Stroke and Neurological Disorders Quiz

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Questions and Answers

What is the primary characteristic of a stroke?

Consistent headache and dizziness

Progressive memory loss

Sudden loss of O2 rich circulation to the brain (correct)

Gradual loss of neurological function

Which type of stroke accounts for the majority of cases?

Cryptogenic stroke

Ischemic stroke (correct)

Cerebral infarction

Hemorrhagic stroke

Which of the following is a nonmodifiable risk factor for stroke?

Obesity

Smoking

Age over 55 years (correct)

Hypertension

Which symptom is most commonly associated with ischemic stroke?

Numbness or weakness on one side of the body Signup and view all the answers

What is a major cause of hemorrhagic stroke?

Cerebral aneurysm Signup and view all the answers

Which condition is commonly considered a modifiable risk factor for stroke?

Diabetes Signup and view all the answers

What presenting symptom is most characteristic of a hemorrhagic stroke?

Exploding headache Signup and view all the answers

Which of the following types of ischemic stroke is caused by atherosclerosis?

Large artery thrombosis Signup and view all the answers

What is hemiplegia characterized by?

Paralysis of the face, arm, and leg on the same side Signup and view all the answers

What condition results in difficulty swallowing?

Dysphagia Signup and view all the answers

What is neglect syndrome?

Unawareness of the existence of the paralyzed side Signup and view all the answers

Which cognitive deficit involves forgetting recent events?

Short-term memory loss Signup and view all the answers

What is characteristic of dysarthria?

Difficulty articulating speech Signup and view all the answers

What sensory deficit involves a tingling sensation?

Paresthesia Signup and view all the answers

Which type of aphasia allows a person to comprehend but not speak?

Expressive aphasia Signup and view all the answers

What psychological symptom presents as drastic mood swings?

Emotional lability Signup and view all the answers

What is a TIA commonly viewed as in relation to a stroke?

A warning of an impending stroke Signup and view all the answers

What is the recommended initial diagnostic test for a patient suspected of having a TIA?

CT scan Signup and view all the answers

Which of the following is NOT a nursing action to be taken in the acute management of a TIA?

Start thrombolytic therapy immediately Signup and view all the answers

What could mimic the symptoms of a stroke or TIA, warranting a blood sugar level check?

Severe hypoglycemia Signup and view all the answers

What is the maximum time frame for symptom onset to qualify for thrombolytic therapy for a stroke?

3 hours Signup and view all the answers

What should be the positioning of the head of the bed in cases showing signs of increased intracranial pressure?

Elevated 30 degrees Signup and view all the answers

Which of the following is a contraindication for intravenous thrombolytic therapy?

Recent head injury Signup and view all the answers

Why is it crucial to treat a TIA with urgency?

Untreated TIAs can lead to ischemic stroke Signup and view all the answers

What symptom is often associated with vasospasm following a hemorrhage?

Worsening headache Signup and view all the answers

What is the primary action of Nimodipine in the treatment of vasospasm?

Block calcium channels Signup and view all the answers

What is a potential complication of using Mannitol for long-term control of increased intracranial pressure?

Dehydration and electrolyte disturbances Signup and view all the answers

When is vasospasm most likely to occur after an initial hemorrhage?

7-10 days post-hemorrhage Signup and view all the answers

Which of the following antihypertensive agents is NOT mentioned for managing elevated systolic blood pressure?

Enalapril Signup and view all the answers

What is the role of CSF drainage in cases of increased intracranial pressure?

To alleviate pressure from the cranial cavity Signup and view all the answers

How does Mannitol reduce intracranial pressure?

By pulling water out of brain tissue Signup and view all the answers

Which intervention is considered helpful for managing increased intracranial pressure?

0 degree head positioning Signup and view all the answers

What percentage of strokes could be prevented through effective management and addressing lifestyle factors?

70% Signup and view all the answers

Which of the following is NOT a nursing diagnosis related to stroke?

Decreased cerebral blood flow Signup and view all the answers

Which treatment is specifically indicated for controlling cholesterol in stroke prevention?

Statins Signup and view all the answers

Which of the following nursing goals focuses on empowering the patient post-stroke?

Enhancing Self-Care Signup and view all the answers

Which complication is associated with inadequate oxygen delivery to the brain?

Decreased cerebral blood flow Signup and view all the answers

What specific problem is indicated by flaccid bladder and detrusor instability?

Impaired urinary elimination Signup and view all the answers

Which is a common misconception about stroke recovery regarding sexual dysfunction?

It can improve with therapy Signup and view all the answers

Hemorrhagic stroke is characterized by bleeding into which areas of the body?

The brain tissue, ventricles, or subarachnoid space Signup and view all the answers

What is the primary concern during the administration of antihypertensive agents?

Detecting changes in blood pressure Signup and view all the answers

What should be done if the patient's bleeding has ceased and they are not mobile after 1 to 4 days?

Prescribe DVT prevention medications Signup and view all the answers

When treating seizures in hemorrhagic stroke patients, which drug is typically utilized?

Phenytoin Signup and view all the answers

Which of the following is NOT a goal of medical treatment for hemorrhagic stroke?

Facilitate physical rehabilitation Signup and view all the answers

What is a potential consequence of lowering blood pressure in acute ischemic stroke patients?

Increased risk of brain ischemia Signup and view all the answers

How is anticoagulation with warfarin typically corrected in a patient experiencing bleeding?

Use of fresh-frozen plasma and vitamin K Signup and view all the answers

Which intervention is recommended for managing fever in a stroke patient?

Tylenol and iced saline boluses Signup and view all the answers

What is the preferred method of surgical evacuation for a cerebellar hemorrhage?

Craniotomy Signup and view all the answers

Study Notes

Management of Patients with Cerebrovascular Disorders: Stroke

Stroke, also known as a cerebrovascular accident (CVA) or cerebral infarction, is the third leading cause of death in the United States.
A stroke is a medical emergency needing immediate attention.
Stroke is characterized by the sudden loss of oxygen-rich blood circulation to an area of the brain, causing nerve cell death and loss of neurological function.
Stroke can lead to serious long-term disability or even death.
Stroke is either ischemic (80-85% of cases) or hemorrhagic (15-20% of cases).

Stroke Types

Ischemic Stroke: Caused by blockage of blood flow to an area of the brain, often due to a thrombus (blood clot) or embolus (traveling clot).
- Large artery thrombosis (atherosclerosis)
- Small penetrating artery thrombosis (lacunar)
- Cardiogenic embolism
- Cryptogenic (unknown cause)
- Other (drug use)
Hemorrhagic Stroke: Caused by bleeding into the brain.
- Intracerebral hemorrhage: Bleeding within the brain tissue, often caused by high blood pressure, head injury, or blood disorders.
- Subarachnoid hemorrhage: Bleeding into the subarachnoid space, often caused by aneurysm rupture.

Risk Factors

Nonmodifiable: Age (over 55, though younger adults can be affected), male gender, African American descent, Hispanics & Asian ethnicity
Modifiable: Hypertension, cardiovascular disease (arterial anomalies, atrial fibrillation, valvular disease), elevated cholesterol, obesity, diabetes, smoking, drug & alcohol abuse, oral contraceptive use, sedentary lifestyle, previous TIA

Clinical Approach to Stroke

Ischemic stroke is further categorized by:
- Thrombotic
  - Large-vessel
  - Small-vessel
  - Cardiac
- Embolic
  - Arterial
Hemorrhagic stroke is further categorized by:
- Intracranial
- Subarachnoid

Ischemic Stroke

Causes: Large artery thrombosis due to atherosclerosis, small penetrating artery thrombosis/lacunar (25%), cardiogenic embolism (20%), cryptogenic (30%), and other (5%).
Main Presenting Symptom: Numbness or weakness of the face, arm, or leg, especially on one side of the body.

Hemorrhagic Stroke

Causes: Intracerebral hemorrhage (often caused by high blood pressure), subarachnoid hemorrhage (often caused by ruptured aneurysm).
Main Presenting Symptom: Exploding headache, decreased level of consciousness

Pathophysiology of Ischemic Stroke

Disruption of blood supply to the artery by obstruction (thrombus or embolus) causes infarction of brain tissue.
Results in temporary or permanent loss of movement, thought, memory, speech, or sensation.
The penumbra is an area of minimally perfused cells surrounding the dead cells where intervention is often effective.

Time Lost is Brain Lost

Around 1.9 million neurons are lost per minute during ischemia.
Reperfusion must occur within 3-4.5 hours (therapeutic window) for effective intervention.
The goal is to salvage the ischemic penumbra and reduce ischemia time.

6 Most Common Manifestations of Ischemic Stroke

Numbness or weakness of face, arm, or leg.
Trouble speaking or understanding speech.
Difficulty in walking, dizziness, or loss of balance.
Confusion or change in mental status.
Visual disturbances.
Sudden, severe headache.

Stroke Assessment: NIH Stroke Scale

Used by healthcare providers to assess stroke severity.
Measures neurological function through questions and physical/mental tests.
Scores a person's level of alertness and ability to communicate and perform simple movements.
Scoring ranges from 0-42.

Acute Ischemic Stroke Syndromes - Classification by Artery Involved

Anterior cerebral artery: Motor and/or sensory deficit (leg > face, arm), grasp, sucking reflexes, abulia, paratonic rigidity, gait apraxia.
Middle cerebral artery: Aphasia, motor and sensory deficit (face, arm > leg > foot).
Posterior cerebral artery: Homonymous hemianopia, alexia without agraphia, visual impairments, sensory loss.
Penetrating vessels: Pure motor hemiparesis, pure sensory deficit, etc.
Vertebrobasilar: Crossed sensory deficits.

Transient Ischemic Attack (TIA)

Transient ischemic attacks (TIAs) precede nearly 15% of ischemic strokes.
Characterized by temporary ischemic cerebral neurologic deficits that last for few minutes to hours (less than 24 hours).
Equivalent to brain angina; temporary disturbance in blood flow that reverses before infarction.
No structural damage or evidence of infarction.

Hemorrhagic Stroke Pathophysiology

Bleeding into brain tissue, ventricles or subarachnoid space.
Disrupts normal brain metabolism.
Increased intracranial pressure (ICP) from the sudden entry of blood.
Secondary ischemia of the brain due to reduced perfusion pressure.

Types of Hemorrhagic Stroke

Intracerebral hemorrhage (ICH): Bleeding within the brain tissue.
Subarachnoid hemorrhage (SAH): Bleeding into the subarachnoid space (between the arachnoid and pia mater).

Intracranial Aneurysm

Dilation of a cerebral artery wall.
Often occurs at bifurcations of large arteries (Circle of Willis).
Can be due to atherosclerosis, congenital defects, or hypertension.
Affected arteries include internal carotids, anterior cerebrals, anterior communicatings, posterior communicatings, and posterior cerebrals.

Arteriovenous Malformations (AVMs)

Abnormal tangle of arteries and veins in the brain, lacking a capillary bed.
Leads to dilation of arteries and veins, risking rupture.
Common cause of hemorrhagic strokes, especially in young people.

Hemorrhagic Stroke Manifestations

Similar to ischemic stroke symptoms, often with a severe sudden headache (exploding headache), nausea, vomiting, hypertension, seizures sudden changes in level of consciousness (LOC)

Assessment and Diagnostic Findings

CT scan: To establish the type of stroke, size and location of hematoma, presence/absence of ventricular blood and hydrocephalus.
Cerebral angiography: Confirms the diagnosis of intracranial aneurysm or arteriovenous malformation (AVM).
Lumbar puncture: Confirms subarachnoid hemorrhage if CT is negative and intracranial pressure (ICP) isn't elevated.

Hemorrhagic Stroke Complications

Cerebral hypoxia and decreased blood flow.
Rebleeding or hematoma expansion.
Increased ICP.
Seizures.
Cerebral vasospasm.

Increased Intracranial Pressure (ICP) Management

Mannitol osmotic diuretic is often administered.

Stroke Hypertension Management

Systolic BP may be lowered to prevent hematoma enlargement, using antihypertensive medications (Labetalol, Nicardipine, Nitroprusside, or Hydralazine).
Close hemodynamic monitoring is essential to avoid precipitous drops in BP, which can lead to ischemia.

Medical Stroke Management

Goals are to allow brain recovery from initial insult, minimize rebleeding risk, and prevent/treat complications.
Management may include bed rest with sedation to prevent agitation and stress, and vasospasm management.

Treatment for Complications

Seizures are treated with antiseizure drugs (Phenytoin).
Hyperglycemia is managed to maintain normal blood sugar levels.
Acetaminophen or other analgesics can be administered to manage head and neck pain.
Cooling blankets may be used to manage fever.

Surgical Management

In many cases, initial intracerebral hemorrhages are not surgically treated.
Surgical evacuation by craniotomy may be necessary for patients with worsening neurologic examination, increasing ICP or signs of brain stem compression.

Rehabilitation

Multidisciplinary team approach including physical therapists, occupational therapists, speech therapists, and dieticians.

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Description

Test your knowledge on strokes, their characteristics, risk factors, and symptoms with this comprehensive quiz. Explore various aspects of ischemic and hemorrhagic strokes, as well as related cognitive and psychological conditions. Perfect for students of health sciences or anyone interested in neurology.