CVA

Question 1

RED FLAGS

Question 2

DIFFERENTIALS

Answer 2

• Hemiplegic migraine
• Hypoglycaemia
• Tumour
• Seizure
• Bell’s palsy

Question 3

RISK FACTORS

Answer 3

• Age
• Diabetes
• Previous TIA
• Hypertension
• AF
• Smoking
• Alcohol

Question 4

CAUSE

Answer 4

• Atherosclerosis
• Ruptured aneurism
• Thrombi
• Embolism

Question 5

TYPES

Answer 5

• Haemorrhagic: due to aneurism, chronic hypertension  weakened blood vessel wall  rupture. If it occurs in the Subarachnoid space, it is an SAH  increase ICP.
• Ischaemic:
  Embolic– fat, gas, amniotic fluid occludes the cerebral blood vessels
  Thrombus – atherosclerosis can occur anywhere in the vasculature - LDLs entre tissue & are oxidated into soap cells  creating plaque  reduce the size of the vessel lumen or rupture  rupture causes clot formation that can dis/relodge in the cerebral vasculature  vessel occlusion  hypoxic neurons  cell death.

TIA– an ischaemic stroke that resolves within 20min as the occlusion dislodges again & allows the brain tissue to reperfuse.

Question 6

PATHOPHYSIOLOGY

Answer 6

• Neurons can only survive for 3-5min without O2  Ischaemic neurons  Inflammation  vascular permeability  BBB  fluid leaches into tissue.
• Ischaemic neurons  calcium influx  Glutamate & Ca cascade  causes apoptosis to cells surrounding that hypoxic tissue  brain death that will expand if hypoxia is not reversed.

Question 7

MANIFESTATIONS

Answer 7

• Head: ALOC, headache, confusion, memory loss, facial droop, unequal pupils, visual disturbance, dysphagia, dysarthria  aspiration.
• Torso: respiratory compromise.
• Limbs: Hemiparesis, paraesthesia.
  Stroke symptoms may not resolve or resolve incompletely

Question 8

TREATMENT

Answer 8

DRAB: O2 (careful not to over oxygenate  vasoconstriction). C: IV access. D: Ondansetron (reduce risk of increased ICP). E: Position 45° (increase perfusion + decrease cerebral oedema).
Secondary Survey: Thorough NSA, CVA + reassessments. NHISS-8, modified Rankin score, stroke referral

Question 9

PARAMEDIC ROLE

Answer 9

Prevent secondary injury. Identify if it’s a LVO in order to Tx to a hospital capable of endovascular clot retrieval. Find time of onset, determine whether the Pt needs thrombolysis or EVCR.

Question 10

DEFINITIVE CARE