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Intracranial Regulation: Ischemic CVA - Coggle Diagram
Intracranial Regulation: Ischemic CVA
Pathophysiology
Cerebral metabolism halts as ischemia stops blood flow from fueling cells
As metabolism stops Na/K pump starts to fail, causing Na to build in the cell. Electrolyte imbalance ensue. Na pulls water into the cell with it.
Decrease in cerebral perfusion results - ischemia
Cerebral edema develops
As ischemia continues for prolonged periods of time necrosis occurs, possibly leading to long term effects or death. (Brain ages 3.6 years/hr during ischemia)
Intracranial pressure increases from the edema
Blockage (clot) or stenosis (plaque) obstructs blood flow in a cerebral artery
Ischemic cascade drives anaerobic respiration and lactic acid build up
Area with decreased blood flow is the "penumbra region." With prompt intervention, tissue in the penumbra may be salvaged
Ischemic cascade threatens penumbra cells as cell membranes depolarize, intracellular Ca increases and glutamate is released - this damages the cell membrane and releases more Ca and glutamate.
Symptoms
Visual disturbances
Loss of balance/trouble walking
Difficultly speaking or understanding speech
Dizziness
Confusion/AMS
Sudden severe headache
Numbness or weakness of arm/face/leg - esp. one sided
Risks
Smoking, as always
Obesity
HTN
High cholesterol
Alcohol abuse
Diabetes
A Fib
Age
Race
Sex
Hereditary
For Cardiac embolic
Ventricular aneurysm
bacterial endocarditis
Recent MI
patent foramen ovale
A fib
Rheumatic heart disease
Complications
Pneumonia
Depression
Cerebral edema
Hemiparesis
Dysphagia
Hemiplegia
Hemineglect
Collaborative Treatment
ABCs
Admin TPA - FAST!!!
anticoagulant therapy (warfarin)
anti-platelet therapy like ASA
Swallow study
Aspiration risk protocols (elevate HOB, thickened liquid diet, no straws)
OT (regain bodily function, learn how to perform ADLs with potential disability)
PT (Rehab to try to regain bodily function and independence)
SLP (help regain speech, determine aspiration risk)
Diagnostics/labs
CT scan, fast and before admin TPA
Pt Hx (TIAs)
Glasgow coma scale
Carotid ultrasound to find source of thrombus/embolus
12 ECG to find source of thrombus/embolus
MRI (but it's slow for an emergent case)