Cerebrovascular Accidents

Question 1

Stroke or CVA

Answer 1

• sudden onset of neurological symptoms due to a disruption of blood flow to a part of the brain
• 3rd leading cause of death in USA

Question 2

Anoxia

Answer 2

• Can cause the brain tissue death within a few minutes

Question 3

Ischemia CVA

Answer 3

• 70% of strokes

- Thrombus or Embolus

Question 4

Thrombus

Answer 4

• Ischemia CVA
• Frequently caused by atherslcorosis which is plaque built up inside the vessel walls.
• Result in hypoxic event
• 100% occlusion = cerebral infart (Brain death)

Question 5

Embolus

Answer 5

• Ischemia CVA
• Blood clot from artery breaks away and sticks in the brain
• Cell death occurs (irreversible)
• Sudden onset
• Clot: dissolving drugs can be successful if administered in the first 3 hours

Question 6

Hemorrhagic

Answer 6

• CVA
• Ruptured vessels, 20% of strokes
• Intercerebral Hemorrhage
• Subarachnoid Hemorrhage
• Arteriovenous Malformations

Question 7

Inercerebral Hemorrhage

Answer 7

• Usually hypertension, and age generated

Question 8

Subarachnoid Hemorrhage

Answer 8

• Bleeding that fills the subarachnoid space

Question 9

• Arteriovenous Malformations

Answer 9

• Congenital abnormalities (arteries and veins directly connected, then swell over time until they rupture)

Question 10

TIA

Answer 10

• Transient Ischemic Attack
• A temporary interruption on the blood supply to part of the brain
• Most symptoms last less than 5 min, all resolve completely within 24 hours
• Prompt medical attention is necessary, but seldom sought
• 36% of pt’s who have TIA’s will have CVA

Question 11

Warning signs of CVA

Answer 11

“SYMPTOMS SHOULD NEVER BE IGNORED”

• Sudden blurred vision or decreased vision in one eye
• Numbness or weakness in face, arm and/or leg on one side
• Severe headache and/or dizziness
• Difficulty speaking or understanding what is being said
• Mental confusion

Question 12

Stoke Screening

Answer 12

• S.T.R.O.K.E “Acronym”
  S: Ask pt to smile
  (Smile should be symmetrical)
  T: Ask the pt to TALK (repeat a simple sentence)
  (Should be repeated accurately and coherently)
  R: Ask the person to RAISE BOTH ARMS
  (Should be symmetrical unless the person has had prior orthopedic problems)
  O: Ask the pt to OPEN their mouth and stick out their tongue.
  (Tongue should be centered without deviation)
  KE: KALL EMERGENCY
  (If the pt has trouble with ANY ONE of these tasks, call emergency # immediately and describe the symptoms to the dispatcher

Question 13

CVA Risk Factors

Answer 13

• Heart Disease
• High Blood pressure (increases risk 4-6 times)
• Cholesterol > 200
• Smoking
• History of TIA
• Gender (Men at slightly higher risk)
• Race (higher in African Americans)
• Obesity
• Heavy alcohol consumption
• Diabetes
• Age (65% occur in people > age 65)
• Lack of exercise
• Birth control pills (due to blood thickening and increased blood pressure)

Question 14

Prognosis of CVA

Answer 14

• Fast recovery = more favorable prognosis
• 10-15% have excellent recovery
• 10-15% Die
• 75-85% Return Home

Question 15

MVA Prognosis

Answer 15

• Typically improve more than other deficits

- Communication, sensory, cognition harder to recover

Question 16

Rehab potential best evaluated ___ __________ post onset due to decrease in cerebral edema

Answer 16

• 2 Weeks

Question 17

Most spontaneous recovery occurs within __ _______?

Answer 17

• 3 Months

- Treatment is believed to be most beneficial during this time

Question 18

Rate of improvement slows dramatically by __ _____, typically resulting in no significant functional improvement after that time

Answer 18

• 6-18 months

- May also be due to “learned non-use”

Question 19

Learned Non-Use

Answer 19

• Decreasing length of stay in hospital and rehab settings have shifted treatment strategies from recovery of function to compensation

Question 20

Factors resulting in poor rehab potential

Answer 20

• Unilateral Neglet
• Anosognosia
• Severe Proprioceptive / Kinesthetic deficits
• Poor (Dependent) sitting balance
• Global Aphasia

Question 21

Unilateral Neglet

Answer 21

• Lack of awareness of one side of the body
• Much slower initial recovery
• Long term recovery is not dramatically less than without neglect

Question 22

Anosognosia

Answer 22

• Lack of awareness of the presence or severity of ones paralysis

Question 23

Global Aphasia

Answer 23

• CVA that affects the frontal and temporal lobes, resulting in difficulty understanding and forming words

Question 24

CVA Surgical Intervention

Answer 24

• Place metal clip on aneurysm (at base)
• Remove abnormal vessel
• Evacuation of hematoma