NURS 5462 VASCULAR DISEASE | STUDY GUIDE
CEREBROVASCULAR DISEASE - Answers - 28% OF STOKES OCCUR IN PATIENTS
<55 YEARS • 80% OF STROKES ARE THROMBOTIC OR EMBOLIC,
Leading cause of disability and death among older adults
NEW EMERGING RISK FACTORS stroke - Answers - Patients with high levels of Lp-
PLA2 twice as likely to suffer an ischemic stroke over the next 6-8 years when
compared to people with normal levels
PLAC test - Answers - available nationwide by Quest Laboratories Normals are 120-342
ng/ml for women and 131-376 ng/ml for men
ASYMPTOMATIC CAROTID STENOSIS - Answers - Detected by a bruit, Duplex scan
can identify which patients with bruits have carotid stenosis, Stenosis >75% is
associated with annual stroke risk of 2-3% Perioperative stroke risk is 3% or less for
CEA
REVERSIBLE ISCHEMIC NEUROLOGIC DEFICIT - Answers - • RIND • EPISODE OF
FOCAL CEREBRAL DYSFUNCTION LASTING >24 HOURS BUT RESOLVES WITHIN
3 WKS. • ALSO KNOWN AS MINOR STROKE
CAROTID ARTERY DISEASE (anterior circulation) - Answers - MONOPARESIS OR •
HEMIPARESIS • SENSORY LOSS OR PARESTHESIAS • SPEECH DISTURBANCES
• COGNITIVE IMPAIRMENT • LOSS OF VISION IN ONE EYE OR PART OF AN EYE •
AMAUROSIS FUGAX • HOMONYMOUS HEMIANOPSIA • LOSS OF VISION OF
NASAL ½ OF ONE EYE AND TEMPORAL ½ OF OTHER EYE
VERTEBROBASILAR ARTERY DISEASE post. circ. - Answers - • VERTIGO /
DIPLOPIA / DYSPHAGIA / DYSARTHRIA • TWO OF THESE OR ONE OF THESE
PLUS • PARESIS • SENSORY LOSS OR PARESTHESIAS • ATAXIA •
HOMONYMOUS HEMIANOPSIA
LACUNAR SYNDROMES intracerebral DZ - Answers - Degenerative process called
lipohyalinosis affecting vessels 200um or less in diameter [Correlates with HTN]
Common lacunar syndromes→→• Pure Motor Hemiparesis • Lesion is in the Pons •
Hemiplegia or hemiparesis of face, arm and leg without sensory deficit, dysphagia or
hemianopsia
LACUNAR SYNDROMES - Answers - *Pure Motor Hemiparesis • Lesion is in the Pons
• Hemiplegia or hemiparesis of face, arm and leg without sensory deficit, dysphagia or
hemianopsia
*Pure Sensory Stroke:• Thalamus • Numbness of face, arm and leg on one side without
weakness or hemianopsia
, *Ataxic Hemiparesis: • Pons • LE affected worse
*Dysarthria or "Clumsy Hand Syndrome"
• Dysarthria, facial weakness, clumsiness of hand with little or no weakness, imbalance
and positive Babinski on affected side
*Multi-Infarct Dementia-• Stepwise, progressive dementia
ISCHEMIC STROKE - Answers - Accounts for approximately 80%85% of strokes
• About 27% are due to cardiac emboli • About 19% are due to large vessel disease •
About 17% are due to small vessel disease, lesions at internal carotid artery=amirosis
fugax
CRYPTOGENIC STROKE - Answers - Ischemic stroke that does not have a clearly
identifiable cause; Consider atypical causes of stroke, such as vasculitis, coagulopathy,
mitochondrial disorder
TIA - Answers - Transient episodes with altered consciousness are almost never
vascular in nature
CHADS2 - Answers - CHF [recent] Hypertension Age [75 or older] Diabetes Mellitus
Stroke [previous]
PHYSICAL EXAM - Answers - • FUNDUSCOPIC EXAM • EMBOLI TO SUGGEST
ATHEROTHROMBOTIC CAROTID OCCLUSIVE DISEASE OR CARDIAC DISEASE, •
PAOD • PERSISTENT NEURO DEFICIT
TREATMENT OF ACUTE ISCHEMIC STROKE - Answers - Quickly use head CT
imaging to
determine whether the patient is suffering
from an ischemic or hemorrhagic event
NIH STROKE SCALE (NIHSS) - Answers - • GREATER SCORE REFLECTS
INCREASED IMPAIRMENT: • <5 SUGGESTS VERY GOOD PROGNOSIS; Screening
tests for treatable causes of occlusive cerebrovascular disease RPR H/H ESR
RECOMBINANT TISSUE-PLASMINOGEN ACTIVATOR [T-PA] [ALTEPLASE] -
Answers - use w/i 3h=doubles positive outcome• AHA RECOMMENDATION:
PROLONGATION OF THE WINDOW TO 34.5 HOURS FOR PATIENTS 80 YEARS
OLD WHO HAVE NIHSS SCORE 25 AND NO PRIOR HISTORY OF STROKE OR
DIABETES
• CARRIES A 6% RISK OF INTRACEREBRAL HEMORRHAGE, USUALLY AMONG
PATIENTS WITH SEVERE STROKES
CONTRAINDICATIONS TO ALTEPLASE - Answers - Systolic BP >185 or diastolic BP
>110 mmHg, Coagulopathy Thrombocytopenia INR >1.7
CEREBROVASCULAR DISEASE - Answers - 28% OF STOKES OCCUR IN PATIENTS
<55 YEARS • 80% OF STROKES ARE THROMBOTIC OR EMBOLIC,
Leading cause of disability and death among older adults
NEW EMERGING RISK FACTORS stroke - Answers - Patients with high levels of Lp-
PLA2 twice as likely to suffer an ischemic stroke over the next 6-8 years when
compared to people with normal levels
PLAC test - Answers - available nationwide by Quest Laboratories Normals are 120-342
ng/ml for women and 131-376 ng/ml for men
ASYMPTOMATIC CAROTID STENOSIS - Answers - Detected by a bruit, Duplex scan
can identify which patients with bruits have carotid stenosis, Stenosis >75% is
associated with annual stroke risk of 2-3% Perioperative stroke risk is 3% or less for
CEA
REVERSIBLE ISCHEMIC NEUROLOGIC DEFICIT - Answers - • RIND • EPISODE OF
FOCAL CEREBRAL DYSFUNCTION LASTING >24 HOURS BUT RESOLVES WITHIN
3 WKS. • ALSO KNOWN AS MINOR STROKE
CAROTID ARTERY DISEASE (anterior circulation) - Answers - MONOPARESIS OR •
HEMIPARESIS • SENSORY LOSS OR PARESTHESIAS • SPEECH DISTURBANCES
• COGNITIVE IMPAIRMENT • LOSS OF VISION IN ONE EYE OR PART OF AN EYE •
AMAUROSIS FUGAX • HOMONYMOUS HEMIANOPSIA • LOSS OF VISION OF
NASAL ½ OF ONE EYE AND TEMPORAL ½ OF OTHER EYE
VERTEBROBASILAR ARTERY DISEASE post. circ. - Answers - • VERTIGO /
DIPLOPIA / DYSPHAGIA / DYSARTHRIA • TWO OF THESE OR ONE OF THESE
PLUS • PARESIS • SENSORY LOSS OR PARESTHESIAS • ATAXIA •
HOMONYMOUS HEMIANOPSIA
LACUNAR SYNDROMES intracerebral DZ - Answers - Degenerative process called
lipohyalinosis affecting vessels 200um or less in diameter [Correlates with HTN]
Common lacunar syndromes→→• Pure Motor Hemiparesis • Lesion is in the Pons •
Hemiplegia or hemiparesis of face, arm and leg without sensory deficit, dysphagia or
hemianopsia
LACUNAR SYNDROMES - Answers - *Pure Motor Hemiparesis • Lesion is in the Pons
• Hemiplegia or hemiparesis of face, arm and leg without sensory deficit, dysphagia or
hemianopsia
*Pure Sensory Stroke:• Thalamus • Numbness of face, arm and leg on one side without
weakness or hemianopsia
, *Ataxic Hemiparesis: • Pons • LE affected worse
*Dysarthria or "Clumsy Hand Syndrome"
• Dysarthria, facial weakness, clumsiness of hand with little or no weakness, imbalance
and positive Babinski on affected side
*Multi-Infarct Dementia-• Stepwise, progressive dementia
ISCHEMIC STROKE - Answers - Accounts for approximately 80%85% of strokes
• About 27% are due to cardiac emboli • About 19% are due to large vessel disease •
About 17% are due to small vessel disease, lesions at internal carotid artery=amirosis
fugax
CRYPTOGENIC STROKE - Answers - Ischemic stroke that does not have a clearly
identifiable cause; Consider atypical causes of stroke, such as vasculitis, coagulopathy,
mitochondrial disorder
TIA - Answers - Transient episodes with altered consciousness are almost never
vascular in nature
CHADS2 - Answers - CHF [recent] Hypertension Age [75 or older] Diabetes Mellitus
Stroke [previous]
PHYSICAL EXAM - Answers - • FUNDUSCOPIC EXAM • EMBOLI TO SUGGEST
ATHEROTHROMBOTIC CAROTID OCCLUSIVE DISEASE OR CARDIAC DISEASE, •
PAOD • PERSISTENT NEURO DEFICIT
TREATMENT OF ACUTE ISCHEMIC STROKE - Answers - Quickly use head CT
imaging to
determine whether the patient is suffering
from an ischemic or hemorrhagic event
NIH STROKE SCALE (NIHSS) - Answers - • GREATER SCORE REFLECTS
INCREASED IMPAIRMENT: • <5 SUGGESTS VERY GOOD PROGNOSIS; Screening
tests for treatable causes of occlusive cerebrovascular disease RPR H/H ESR
RECOMBINANT TISSUE-PLASMINOGEN ACTIVATOR [T-PA] [ALTEPLASE] -
Answers - use w/i 3h=doubles positive outcome• AHA RECOMMENDATION:
PROLONGATION OF THE WINDOW TO 34.5 HOURS FOR PATIENTS 80 YEARS
OLD WHO HAVE NIHSS SCORE 25 AND NO PRIOR HISTORY OF STROKE OR
DIABETES
• CARRIES A 6% RISK OF INTRACEREBRAL HEMORRHAGE, USUALLY AMONG
PATIENTS WITH SEVERE STROKES
CONTRAINDICATIONS TO ALTEPLASE - Answers - Systolic BP >185 or diastolic BP
>110 mmHg, Coagulopathy Thrombocytopenia INR >1.7
