CVA and Ischemic Stroke Overview

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Questions and Answers

What are the common symptoms associated with Multiple Sclerosis?

Nuchal rigidity and photophobia

Slow tremors and dysphagia

Numbness, weakness, and ataxia (correct)

Diplopia and bulbar weakness

Which medication is commonly used in the treatment of Myasthenia Gravis?

Levodopa

Acyclovir

Mestinon (Pyridostigmine) (correct)

Dexamethasone

What is the primary characteristic of Guillain-Barré Syndrome?

Bradykinesia and tremors

Dysphonia and ptosis

Absent reflexes starting from lower extremities (correct)

Nuchal rigidity and fever

Which sign is indicative of meningitis during a physical examination?

Kernig's Sign Signup and view all the answers

What is a common treatment for bacterial meningitis?

Penicillin G and cephalosporin Signup and view all the answers

What condition is characterized by weakness that starts in the legs and progresses upwards?

Guillain-Barré Syndrome Signup and view all the answers

Which symptom is NOT commonly associated with Parkinson’s disease?

Absent reflexes Signup and view all the answers

What is a symptom that can indicate a potential health issue in patients with spinal cord injuries?

Diaphoresis above the injury site Signup and view all the answers

Which treatment is associated with managing symptoms in Parkinson’s disease?

Levodopa Signup and view all the answers

What symptom is commonly observed in a patient suffering from meningitis?

Fever and headache Signup and view all the answers

What is a characteristic sign of a Transient Ischemic Stroke (Mini Stroke)?

Temporary neurological deficits Signup and view all the answers

Which of the following is NOT a condition that would disqualify a patient from receiving tPA therapy?

Non-hemorrhagic stroke confirmed by CT Signup and view all the answers

Which diagnostic test is commonly used to detect blood presence in the cerebrospinal fluid?

Lumbar puncture (Spinal Tap) Signup and view all the answers

In assessing a patient post-stroke, which of the following is least likely to be included in the evaluation?

Blood pressure regulation Signup and view all the answers

What observation indicates a person may be experiencing a hemorrhagic stroke?

Sudden loss of consciousness and severe headache Signup and view all the answers

Which statement is true regarding Cushing's Triad?

It includes symptoms of high blood pressure, bradycardia, and irregular respirations. Signup and view all the answers

What is the best initial treatment for a patient suffering from a severe headache due to a hemorrhagic stroke?

Morphine sulfate Signup and view all the answers

Which symptom is an early warning sign of impending stroke from a Transient Ischemic Stroke?

Temporary numbness or weakness Signup and view all the answers

Which of these assessments is noteworthy in the management of brain herniation?

Observing pupil changes and consciousness levels Signup and view all the answers

What symptom would suggest a patient is experiencing a concussion rather than a contusion?

Temporary neurological impairment Signup and view all the answers

Which therapy is primarily used to prevent clot formation in stroke patients?

Anticoagulant therapy Signup and view all the answers

Which of the following describes the Monro-Kellie doctrine?

It addresses the compensatory mechanisms following hemorrhage. Signup and view all the answers

Study Notes

CVA (Stroke)

Leading cause of CVA is stroke
Risk factors include hypertension, trauma, illicit drug use, obesity, smoking, and excessive alcohol consumption.
All strokes can cause seizures.
Primary prevention is key to stroke prevention

Ischemic Stroke

Disruption of blood supply due to obstruction
Types include large artery thrombosis, atrial fibrillation (A-fib) - blood pooling causing clot formation, cryptogenic (unknown cause), and illicit drug use (e.g., cocaine).
Symptoms include severe headache, numbness/weakness on one side of the body (face, arms, or legs), changes in mental status, ataxia, hemiplegia (complete weakness), hemiparesis (partial weakness), dysarthria (difficulty speaking), and aphasia (language impairment)
BEFAST is a quick assessment tool: Balance, Eyes, Facial drooping, Arm weakness, Speech difficulties, and Time.
Treatment for ischemic strokes includes tPA (thrombolytic therapy) also known as clot busters.

tPA Guidelines

Administered within 3-4.5 hours of stroke onset
Contraindicated in cases of hemorrhagic stroke, history of intracranial hemorrhage, recent seizure at stroke onset, or GI/UT hemorrhages within the last 3 weeks.
Use if there is a clinical diagnosis of ischemic stroke and a baseline CT scan that shows no evidence of hemorrhage

Transient Ischemic Stroke (Mini Stroke)

Stroke that resolves on its own
Temporary neurological deficits
Warning sign of an impending stroke
Possible causes include plaque buildup or stenosis of the carotid arteries

Prevention Treatments

Anticoagulant therapy
Antiplatelet therapy (e.g., clopidogrel and aspirin)
Statins to decrease plaque formation
Antihypertensives
Carotid endarterectomy may be necessary

Hemorrhagic Stroke

Sudden loss of consciousness (LOC)
Severe headache
Increased intracranial pressure (ICP)
Low systemic blood pressure
Bleeding or hemorrhagic shock
Vomiting
Common cause is hypertension

Stroke Care and Monitoring

Maintain airway and ventilation
Monitor vital signs (VS)
Elevate head of bed (HOB) 30 degrees
Monitor for bleeding
Monro-Kellie doctrine; the sudden increase in blood volume within the skull due to bleeding will cause a compensatory decrease in the volume of either cerebrospinal fluid (CSF) or brain tissue, aiming to maintain a constant intracranial pressure within the rigid cranial vault
- Low BP, Tachycardia, Low Cardiac Output, Low Urine Output – check BUN and Creatinine ; increased levels mean you need to give isotonic fluids
Monitor for neurological function changes (e.g., motor, speech, pupil responses)
Assess mental status, perception, motor control, swallowing, skin integrity, and nutritional status
Thickened foods or pureed diets, may need total parenteral nutrition (TPN)
Elevated be to 90 degrees when feeding and have them tuck in chin
Use pillows to prop, align limbs, look for fecal impaction or bladder problems
Provide a bathroom schedule and give laxatives, they may need catheterization
Monitor for infection risk

Concussion vs. Contusion

Concussion: temporary neurological impairment
Contusion: bruising of the brain tissue
Hematomas: (Epidural, subdural, and intraduarl) bleeding in the brain

Primary vs Secondary Prevention

Primary: addressing the initial cause of the stroke (e.g., skull fractures, contusions)
Secondary: focuses on managing complications that arise after the initial stroke (e.g., increased intracranial pressure (ICP), hypoxia, hypotension, hyperthermia)

Skull Fractures

Increased infection risk
CSF leaks into nose/ears
Raccoon and Battle signs (bruising around eyes/ears)

Glasgow Coma Scale

Assessing motor, eye opening, and verbal function. Lower score means more severe coma.
Herniation of the brain
Compression of cranial nerve III (Cushing's Triad)

Cushing's Triad

High blood pressure
Low heart rate
Irregular breathing

Seizures

If seizures occur, treat with sedation first before paralytic agents
Anticonvulsants like Keppra and Dilantin are given
EEG monitors brain conductivity

Autonomic Dysreflexia

Life-threatening medical emergency
Overreaction of the autonomic nervous system, often in those with spinal cord injuries above T6.
Usually caused by stimuli below the level of the injury (e.g., bladder distention or urinary infection).
Symptoms include uncontrolled hypertension, cardiac dysrhythmias, and potentially respiratory depression (the diaphragm may become paralyzed).

Meningitis

Inflammation of the meninges (Dura mater, Arachnoid, Subarachnoid space, and pia mater).
Bacterial (septic): caused by bacteria like Streptococcus pneumoniae or Neisseria meningitidis
Viral: caused by herpes or HIV

Other Conditions

Myasthenia Gravis
Guillain-Barré syndrome
Parkinson's Disease.

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Description

This quiz covers the critical aspects of Cerebrovascular Accidents (CVA) and ischemic strokes. It discusses the leading causes, risk factors, symptoms, and treatment options including tPA guidelines. Test your knowledge on prevention, assessment tools, and treatment strategies for stroke.