Cerebrovascular Accident (Stroke) Comprehensive Review

A comprehensive 140-flashcard vocabulary study deck covering the pathophysiology, clinical manifestations, assessment tools (GCS, NIHSS, BE-FAST), imaging, medical/surgical management, tPA protocols, and nursing care of acute ischemic and hemorrhagic strokes.

Cerebrovascular Accident (CVA)

A clinical condition occurring when cerebral ischemia or hemorrhage into the brain results in brain cell damage and death due to deprivation of oxygen-rich blood.

Brain Attack

An alternate lay term for a cerebrovascular accident (CVA) or stroke, emphasizing that acute stroke requires emergency response similar to a heart attack.

Gross Pathologic Brain Specimen: Intracerebral Hemorrhage

A coronal section of human brain tissue illustrating massive intraparenchymal bleeding and tissue destruction in one cerebral hemisphere, sourced from Robbins and Cotran Pathologic Basis of Disease.

Cerebral Ischemia

Inadequate blood supply to cerebral tissue resulting from arterial occlusion or stenosis, depriving brain cells of necessary glucose and oxygen.

Cerebral Hemorrhage

Bleeding into brain tissue, the ventricular system, or the subarachnoid space caused by the rupture of a cerebral blood vessel.

Major Pathophysiologic Types of Stroke

The three primary stroke classifications: thrombotic (arterial lumen narrowing from clot formation), embolic (circulating embolus occluding a narrower brain artery), and hemorrhagic (vessel rupture leaking blood into brain parenchyma).

Thrombotic Stroke

An ischemic stroke mechanism wherein an injury to a blood vessel triggers the local formation of a blood clot (thrombosis), narrowing the lumen until arterial flow is blocked.

Embolic Stroke

An ischemic stroke caused when an embolus (a blood clot or debris) originates elsewhere in the circulation, travels into the cerebral arterial tree, and lodges in a lumen too narrow to permit passage.

Hemorrhagic Stroke

A stroke caused by a burst cerebral blood vessel that leaks pressurized blood into brain tissue, increasing pressure and destroying cells until clotting seals the leak.

Thunderclap Headache

A sudden, severe headache of maximum intensity at onset, described as a warning or presenting symptom of acute intracranial hemorrhage or aneurysm rupture.

Arterial Thrombosis Diagram

A vascular cross-section illustrating atherosclerotic plaque accumulation along the arterial wall with secondary intraluminal blood clot formation causing luminal obstruction.

Embolus

A detached intravascular physical mass—such as a blood clot, plaque fragment, or debris—that travels through the bloodstream until it lodges in a distal, smaller-caliber vessel.

Stroke Risk Factors Infographic

A circular diagram summarizing major clinical and behavioral stroke risk factors: high blood pressure, obesity, diabetes, sleep apnea, heavy alcohol use, smoking/drug use, lack of exercise, cardiovascular disease, and high cholesterol.

Reversible Stroke Risk Factors

Modifiable lifestyle risk factors for stroke that can be eliminated completely through behavioral change: cigarette smoking, obesity, elevated dietary salt intake, sedentary lifestyle, elevated psychological stress, and oral birth control (O.B.C.) use.

Partially Reversible Stroke Risk Factors

Medical conditions contributing to stroke risk that can be medically controlled or mitigated but typically not entirely cured: elevated blood pressure, cardiac valve disease, cardiac dysrhythmias, diabetes mellitus, and elevated serum cholesterol.

Non-Reversible Stroke Risk Factors

Inherent biological risk factors for stroke that cannot be altered: biological sex, advancing age, race, and genetic heredity.

Hypertension (in Stroke Etiology)

The single most significant modifiable risk factor for stroke; chronic vascular wall stress promotes atherosclerosis, vessel occlusion, and microaneurysm rupture.

Oral Birth Control (O.B.C.)

A reversible pharmacological stroke risk factor associated with hypercoagulability, especially in females who smoke cigarettes or have underlying hypertension.

Sedentary Lifestyle

A lack of regular physical activity that independently increases stroke vulnerability by worsening vascular compliance, obesity, insulin resistance, and hypertension.

Dietary Sodium Intake Reduction

A stroke prevention recommendation to lower sodium consumption in order to decrease systemic vascular resistance and reduce systolic blood pressure.

Target Body Mass Index (BMI)

A stroke prevention goal instructing patients to maintain a normal body mass index ($18.5\text{--}24.9\,\text{kg/m}^2$) to mitigate cardiovascular load and metabolic strain.

Low Saturated Fat Diet

A nutritional strategy in stroke prevention designed to decrease circulating low-density lipoproteins and retard the progression of arterial plaque accumulation.

Alcohol Moderation in Stroke Prevention

Limiting alcohol consumption to moderate levels to avoid sharp rises in systemic blood pressure, cardiac dysrhythmias, and coagulation abnormalities.

Primary Prevention Blood Pressure Goal

Maintaining baseline systolic blood pressure at $\text{SBP} < 140\,\text{mm\,Hg}$ to decrease chronic vascular stress and prevent initial stroke occurrence.

Stroke Prevention Exercise Recommendation

Engaging in moderate-intensity physical exercise for greater than $150\,\text{min/week}$ to promote cardiovascular health and stroke risk reduction.

Nicotine Avoidance

Refraining from all nicotine products to eliminate acute vasoconstriction, endothelial damage, platelet hyperaggregability, and accelerated atherogenesis.

Glycemic Control in Stroke Prevention

Strict management of blood glucose levels in diabetic patients to minimize microvascular and macrovascular endothelial damage that accelerates cerebral atherosclerosis.

Sleep Apnea (in Stroke Risk)

A condition causing episodic nocturnal hypoxia, sympathetic activation, and abrupt blood pressure elevations, serving as a significant predisposing risk factor for stroke.

Cardiovascular Disease (in Stroke Risk)

Underlying conditions such as heart failure, prior myocardial infarction, or cardiomyopathy that impair cerebral perfusion and predispose patients to cardioembolic phenomena.

Atrial Fibrillation (Afib)

A cardiac dysrhythmia causing ineffective atrial contraction, blood stasis, and thrombus formation, heavily predisposing patients to embolic cerebral infarction.

Transient Ischemic Attack (TIA)

A transient episode of neurologic dysfunction caused by focal brain, spinal cord, or retinal ischemia without acute infarction, presenting as a serious clinical warning sign.

TIA Arterial Embolism Graphic

An anatomical illustration demonstrating a temporary embolus lodged within a cerebral blood vessel, transiently reducing regional blood flow to the brain before resolving.

TIA Typical Clinical Duration

The clinical time window for a transient ischemic attack; symptoms typically resolve in less than $60\,\text{minutes}$, although definitionally lasting minutes to $24\,\text{hours}$.

TIA Progression to Ischemic Stroke

The epidemiological rate at which patients experiencing a transient ischemic attack subsequently progress to an ischemic stroke: approximately $1/3$ of patients.

TIA as a Warning Sign

The clinical significance of a TIA as a critical harbinger of impending cerebrovascular thrombosis, demanding immediate diagnostic evaluation and secondary prevention.

Transient Hemiparesis

Temporary weakness on one side of the body that spontaneously resolves, serving as a common presenting manifestation of a transient ischemic attack.

Temporary Vision Loss (in TIA)

A transient loss of vision in one eye (amaurosis fugax) or visual field defect caused by temporary microembolization to the retinal or cerebral vasculature.

Vertigo (in TIA)

A temporary sensation of spinning or loss of equilibrium resulting from transient ischemia in the posterior or vertebrobasilar cerebral circulation.

Carotid Artery Embolization Diagram

An illustration showing an atheroma in a diseased carotid artery fragmenting, forming a thrombus that dislodges and travels superiorly to lodge in a cerebral artery.

Diseased Carotid Artery

A carotid artery narrowed by atherosclerosis and endothelial ulceration, acting as a primary source for cerebral thrombi and embolic stroke.

BE-FAST Stroke Symptoms Mnemonic Diagram

An educational infographic outlining the rapid clinical recognition of stroke: Balance loss, Eyes/visual changes, Facial drooping, Arm weakness, Speech difficulties, and Time to call emergency help immediately.

Balance (in BE-FAST)

The 'B' component assessing sudden loss of balance, unsteady gait, dizziness, or loss of coordination signaling acute neurological ischemia.

Eyes (in BE-FAST)

The 'E' component evaluating sudden loss of vision in one or both eyes, diplopia, or visual field deficits characteristic of acute stroke.

Face (in BE-FAST)

The 'F' component assessing unilateral facial drooping, asymmetric smile, or loss of normal nasolabial fold due to acute cranial nerve / motor pathway deficit.

Arms (in BE-FAST)

The 'A' component testing for sudden unilateral weakness, numbness, or downward motor drift when holding both upper extremities extended.

Speech (in BE-FAST)

The 'S' component screening for speech difficulties including slurred speech (dysarthria), expressive difficulty, or comprehension impairment (aphasia).

Time (in BE-FAST)

The 'T' component emphasizing that time is brain tissue; healthcare providers or bystanders must immediately call for emergency medical transport.

Facial Drooping Clinical Sign

A patient photograph demonstrating pronounced unilateral facial weakness, ptosis, and asymmetric downward drooping of the corner of the mouth indicating acute stroke.

Last Known Well (LKW) Time

The exact recorded time the patient was last witnessed at their baseline neurologic state without symptoms, critical for calculating eligibility for acute thrombolytic therapy.

Stroke Center Emergency Triage

The urgent prehospital transport priority directing suspected acute stroke patients directly to a designated Primary or Comprehensive Stroke Center (or closest ED if unavailable).

Glasgow Coma Scale (GCS)

A standardized neurological assessment tool grading level of consciousness based on three behavioral domains: eye opening ($1\text{--}4$), verbal response ($1\text{--}5$), and motor response ($1\text{--}6$).

GCS Eye Opening Scoring Criteria

Grading of ocular responsiveness: $4 = \text{Spontaneous}$, $3 = \text{To sound}$, $2 = \text{To pressure}$, and $1 = \text{None}$.

GCS Verbal Response Scoring Criteria

Grading of communicative function: $5 = \text{Oriented}$, $4 = \text{Confused}$, $3 = \text{Words}$, $2 = \text{Sounds}$, and $1 = \text{None}$.

GCS Motor Response Scoring Criteria

Grading of physical motor movement: $6 = \text{Obeys commands}$, $5 = \text{Localising}$, $4 = \text{Withdrawal}$, $3 = \text{Abnormal flexion}$, $2 = \text{Extension}$, and $1 = \text{None}$.

Glasgow Coma Scale Severity Brackets

Classification of traumatic/acute brain impairment based on total score: Mild ($13\text{--}15$), Moderate ($9\text{--}12$), and Severe ($3\text{--}8$).

Action for GCS Score of 8 or Less ($\le 8$)

A critical emergency clinical threshold where a Glasgow Coma Scale score of $8$ or below indicates inability to protect the airway, requiring assistance with endotracheal intubation.

National Institutes of Health Stroke Scale (NIHSS)

A comprehensive 11-item quantitative assessment tool utilized by clinical staff to evaluate acute neurological deficits and monitor stroke severity.

NIHSS Total Score Range

The numerical point boundary of the NIH Stroke Scale spanning from $0$ to $42$ points.

NIHSS Score Interpretation Principle

The core scoring principle of the scale wherein a higher total score corresponds directly to greater neurological impairment and stroke severity.

NIHSS Severity Classification Ranges

The clinical brackets for stroke severity: $0 = \text{No stroke symptoms}$, $1\text{--}4 = \text{Minor stroke}$, $5\text{--}15 = \text{Moderate stroke}$, $16\text{--}20 = \text{Moderate to severe stroke}$, and $21\text{--}42 = \text{Severe stroke}$.

NIHSS Category 1: Consciousness, Orientation, Commands

The subscale evaluating alertness (1a: 0-alert to 3-coma), orientation to month and age (1b: 0-both to 2-neither), and response to eye/grip commands (1c: 0-both to 2-neither).

NIHSS Items 2 & 3: Horizontal Gaze and Visual Fields

The items testing horizontal voluntary eye movement (Item 2: 0-normal to 2-complete palsy) and visual field confrontation across quadrants (Item 3: 0-no defect to 3-bilateral hemianopia).

NIHSS Item 4: Facial Movement

The item testing symmetry of facial movement upon smiling, grimacing, and closing eyes, scored from $0$ (normal) to $3$ (complete unilateral palsy).

NIHSS Items 5 & 6: Motor Function of Arms and Legs

Evaluation of motor drift against gravity for $10\,\text{seconds}$ in arms (Item 5) and $5\,\text{seconds}$ in legs (Item 6), scored from $0$ (no drift) to $4$ (no movement).

NIHSS Items 7 & 8: Limb Ataxia and Sensory Testing

Assessment of cerebellar coordination via finger-to-nose / heel-to-shin testing (Item 7: 0-2) and sensation to pinprick (Item 8: 0-normal to 2-severe sensory loss).

NIHSS Items 9, 10, & 11: Language, Articulation, Inattention

Assessment evaluating expressive/receptive aphasia (Item 9: 0-3), dysarthria / articulation clarity (Item 10: 0-2), and hemi-inattention / sensory extinction (Item 11: 0-2).

Hemispheric Stroke Comparison Diagram

An anatomical chart comparing right-brain damage (paralyzed left side, left-sided neglect, impulsivity) against left-brain damage (paralyzed right side, speech/language aphasia, slow cautious performance).

Right-Brain Damage: Left-Sided Hemiplegia

Paralysis or profound motor loss affecting the left side of the body resulting from an acute ischemic or hemorrhagic lesion in the right cerebral hemisphere.

Left-Brain Damage: Right-Sided Hemiplegia

Paralysis or profound motor deficit affecting the right side of the body resulting from an acute ischemic or hemorrhagic lesion in the left cerebral hemisphere.

Right-Brain Stroke Behavioral Mnemonic ('R = Ridiculous')

A clinical mnemonic highlighting the distinct behavioral alterations of right-hemisphere damage: 'R = Ridiculous, impulsive, confused', denoting poor judgment and lack of safety awareness.

Left-Brain Stroke Behavioral Mnemonic ('Left = Lazy')

A clinical mnemonic capturing the typical behavioral alterations of left-hemisphere damage: 'Left = Lazy, anxious, depression', denoting slow performance, hesitation, and distress.

Left-Sided Neglect

A perceptual deficit commonly observed in right-hemisphere strokes where the patient entirely ignores visual, auditory, and sensory stimuli located on their left side.

Spatial-Perceptual Deficits

Impairments in judging distances, spatial relationships, and orientation in the environment, characteristically resulting from right cerebral hemisphere stroke.

Anosognosia (Deficit Minimization)

A neurological condition wherein a patient with right-brain damage tends to deny, minimize, or remain unaware of their paralysis and functional deficits.

Impulsive Behavior (in Right-Brain Stroke)

A rapid, uncontrolled execution of actions without considering physical limitations or environment, creating severe safety and fall hazards.

Impaired Judgment (in Right-Brain Stroke)

The compromised ability to evaluate risk, make safe decisions, or predict the physical consequences of actions, typical of right-hemisphere lesions.

Cognitive Deficits in Right-Brain Stroke

Neurocognitive alterations including impaired time concepts, misjudgment of temporal sequences, and an abnormally short attention span.

Aphasia (in Left-Brain Stroke)

An acquired impairment of language comprehension (receptive) and/or production (expressive) resulting from damage to dominant left-hemisphere language centers.

Impaired Right/Left Discrimination

The cognitive inability to distinguish between the right and left sides of one's own body or the external environment, characteristically caused by left-brain damage.

Slow, Cautious Performance

A behavioral presentation characteristic of left-hemisphere damage where the patient executes movements deliberately, slowly, and with heightened anxiety.

Awareness of Deficits (Depression and Anxiety)

A psychological state common in left-brain damage where retained insight into physical losses produces profound emotional distress, anxiety, and depression.

Impaired Language and Math Comprehension

A cognitive deficit characteristic of left-hemisphere damage causing difficulty understanding spoken or written words and executing arithmetic operations.

Pupillary Abnormalities in Acute Stroke

An asymmetrical pupillary presentation where the pupil on the side opposite the cerebral lesion is typically larger, signaling elevated intracranial pressure or herniation.

Conjugate Gaze Deviation

An abnormal eye finding in hemispheric stroke where tonic conjugate deviation forces the patient's eyes to look toward the side of the cerebral lesion.

Homonymous Hemianopsia Place Setting Graphic

An overhead dining table illustration where the left half of the place setting (napkin, forks, half of food plate) is invisible to a patient ignoring the left visual field.

Homonymous Hemianopsia Definition

Loss of the same half (nasal or temporal) of the visual field in both eyes following injury to the contralateral post-chiasmatic optic pathway.

Environmental Scanning Technique

A vital compensatory nursing and rehabilitation strategy teaching the hemianopsic patient to intentionally turn their head and scan the affected blind visual field.

Neglect Syndrome Fall Risk

A major safety concern in right-brain stroke where unawareness of the affected limb leads the patient to step on flaccid limbs, fall, or sustain burns and trauma.

Apraxia

The inability to perform previously learned purposeful motor tasks and skilled movements despite intact motor strength, sensation, and coordination.

Hypotonia vs. Hypertonia

The neuromuscular progression in stroke transitioning from initial flaccidity/lack of tone (hypotonia) to spasticity and increased involuntary resistance (hypertonia).

Emotional Lability

An acute post-stroke manifestation characterized by exaggerated, unpredictable, rapid emotional shifts such as inappropriate weeping or unprovoked laughter.

Neuromuscular Impairments in Stroke

Loss of neuromuscular control over vital reflexes and visceral functions, resulting in respiratory compromise, impaired swallowing/cough, and bowel/bladder incontinence.

Non-Contrast Head CT Scan

The gold-standard initial emergent neuroimaging study ordered immediately upon acute stroke alert to differentiate ischemic stroke from hemorrhagic stroke.

Non-Contrast CT Scan 25-Minute Window

The emergency clinical quality standard dictating that a non-contrast head CT scan must be performed within the first $25\,\text{minutes}$ of calling a stroke alert.

Urgent Goal of Initial CT Scan

The primary objective of immediate non-contrast head computed tomography: to definitively rule out intracranial hemorrhage prior to considering thrombolytics.

Magnetic Resonance Imaging (MRI) in Stroke

A highly sensitive neuroimaging modality taking $3\text{--}30\,\text{minutes}$ that provides superior early ischemic tissue detail, typically performed after initial treatment decisions.

Magnetic Resonance Angiography (MRA)

A specialized vascular imaging test that visualizes cerebral arterial architecture, identified as the best imaging test for evaluating hemorrhagic stroke vascular sources.

Carotid Duplex Ultrasonography

A non-invasive diagnostic ultrasound study evaluating carotid blood flow velocity and plaque stenosis to identify the source of TIAs or embolic strokes.

Cardiac Telemetry Monitoring

Continuous inpatient rhythm monitoring utilized to detect occult cardiac dysrhythmias—particularly paroxysmal atrial fibrillation—responsible for cardioembolic stroke.

Lumbar Puncture (LP) in Stroke Assessment

A diagnostic procedure analyzing cerebrospinal fluid to detect gross blood or xanthochromia when subarachnoid hemorrhage is suspected despite negative CT findings.