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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)
- Thrombotic CVA
- Embolic CVA
- Hemmorhagic CVA
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
- Gait disturbance
- 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
- Imperitive NOT to disrupt clot that has formed following hemmorhagic CVA
- Surgery usually not indicated as treatment modality
- Rehab is crucial to improve deficits
- Stabilize pt
- Neurochecks, lab work, ECG, CT
- Antiplatelet agents
- Thrombolitic therapy
- Anticoagulant therapy
- Osmotic diuretics
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
- monitor BP
- annual physical
- regular exercise
- stop smoking
- 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
- TED hose
- 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