EXAM 3 CELEBRAL VASCULAR ACCIDENT

EXAM 3 CELEBRAL VASCULAR ACCIDENT


Exam 3
Cerebral Vascular Accident

 Incidence of Stroke
o ~ 780,000 strokes/year
 ~540,000 1st time strokes
 ~240,000 recurrent strokes
rd
o 3 leading cause of death in US
 160,000 deaths per year
o If you survive 1st stroke – 9x more likely to suffer 2nd stroke
o One death every 37 seconds from cardiovascular disease or
stroke each day
o 2008 cost burden = $448 billion
o Hemorrhagic strokes are the most lethal
 Non-modifiable Risk Factors
o Men > women
o Age
o African-American > Hispanic or Asian/Pacific Islander >
Caucasians
o Family history
o Previous Stroke or TIA
o Sickle Cell Anemia
 Modifiable Risk Factors
o Smoking
o ETOH
o Obesity
 Walking, non-strenuous activity
o High cholesterol
 Statin based medication, educate about statins and effects
on liver
 Low fat, low sodium diet (heart healthy)
 Folic acid, vitamin D
o Hypertension
o Diabetes
o Atrial Fibrillation
 Signs and Symptoms of TIA
o Blurred vision
o Caused by lack of blood flow/oxygen
o Headache
o Any neurological changes = need to seek medical attention

,




 Ischemic vs. Hemorrhagic
o Ischemic
 Thrombotic
 Embolic
o Hemorrhagic
 Intracerebral
 Subarachnoid
 Clinical Manifestations
o Headache
o Dependent on area affected
o Weakness/paralysis
o Speech
o Sensation
o Visual
o Decreased LOC
o Cognitive
 Review of Terminology
o Aphasia – loss of speech
 Expressive – unable to form words
 Receptive – speaks but makes no sense
o Dysarthria – difficulty speaking
o Dysphagia – difficulty swallowing
 Do not eat or drink until we know they can swallow (at risk
for aspiration)
 Need to be NPO
 When did they last have something to eat/drink?
o Ataxia – unsteady gait
o Hemiparesis – weakness of face, leg on same side.
o Hemiplegia – paralysis of the face, leg on same side.
o Parethesia – numbness and tingling.
 Perceptual Disturbances

, o Homonymous Hemianopia




o
 Homonymous Hemianopsia
o Right eye visual field, left hemisphere
 Common Symptoms
o Unsure of footing while walking and may trip or stumble.
o Often startled by moving objects or people appearing suddenly.
 Maximize other senses such as hearing (announce or knock
when coming in the room)
 If they cannot see out of their right eye, place food on tray
to the left
 Be aware of coffee (hot) and utensils (sharp) – safety
first!!!! Put it on the side they can see
o May have bruises on shoulder or arm from colliding with door-
frames.
o Has withdrawn from most reading.
o Frequently spills drinks when eating.
o Unsteady Balance in walking or Fear in walking through
unfamiliar areas.
o Uneasiness, anxiety or even panic attacks in crowded area.
o Withdrawal from going to stores or other crowded areas.
o Gets around well at home, but avoids outside activities.
 Should have a home safety assessment
o Patient may deny the above problems that caregivers observe.
o Right Hemispheric o Left Hemispheric

o Left Hemiplegia o Right Hemiplegia
o Left neglect from visual o Aphasia or Impaired
o Field impairments language ability
o Short-term memory o Impaired right/left d
o Impulsive/Dangerous behavior style o Slow and cautious b
frequent instruction

, o Impaired judgment o Difficulty learning ne
o Impaired time concepts o Depression
 Initial Evaluation
o Note time of onset of symptoms
 Last time they ate/drank
 When did the symptoms start??!!!!
 Take them to imaging
o Imaging will determine ischemic vs.
hemorrhagic
 Ischemic strokes – TPA is a blood thinner, but there is
a time window!!!
 Never give TPA to a patient experiencing a
hemorrhagic stroke!!!!!
o Rapid transport
 Should not be driving themselves!!
o Assess ABCs and glucose
o Use of stroke scale
 Cincinnati
 NIH
o Monitor Neuro status
 Diligent and frequent neuro checks
o EKG
 Could be in a fib (likely an ischemic based stroke)
o Patient history
 Get a good set of vital signs!
 280/110 is very rough on blood vessels (likely a
hemorrhagic stroke)
 Stroke Scales
o Cincinnati Scale
 Facial Droop
 Arm Drift
 Speech
o NIH Scale score from 0 to 42.
o A score of more than approximately 25 indicates a large stroke
 Diagnostic Studies
o CT Scan
o MRI/MRA
o Carotid Dopplers
o TTE/TEE
o C-spine if any trauma suspected
o Labs
 Blood thinners
 PT/PTT/INR
 Platelets