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. |