Flashcards in Stroke, HA, HTN Deck (112)
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1
Stokre sxs
• Symptoms vary – location dependent
• Weakness/numbness face/limbs, one side
• Confusion, difficulty speaking/understanding
• Agitation, seizure
• Vision changes – one/both eyes, visual field cut
• Difficulty walking, ataxia, loss of coordination
• Dizziness, vertigo, loss of balance
• Atraumatic loss of consciousness (did they have a seizure? Did they faint? Did they have a stroke?)
• Sudden, severe headache
2
VA changes associated with stroke
visual periphery changes
difficulty seeing out of one eye
3
Sudden, severe headache would be associated with what type of stroke
hemorrhagic
4
RF for stroke (11) starting with number 1
• TIA or previous CVA (#1)
• HTN
• DM
• Atrial Fibrillation
• EtOH, IVDU, stimulants
• Atherosclerosis
• High cholesterol
• Sickle Cell
• Obesity/inactivity
• Tobacco
• Increasing age
5
hx that would contribute to RF
• Heredity
Family Hx of CVA
• Ethnicity
African Americans
Hispanic Americans
• Gender
Men > Women
6
women are at greater risk for
Women > for SAH
7
critical timing hx for stroke pt
1. When did symptoms begin?
Treatment is time dependent
When were you/they last normal?
2. Sudden or gradual onset?
3. What are the symptoms, exactly?
4. Symptoms persistent or transient?
5 are you on anticoagulants?
6. PMHx, meds, risk factors
7 . Trauma? Syncope? N/V?
8 . Headache??
what are out CI for TPA
8
what % of strokes are ischemic
1. ~85% of all strokes
9
gradual vessel occlusion is known as a
2. Thrombotic
Atherosclerosis, gradual vessel occlusion
b. Sx onset may be gradual, stuttering
c. May have hx TIA
no blood distal
10
Sudden occlusion; sudden, fixed deficit
embolic stoke
11
who has embolic strokes
A fib, atrial clot, endocarditis (
12
pts with a thrombotic strokes may have has
TIA
13
Types of hemorrhagic CVA
2. Intracerebral Hemorrhage
3. Subarachnoid Hemorrhage
THESE ARE 15% OF ALL STROKES
14
evens that made lead to hemorrhagic stroke
a. HTN --> really uncontrolled
b. Cocaine, Meth, stimulants
c. Aneurysm bursts open
d. Arteriovenous Malformation (AVM)
15
Tx for hemorrhagic stroke
a. ABCDE’s
b. Control BP carefully
c. Neurosurgical consult
d. Multi-detector CT angiography
e. NIHS will be greater than 20
16
Left is dominant hemisphere in what pts
a. All right-handed
b. 80% left-handed
17
what % of people are right hemisphere dominant
3. Right is dominant in 20% lefties
18
how to tell where a stroke is- two major possibilities
2. Anterior circulation CVA
3. Posterior circulation CVA
19
Anterior circulation CVA comes off of and includes
CC
i. Anterior Cerebral Artery
ii. Middle Cerebral Artery
20
Posterior circulation CVA is where in origin and includes what
a. Vertebral artery origin
i. Posterior Cerebral Artery
ii. Vertebrobasilar stroke
iii. Cerebellar stroke
21
motor differences seen with
anterior Circulation CVA
: Contralateral weakness (If R sided symptoms, then your bleed is on the left)
• Leg, foot symptoms> arm symptoms
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Sensory differences seen with
anterior Circulation CVA
Contralateral deficit
• Leg sx’s > arm sx’s
23
Loss of frontal lobe control seen with anterior cerebral artery
• Personality change
• Perseveration
• Incontinence
• Gait disturbances
• Apraxia (you know you want to move the muscle but you cannot)
this is seen in anterior cerebral artery strokes
24
apraxia is
can’t perform tasks or follow commands even though they know the task and wish to follow the command. Several specific types
seen with loss of anterior cerebral artery
25
Most common area to get a stroke – bad if big/central
Middle Cerebral Artery
often in the corners of the middle cerebral artery
26
Motor deficits with middle cerebral CVA
Contralateral weakness
• Face/arms > legs
• Facial droop
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sensory deficits with middle cerebral CVA
Contralateral deficit
• Arms > legs
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if a pt has a CVA in the middle cerebral of dominant hemisphere
If affecting the dominant hemisphere: aphasia (either receptive or expressive
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if a pt has a CVA in the middle cerebral of non dominant
Non-dominant: neglect (neglect that part of the body that is affected completely)
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