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TIA/CVA
Transient Ischemic Attack/Cerebrovascular Accident
Question | Answer |
---|---|
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. |