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171 Cards in this Set
- Front
- Back
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What is the weakest part of cerebral blood system?
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Circle of Willis
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What type of aneurysm occurs at the bifurcations within the cerebral vascular system?
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berry aneurysm
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Which cranial nerve is most often affected by a CVA?
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oculomotor nerve, so these pt's can also have problems with vision
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the circle of willis sits atop the floor of the __.
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hypothalamus
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what constitutes the blood brain barrier?
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capillaries and astrocytes
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Where are the surface blood vessels located ?
-arachnoid -subarachnoid space -dura -pia |
subarachnoid space
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The subarachnoid space is filled with?
-blood -csf -water |
csf
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__is the connective tissue that creates a space in the arachnoid layer.
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Trabecula (arachnoid trabecula)
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The subarachnoid trabecula are found between what 2 layers in the brain?
-dura and arachnoid -dura and pia -arachnoid and pia |
arachnoid and pia
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What are the 3 layers of the meninges?
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dura
arachnoid pia |
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astrocytes and capillaries are found in the __space
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subarachnoid space
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What is the relationship between a brain capillary and astrocyte end feet?
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subarachnoid space
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What is the hallmark treatment of meningitis?
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antibiotics and steroids
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Pericytes and endothelial cells are completely encapsulated by __?
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the basement membrane
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Strokes are usually __?
-venous -arterial |
arterial
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A __ is an injury to the brain caused by interruption of its blood flow or by bleeding into or around the brain.
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stroke
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A stroke produces neurologic deficits that have a relatively sudden onset and persist for more than __ hours.
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24 hours
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What does TIA stand for?
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transient ischemic attack
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__ is a most usually a brief spell of numbness, weakness, or blindness that lasts less than 10 minutes.
-TIA -CVA |
TIA
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During a TIA an __ is temporarily blocked.
-vein -artery |
artery
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A TIA is an important indicator that the stage is set for an __ stroke
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ischemic
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__ is the brain sounding an alarm.
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TIa
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How much does having a TIA increase your risk of having a stroke compared to someone of the same age and gender who has NOT had a TIA?
-TIA approx. doubles the riske -TIA increas. the risk of CVA x10 -TIA doesn't alter the risk of CVA -after tx for the underlying causes, a TIA doesn't alter the risk of CVA |
TIA increases the risk of CVA by 10 times
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Which ONE of the following factors puts a 40 year old man at the greatest risk of having a stroke?
-BP of 160/95 on repeated meausurement -consumption of 1-2 cans of beer after dinner most nights -h/o smoking presently or in the past -BMI of 31 |
BP of 160/95 on repeated measurement
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What is the greatest risk factor for CVA?
-smoking -HTN |
HTN
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Comprimised cerebral blood flow leads to a __ stroke.
-Ischemic -Hemorrhagic -Embolic -Lacunar |
Ischemic
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What is the most common type of stroke?
-ischemic -hemorraghic -embolic -lacunar |
ischemic
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A __ usually results in an ischemic stroke.
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thrombosis
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An __ stroke occurs when a clot forms and moves to the brain.
-ischemic -hemorragic -embolic -lacunar |
embolic
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What are 2 common cardiac causes of embolic stroke?
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-atrial fib
-dialated cardiomyapathy |
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Cavitary strokes are also known as __?
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lacunar strokes
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A pt. with a history of DM and HTN is most likely to have a __ stroke.
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lacunar
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Lacunar strokes, a subtype of __ stroke, have earned their name because the area rendered ischemic takes the form of a small lacune or cavity.
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ischemic stroke
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Lacunar strokes are usually less than __mm
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15 mm
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In what type of MI is the pumping mechanism really affected to the point of clot formation?
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Inferior wall MI
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What type of stroke USUALLY has a very bad outcome?
-ischemic -hemorrhagic -embolic -lacunar |
hemorrhagic
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What type of stroke will you usually find lesions in the putamen?
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lacunar strokes
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There are several different causes of a CVA or brain attack. What are these causes?
-thrombotic, embolic -lacunar -hemorrhagic -all of the above |
all of the above
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What are the risk factors for developing a thrombotic/ischemic CVA?
-arteriosclerosis, hyperthyroidism, sickle cell dx -chr. hypoxia, use of OCP, HTN -coagulation dos, global hyperperfusion, polycythemia -smoking, dec. blood cholesterol, malignant HTN |
arteriosclerosis, typerthyroidism, sickle cell dx
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If hx of a pt had included a hx of MI, a-fib, or rheumatic heart dx, what type of stroke might you expect?
-ischemic -embolic -hemorrhagic -lacunar |
embolic
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An ischemic stroke may arise from?
-arterial thrombosis -venous thrombosis -arterial embolism -all of the above |
all of them
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what % of strokes are hemorrhagic?
-5% -10% -15% -20% |
15 %
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__% of all CVA's are ischemic.
-50% -60% -70% -80% |
80%
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bleeding from a ruptured blood vessel is a __ stroke.
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hemorrhagic
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T/F
a stroke can cause permanent or temporary neurologic deficits. |
true
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what does RIND stand for?
what is it? |
reversible ischemic neurologic deficit
a neurologic deficit that slowly reolves over days or weeks. |
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a ruptured berry aneurysm is AKA:
-ischemic stroke -hemorrhagic stroke -embolic stroke -subarachnoid hemorrage |
subarachnoid hemorrage
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A CVA that occurs secondary to a fib, is a thromboembolic source from the ?
-left atrial appendage -right atrial appendage -left ventricle -right ventricle |
left atrial appendage
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T/F
The incidence of stroke increases with age |
true
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What are the risk factors for stroke divided into?
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major and minor risk factors
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All atrial fib pt's must be ???
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anticoagulated
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__ strokes are caused by occlusion of small, penetrating intracerebral arteries and are most commonly assoc. with HtN and/or DM.
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lacunar strokes
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Pt's that suffer from lacunar strokes are also at risk for what complication?
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vascular dementia
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The sudden onset of neuro. deficit, h/a, LOC, speech disturbances, homonymous hemifield visual deficits, and contralateral motor and/or sensory deficits....are all s/s of what condition?
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CVA
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Bilateral visual loss suggest ischemia of the __ system.
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vertebrobasilar system
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__ strokes are caused by occlusion of small, penetrating intracerebral arteries and are most commonly assoc. with HtN and/or DM.
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lacunar strokes
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Pt's that suffer from lacunar strokes are also at risk for what complication?
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vascular dementia
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The sudden onset of neuro. deficit, h/a, LOC, speech disturbances, homonymous hemifield visual deficits, and contralateral motor and/or sensory deficits....are all s/s of what condition?
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CVA
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Bilateral visual loss suggest ischemia of the __ system.
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vertebrobasilar system
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Transient mono-ocular blindness indicates involvement of the __ system.
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carotid
**Remember that bilateral vision loss suggests ischemia of the vertebrobasilar system** |
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All of the following are signs/symptoms of increasing ICP except?
-vomiting -decreased LOC -papillary edema -posturing of extremities |
NOT papillary edema but papillary ASYMMETRY
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Irregular heart beet suggests __ __, which can result in thrombus formation that leads to a cerebral embolic event.
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atrial fibrillation
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Heart murmurs may suggest __ as the origin of the embolus.
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endocarditis
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The presence of multiple vascular areas of infarction strongly suggest __ embolus (multiple emboli)
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cerebral embolus
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Age, male gender, race, family hx, DM, smoking, HTN, prior CVA, TIA's, heart dx, asymptomatic bruit...are these?
-major risk factors -minor risk factors |
major risk factors
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hypercholesterolemia, obesity, physical inactivity, OCP use, ETOH consumption are examples of...?
-major risk factors -minor risk factors |
minor risk factors
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What is the test of choice in the diagnosis of a stroke?
-mri -ct |
ct scan
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T/F
a CT scan of the head can differentiate a hemorrhagic from a thromboembolic stroke. |
true
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With an ischemic stroke the initial Ct scan should show?
-blood clot -blood collection -nothing |
nothing, the initial is usually normal, with a repeat in 24 hours typically showing pathology
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What is the tPA window?
-1 hour -2 hours -3 hours -4 hours |
3 hours
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__ strokes typically appear as a small area of infarction in the subcortical area (usually < 1cm)
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lacunar
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An initially ischemic stroke that becomes hemorrhagic suggests an __ etiology.
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embolic
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The presence of intraventricular blood is associated with a __ stroke and a poor prognosis.
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hemorrhagic
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T/F
Lumbar puncture is not routinely indicated and, in fact, is contraindicated due to the risk of herniation in pt's who have mass effects assoc. with the stroke. |
true
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Indications for lumbar puncture include all except?
-suspected syphillis -meningeal irritation -TIA -unexplained fever |
TIA is absolutely not a reason to do a LP
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What type of stroke is tPA not indicated?
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subarachnoid hemorrhage
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What diagnostic test must you do before performing a LP?
-CBC -CT of the head -CT of the lower spine -MRI |
CT of the head
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At what level do you do a LP?
-L3 -L4 -L5 |
L4 usually
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A ventriculostomy, intraparenchymal fibreoptic catheter, epidural transducer, sudural catheter, subdural bolt are all examples of devices to ___?
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measure pressure
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Bleeding or swelling in the brain can cause pressure that forces the brain __ in the skull.
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downward
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What is the most common type of herniation?
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transtentorial
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In a transtentorial herniation, what is physically happening within the brain?
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the temporal lobe is forced thru the tentorial notch--opening in the sheet of tissue between the temporal lobe and cerebellum
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With increased ICP the pupils may become:
-dialated; not reactive to light -dialated; reactive to light -constricted; not reactive to light -constricted; reactive to light |
dialated and not reactive to light
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When examining a pt with a neurological deficit what is the most important part of your exam?
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determining the level of the lesion
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T/F
A transtentorial herniation can have catastrophic consequences such as paralysis, stupor, coma, etc |
true
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An injured brain may __ or __
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bleed or swell
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The 1st sx's of inc. ICP within the skull include all except...
-worsening h/a -impaired mentation -dec. LOC -vomiting -diplopia |
diplopia
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What is Cushing's sign?
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HTN and bradycardia
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As ICP rises, arterial HTN, bradycardia, widened pulse pressure, Cheyne-Stokes respirations or Kussmaul's respirations, and __ may develop
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coma
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If a pt. is lying supine, flex the hip and knee, and then extend the leg with the hip still flexed...what is this called?
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kernig's sign
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If a pt. has a positive Kernig's sign...this indicates what?
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meningeal irritation via...
meningitis or subarachnoid hemorrhage |
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If a pt has a positive Kernig's sign that reproduces sciatic pain...what may be the problem?
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disk or tumor pressure on spinal nerve roots
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If a diagnosis of meningitis is supected, ask about recent infections, especially....?
-sinus infections -tooth abcess -strep pharyngitis |
tooth abcess
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The sudden onset of a severe severe h/a, nuchal reigidity, photophobia and possibly the loss of consciousness usually indicates...
-meningitis -subarachnoid hemorrage |
subarachnoid hemorrage
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If a pt. c/o a progressive onset of a h/a, a fever, nuchal rigidity, and confusion suggests?
-meningitis -subarachnoid hemorrage |
meningitis
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Bradycardia, dialated pupils, increased systolic blood pressure and a widened pulse pressure indicates....
-meningitis -subarachnoid hemorrhage |
subarachnoid hemorrhage
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A CT will miss __% of subarachnoid hemorrhages.
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10%
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If you suspect a pt. has a subarachnoid hemorrhage but has an a negative CT..what should you do next?
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lumbar puncture
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If a pt. is unconscious and shows signs of increasing ICP what signs might he be displaying?
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cheyne stokes
pupils sluggish and dialated widened pulse pressure |
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a spinal tap reveals bloody CSF. What do you think?
-embolic stroke -hemorrhagic stroke -bleeding intracranial aneurysm -b or c |
hemorrhagic stroke or bleeding intracranial aneurysm
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When you do a LP, you draw how many tubes of CSF and which tube do you evaluate for blood?
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draw 4 but look for blood in the second as the first tube may have blood in it due to the trauma of the LP
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An increased tone in the extensor muscles with active tonic reflexes resulting in all 4 limbs being rigidly extended is?
-decerebrate posturing -decorticate posturing |
decerebrate posturing
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decerebrate posturing generally indicates?
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severe injury to the brain and brain stem
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How do you perform Brudzinski's sign?
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pt lies supine and when you flex the pt's neck they c/o pain and will flex their knees
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a spinal tap reveals bloody CSF. What do you think?
-embolic stroke -hemorrhagic stroke -bleeding intracranial aneurysm -b or c |
hemorrhagic stroke or bleeding intracranial aneurysm
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When you do a LP, you draw how many tubes of CSF and which tube do you evaluate for blood?
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draw 4 but look for blood in the second as the first tube may have blood in it due to the trauma of the LP
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An increased tone in the extensor muscles with active tonic reflexes resulting in all 4 limbs being rigidly extended is?
-decerebrate posturing -decorticate posturing |
decerebrate posturing
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decerebrate posturing generally indicates?
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severe injury to the brain and brain stem
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How do you perform Brudzinski's sign?
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pt lies supine and when you flex the pt's neck they c/o pain and will flex their knees
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What does a positive brudzinski's sign indicate?
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common and important early indicator of life-threatening meningitis and subarachnoid hemorrhage.
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How soon can a positive brudinski's sign be elicited?
-24 hrs after onset -3 days after onset -7 days after onset |
24 hours after onset
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In subarachnoid hemorrhage how soon can a positive brudzinski's be elicited?
-minutes -hours -days |
minutes
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Which form of stroke has the best prognosis?
-ischemic -hemorrhagic -lacunar |
lacunar
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What type of stroke occurs in very small arteries in the brain and because there are blockages over time in these small arteries.
-ischemic -hemorrhagic -lacunar |
lacunar
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T/F
early, vigorous tx of HtN immediately after a non-hemorrhagic CVA is not indicated. |
true; becuz hypotension may lead to further ischemic insult, gradual lowering of the blood pressure is desirable unless the pt is in htn crisis
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What is the target BP in a pt with a non-hemorrhagic CVA.
-130/70 -110/60 -160/90 |
160/90
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Why don't you want to lower a pt's BP initially after having a lacunar stroke?
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so that the BP will provide adequate perfusion
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If you overly tx a nonhemorrhagic stroke and lower the BP too fast and too low what could happen?
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may lead to further ischemic insult
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In what type of CVA is tPA not appropriate?
-ischemic -embolic -hemorrhagic |
hemorrhagic
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Anticoagulation therapy is indicated for a cardiogenic source of emboli if the stroke is __.
-hemorrhagic -nonhemorrhagic |
hemorrhagic
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A stroke that is progressing should be __ once hemorrhage is excluded.
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heparized
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pt's who experience TIA's or are at increased risk for stroke may take daily doses of __?
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aspirin
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what are management tx of hemorrhagic CVA's?
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elevated HOB
mannitol intubation |
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__ hematomas are particularly responsive to surgical evactuation if they are surgically accessible.
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cerebellar
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In what type of stroke is the BP "lower the better"?
-ischemic -hemorrhagic -embolic -lacunar |
hemorrhagic
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Medications that can be used for the reducing BP in a pt with hemorrhagic stroke inclule all of the following except?
-cardizem -nitro -labetolol -hydralazine |
cardizem
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The majorityy of strokes are secondary to an ischemic event such as a __ or embolic phenomenon rather than a primary hemorrhagic event.
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thrombus
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A __ is an injury to the brain caused by interruption of its blood flow or by bleeding into or around the brain.
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stroke
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bloody spinal fluid usually means what 2 things?
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subarachnoid hemorrhage or
xanthochromia |
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what is the purpose of capillaries within vascular system within the brain?
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"speed bumps" to slow things down
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What are some of the most common causes of subarachnoid hemorrhage?
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ruptured intracranial aneurysm
arteriovenous malformation |
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if there are no capillaries between the arterio/venous systems within the head? What is this called?
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AVM
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AVM's usually occur in pt's under age...
-60 -50 -40 |
under age 40
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T/F
AVM's are not congenital |
false; they are congenital
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AVM's are more common in..
-men -women |
twice as common in men
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T/F
AVM's are congenital but not inherited |
true
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__ are a tangle of abnormal arteries and veins joined together without the presence of the smallest blood vessels in the brain (capillaries).
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AVM's
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How do AVM's cause trouble?
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without checked rate/pressure of flow; wear and tear develops on the surface of the blood vessels. So the arteries dialate without the 'speed bumps' of capillaries they will rupture at some point.
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Where else can you commonly find AVM's
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the colon
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if your pt has a berry anuerysm, what should you be thinking about?
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the family must be screened
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Intercranial hemorrhages are more likely to bleed during periods of __ with increased blood pressure.
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stress
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T/F
intercranial aneurysms are usually congenital |
true!
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The arteries that are involved with aneurysms are the blood supply to the brain and are situated within the __.
-pia -dura -subarachnoid space |
subarachnoid space
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the most common cause for trouble is hemorrhage caused by __ __.
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aneurysm rupture
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T/F
most people with a cerebral aneursym do not know they have one until it ruptures. |
true true true
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What is the most common complaint when an aneurysm ruptures?
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usually explosive onset of severe h/a
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The chance of rebleed from a hemorrhagic CVA is highest in the first..?
-6 hours -12 hours -24 hours -36 hours |
24 hours
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Why is there vasospasm after a hemorrhagic CVA?
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this is due to the dying RBC's releasing vasoactive substances
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Another complication of hemorrhagic CVA is known as "fluid on the brain"
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hydrocephalus
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T/F
aneurysms usually are present at birth |
false; normally they develop after birth and in some cases, but also may be only present for only months or weeks before rupturing
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Rupturing appears to be most common from the age of...
5-15 10-20 30-40 40-70 |
40-70
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occasionally, other health problems are associated with aneurysms such as ?
-PKD -coarctation of aorta -collagen disorders -all of the above |
all of them
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An aneurysm with the size of 2-6mm has what chance of rupture in the next 5 years?
-1-2% -6% -11% -28% |
1-2%
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An aneurysm with the size of 10-24mm has what chance of rupture in the next 5 years?
-1-2% -6% -11% -28% |
11%
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An aneurysm with the size of 7-9mm has what chance of rupture in the next 5 years?
-1-2% -6% -11% -28% |
6%
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An aneurysm with the size of >24 mm has what chance of rupture in the next 5 years?
-1-2% -6% -11% -28% |
28%
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What is the meningism triad include?
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nuchal rigidity
photophobia headache |
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seizures may be the first sign of __.
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AVM
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__ is the term used when the pt is experiencing nuchal rigidity, photophobia, and headache without actual infection or inflammation.
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meningismus
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What is the diagnostic test for AVM and cerebral aneurysm?
-EEG -CT -MRI -MRA |
MRA
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What 2 lab studies should be done immediately in a pt in which an aneurysm is suspected?
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CBC, coagulation studies to assess the pt's coagulation ability, becuz surgical intervention is often immediately necessary.
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If a pt presents with meningeal signs, what radiological test should be done and why?
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CT initially in order to localize the lesion and confirm or rule out the presence of subarachnoid/intracerebral blood.
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What med can you give to a pt that presents with a seizure?
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valium is a good one
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Increased ICP should be managed with?
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elevated HOB
mannitol intubation |
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What medication is good for prevention of stroke?
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aspirin
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What are 3 good interventions in a pt at risk for an ischemic CVA?
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decrease htn if present
improve DM if present lifestyle changes |
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Giving __ with ASA is more effective at preventing stroke than aspirin alone?
-plavix -persantine -coumadin |
persantine
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In an ischemic stroke where do you want the BP initially?
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high is ok, 160/90
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in an ischemic stroke should you agressively tx the hyperlipidemia or wait?
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treat aggressively
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__ is an acquired, persistent, and progressive impairment of intellectual fcn?
-dementia -delerium |
dementia
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when examining the carotids what should you be looking for?
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bruit
upstroke |
