DH 410: Emergencies in Dental Practice

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Questions and Answers

What characterizes a cerebrovascular accident (CVA)?

Overproduction of cerebrospinal fluid

Infection in the brain tissue

Occlusion or hemorrhage of a blood vessel (correct)

Increased blood flow to the brain

What is one major risk factor associated with cerebrovascular accidents?

Atrial fibrillation (correct)

Chronic lung disease

Diabetes mellitus type 1

Hyperthyroidism

Which type of cerebrovascular accident is characterized by a temporary blockage of blood flow to the brain?

Cerebral Infarction

Permanent Ischemic Attack

Hemorrhagic stroke

Transient Ischemic Attack (TIA) (correct)

Which of the following is NOT a common cause of cerebrovascular accidents?

Inflammatory response Signup and view all the answers

What is the global ranking of cerebrovascular accidents in terms of leading causes of death?

2nd leading cause Signup and view all the answers

Which demographic is at higher risk of experiencing a stroke?

Individuals aged 65 and older Signup and view all the answers

What is the primary factor that increases the risk of a cerebrovascular accident (CVA) significantly for individuals above systolic 160 mmHg?

Hypertension Signup and view all the answers

Which type of CVA is characterized by the blockage of blood flow in cerebral blood vessels?

Ischemic CVA Signup and view all the answers

What is a significant consequence of a Transient Ischemic Attack (TIA)?

High likelihood of a subsequent CVA Signup and view all the answers

Which of the following symptoms could indicate the onset of a CVA?

Confusion Signup and view all the answers

How important is the time since the onset of symptoms in treating ischemic strokes?

3 hours is vital for treatment eligibility. Signup and view all the answers

Which of the following factors is associated with a hemorrhagic CVA?

Aneurysm Signup and view all the answers

What is one of the main purposes of the Cincinnati Prehospital Stroke Scale?

To identify early signs of a stroke. Signup and view all the answers

Which of the following is true regarding the treatment for ischemic CVA?

IV thrombolytic therapy must be administered within 3 hours. Signup and view all the answers

What characterizes a hemorrhagic CVA compared to an ischemic CVA?

It is caused by a blood vessel rupture. Signup and view all the answers

Which risk factor is associated with a threefold increased likelihood of experiencing a CVA?

Familial history of CVA Signup and view all the answers

Study Notes

Cerebrovascular Accident (CVA)

Commonly referred to as "stroke" or "brain attack."
Occurs due to occlusion or hemorrhage of a blood vessel, leading to a lack of oxygen and potential brain damage.

Types and Etiologies

Types of CVA:
- Transient Ischemic Attack (TIA)
- Ischemic CVA
- Hemorrhagic CVA
Etiologies:
- Thrombus: formed in blood vessel.
- Embolus: detached thrombus traveling through the bloodstream.
- Ruptured blood vessel causing hemorrhage.

Epidemiology

2nd leading cause of death worldwide, accounting for approximately 4.6 million fatalities annually.
In the U.S., it ranks as the 5th leading cause of death and disability, occurring on average every 40 seconds.
Higher risk for women; 1 in 5 women will experience a stroke in their lifetime.

Risk Factors

Atrial fibrillation increases CVA risk by 5 times; affects ~2 million Americans.
Oral contraceptives and menopause-related estrogen changes can elevate risk.
Diabetes, familial history (3 times more likely), smoking, physical inactivity, and atherosclerosis are significant contributors.
Hypertension: Every 10 mmHg increase over 160 systolic raises risk by 30%.

Transient Ischemic Attack (TIA)

Often called a "mini stroke," similar to angina in relation to myocardial infarction.
Results in temporary blood supply interruption to the brain; no permanent damage occurs.
Lasts from 15 to 60 minutes and serves as an important warning sign for impending CVA.

Ischemic and Hemorrhagic CVA

Ischemic CVA:
- Responsible for 85% of strokes; produces cerebral infarction due to blockage.
Hemorrhagic CVA:
- Accounts for 15% of strokes; results from cerebral blood vessel rupture and can have a 50-60% mortality rate depending on the area affected.

Signs and Symptoms of CVA

Symptoms may vary based on severity and location of brain damage, including:
- Confusion
- Difficulty finding or forming words
- Slurred speech
- Loss of balance and dizziness
- Weakness or numbness, often on one side (facial droop)
- Vision changes, such as loss of visual field.
Importance of determining onset time of symptoms for treatment eligibility.

Emergency Management

Emphasizes the phrase "Time is brain" indicating the urgency of treatment.
For ischemic CVA, treatment is critical within 3 hours of symptom onset.
Immediate actions include performing a stroke scale, noting the time, positioning the patient, and contacting emergency medical services.

Stroke Assessment Scales

Cincinnati Prehospital Stroke Scale (CPSS):
- Assesses facial palsy, arm weakness, and speech difficulties.
Los Angeles Pre-hospital Stroke Scale:
- Evaluates age, seizure history, time since onset, ambulatory status, and vital signs (glucose level, symmetric facial movement, grip strength).

Hospital Management

CT scan is critical to identify whether the CVA is ischemic or hemorrhagic.
Ischemic stroke may be treated with IV thrombolytic therapy (Alteplase) within 3 hours to restore blood flow, but is contraindicated in hemorrhagic cases.
Surgical intervention may be necessary for hemorrhagic strokes.

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Description

This quiz focuses on cerebrovascular accidents (CVA) and their implications in dental practice. Participants will learn to identify the types of CVA, understand their pathophysiology, recognize symptoms, and discuss precautions for treating patients with a history of CVA. Essential knowledge for dental professionals to ensure patient safety during emergencies.