, valvular disease, smoking, heavy alcohol use, cocaine,
diabetes, high stree level, hyperlipidemia (LDL), high triglyceride, oral contraceptives, black males, over 55 yrs
81 mg asa
decrease alcohol intake
diet changes (low fat, low cholesterol)
Face-does face look uneven? Ask them to smile.
Arm-Does one arm drift down? Ask them to raise both arms.
Speech-Does their speech sound strange? Ask them to repeat a phrase.
Time-Every second brain cells die. Call 911 at any sign of stroke.
Left/Right sided stroke
If stroke occurs on left then stroke manifestations occur on the right and affect behaviors controlled by the right hemisphere of the brain
L and R hemispheres
Left- dominant, center for language, math skills, analytical thinking, aphasia, dyslexia, agraphia, acalculia, possible memory deficit
Right- visual and spatial awareness, proprioception, pt disorientation to time and place, unaware of changes, personality changes
Airway, oxygen therapy
Thromolytics- if trtmnt sought within 3 hrs of ischemic stroke (streptokinase)
Anticoagulants- heparin, lovenox, coumadin, arixtra, pradaxa
Antiplatelets- plavix, ticlid
Paralysis, loss of muscle mvmnt
Difficulty talking or swallowing
Memory loss, trouble understanding
Changes in behavior/self care
Goals of therapy c stroke pt
First- initiate p physical conditioning regimen designed to regain pre-stroke levels of activity
Second- prevent recurrent stroke and cardiovascular events
Third- improve aerobic fitness