CVA

[username33]

What are the main symptoms of CVA? How do I know if my pt had CVA or he had some kind of seizure w/o visible manifestations like jerking movements?

[ghillbert, MSN, NP]

CVA symptoms can be found in any nursing or medical text or journal:

- altered level of consciousness

- changes to pupil reactions

- motor deficits eg. weakness on one side, facial droop, unable to stick tongue out

- slurred speech

- using inappropriate words

- inability to understand instructions

The deficit seen depends on the area of the brain affected by lack of oxygen.

Head CT can confirm or rule out CVA. It cannot distinguish between TIA (stroke symptoms lasting less than 24hrs and resolving, with no evidence on CT) and seizure. You can do other investigations like EEG etc to check brain activity re seizures.

[papawjohn]

Well, Username33, that's a simple question that actually covers a huge am't of ground -- how would you tell a seizure from a stroke? There are similarities of course. Changes in consciousness, deflections of gaze, loss of speech.

A seizure is always followed by a period of (at least partial) unconsciousness. This is called "post-ictal period". A stroke does not

A seizure you or I will witness is virtually certain to NOT be this person's first seizure. Look in the chart, evaluate the meds he gets. If you're giving anti-seizure drugs there's a big clue there.

A seizure will almost always involve the entire patient. There are some that we used to call 'absence' seizures that might just give facial twitches and then a fade-away with a 'thousand-meter-stare'. But if one leg is twitching -- or one arm -- then probably all 4 extremities are also.

With a CVA, things are pretty clearly different. No 'post-ictal' unconsiousness. Effects might be dramatic or subtle but they're usually on just the one part of the body controlled by the brain-part that suffered the 'stroke'.

The most common CVA is this: A 'mural thrombus' from the wall of the Left Atrium breaks off and travels through the L Ventricle into the Aorta. The first really large artery it gets to is the L Carotid. Up into the brain it goes. It follows cerebral arteries until it gets to the L Middle Cerebral Artery and there it can't go any further so it lodges there and clocks the flow of blood to the language center ('Broca's area') and the motor area that controls the R side. You find your patient dysphasic and hemiplegic.

But strokes and seizures come in all shapes and sizes. Stay very alert and when you notice a neuro change in your patient -- gets lots of help!!

[MaroonTX]

CVA symptoms can also be subtle.. I had a patient recently who came up to us after getting tpa for an ischemic stroke. When they brought him up he was intubated and sedated so in order to do neuro checks they just had me cut off his sedation every 1-2 hrs as tolerated. Since his blood pressure would sky rocket soon after the drips were turned off I had very limited time (basically just long enough to see some movement and eye opening, but not following commands) Then during one of my checks I noticed a slight decrease in the amount of activity. Since I had only been working in the ICU for ~1 month, I wasn't sure if the change was significant or not, especially since I wasn't able to perform any sort of objective assessment. It just seemed to me that he was moving a little less, so I decided to let the docs know anyway, just to be safe. A stat MRI was ordered and he had indeed had a hemorrhagic stroke as a complication of the tpa. It was definitely a learning experience!