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TIA/CVA

Transient Ischemic Attack/Cerebrovascular Accident

QuestionAnswer
What is a transient episode of focal cerebral dysfunction causing sudden weakness, numbness, or difficulties with vision or speech? TIA
TIA has a rapid onset and a variable duration, lasting from a few minutes to 24 hours. True or False? True
What is an irreversible focal, and sometimes multifocal, brain damage caused by blood disruption to the affected area? Stroke (CVA)
What are some common risk factors for CVA and TIA? Advanced age, smoking, DM, MI, HTN, hx of stroke, cardiac dx, asymptomatic carotid stenosis, sickle cell dx, hyperlipidemia
What are some common causes of CVA and TIA? Partial blockage in an artery in the brain caused by sm. clot broken away from a blood vessel. Atherosclerotic dx of carotid & vertebral arteries. carotid/vertebrobasilar ischemia localized to the portion of the brain supplied by that vascular system.
TIA symptoms appear suddenly and usually resolve within 24 hours. Name some of these symptoms. Aphasia, Temporary weakness/numbness of the face, arm, leg, or one side of the body sudden loss of vision in 1 or both eyes/visual disturbance. sudden severe HA, confusion, fainting/dizziness without loss of consciousness, dysphasia
What do these symptoms have in common? 1. Arteritis primarily caused by noninfectious necrotizing vasculitis 2. Lg stenosis of carotid/vertebral arteries 3. vent. thrombosis/thrombosis caused by AFIB 4. carotid/vertebral dissection r/t trauma/injury These are all common causes of CVA and TIA's
What are the key symptoms of TIA? 1. Transient weakness 2. Numbness 3. difficulty with speech or vision
Differential diagnoses for TIA may include: Migraine Seizures Meniere's Disease Hypoglycemia MS Sensory phenomena associated with hyperventilation, electrolyte imbalance, syncope or near syncope assoc. with hypotension
Name some important (imperative) clinial information needed to properly diagnose TIA's. 1. a complete physical exam, including a detailed neurological exam 2. family members/caregivers/should participate in order to accurately document the symptoms of the episode 3. accurate documentation of onset/duration/intensity of symptoms is vital
What are some diagnostics used to identify TIA's? -complete lab work-up -Noncontrast CT-can be done quickly, readily available/not expensive -RI/MRA of the brain -Cerebral arteriography:evaluate carotid/vertebral/basilar arteries: define intracranial stenosis/occlusion -12 lead EKG
What is the goal of therapy with TIA's? To prevent a future stroke. Treatment involves pharmacological/surgical intervention
What is the medication recommendations for prevention of TIA/CVA? Pharmacologic treatments fall into 2 categories: anti-platelets & anticoagulants. Antiplatelets: asa, persantine, ticlid, plavix anticoagulants: coumadin, heparin
What is the surgical option for TIA/CVA? With patients with carotid stenosis of 70% or greater, carotid endarterectomy is advised.
Which is the more common type of stroke? Ischemic strokes are the most common type (70%) of all strokes and may occur as a result of several factors.
Ischemic strokes are a result of such factors such as: - thrombus r/t atherosclerosis or carotid or large intracranial arteries - embolus from cardiac source - sm vessel dx (HTN)(frequently called lacunar strokes) - unknown, multiple, or uncommon causes
Intracerebral hemorrhage accounts for what percentage of all strokes? 15%
Describe subarachnoid hemorrhage. bleeding around the brain caused by ruptured congenital aneurysm or inflammatory/infectious processes
Intracerebral hemorrhage, which accounts for 15% of all strokes is described as: bleeding directly into the brain parenchyma. Most commonly caused by hypertensive arterial dx, arteriovenous malformations (AVM's) and anticoagulant drugs
CVA focal symptoms include: Neuro deficit lasting > 24 hrs carotid system symptoms can involve upper/ lower/both ext & or face on the opp side/opp visual field/eye on the same side. Vertebrobasilar system s/s can involve any combo of upper/lower ext./face/left/& or right sides.
Non-focal symptoms that suggest increased ICP and are common in subarachnoid hemorrhage, hypertensive cerebral hemorrhage, or major ischemic stroke with cerebral edema 1. headache 2. vomiting 3. impaired level of consciousness 4. cranial nerve palsies
Physical exam clues to etiology for CVA include: 1. carotid bruit: indicates presence of stenosis of the carotid artery 2. Hollenhorst;s plaque: arheromatous emboli visible in retinal arterioles on fundoscopic exam
Diagnostics used for determination of CVA include carotid artery doppler to screen for stenosis and identifies candidates for potential CEA. Other diagnostics include: 1. CT: used to distinguish ischemic and hemorrhagic stroke/guide choice of treatment 2. MRI brain: more sensitive than CT scan 3. EKG: used to ID AFIB /other arrhythmia 4. ECHO/TEE: ID's intracardiac thrombi/valvular heart dx-may cause clot
What is the purpose of cerebral angiography? It determines the degree and location of known stenosis and identifies aneurysm or AVM suspected from CT scan in hemorrhagic stroke.
Differential diagnoses for CVA can be the following: 1. Migraine prodome 2. Subdural hematoma 3. Brain tumors 4. Seizure disorders 5. Arteritis 6. multiple Sclerosis 7. CNS infection (meningitis or encephalitis)
Important follow up treatment for CVA is: 1. monitor for depression, which is common following stroke 2. prevent recurrent stroke - anticoagulant therapy as indicated, risk factor modification, & blood pressure control
Acute phase treatment for CVA includes what? 1. Thrombolytic therapy (if a candidate) 2. serial neurological exams to recognize progressing stroke 3. BP control (if too high) 4. Avoid hypotonic fluids such as D5W which may exacerbate cerebral edema.
Created by: MissyGirl3971