CVA /TIA
____ % pt post CVA make complete recovery
10% 25% minor impairment 40% moderate to severe 10% SNF 15% die
hemorrhagic stroke ____%
13%
___ % of pt with TIA will have stroke
40%
____% strokes preventable through risk factor management
80%
ischemic stroke ____%
87%
CHADS2VASC scoring
CHF HTN (140/90 on 2 occasions or on tx for HTN ) Age >75. (2pt) DM ( fasting BGL>125mg/dL or tx) Stroke , TIA or TE hx. (2pt) Vascular(MI,PAD,or aortic plaque) Age 65-74 Sex category Female Max score 9 points Men =1, Women = 2 consider Anticoagulant Men > 2 or Women >3 anticoag reccomended Starch NOAC unless Mechanical heart valve
Chronic conditions management and education to prevent stroke :
ETOH moderation Smoking - cessation HTN mngmnt DM control BGL Hyperlipidemia Daily excercise Lower NA + & fat intake FAST signs = 911
CVA Recognition FAST
Face - face drooping Arm- weakness Speech difficulty - trouble speaking simple sentence Time to call 911! "brain attack" "time is tissue"
HAS-BLED score
Hypertension >160 Abnormal Renal/liver function 1-2pt stroke hx labile INR (coumadin) 2pt elder over 65 years old drugs (ASA , Plavix) Max points = 9 Reminds us of risk factors but is not used for treatment decisions
signs and symptoms stroke
Sudden and severe headache Vision change one or both eyes Dizzy and balance, trouble walking Sudden confusion and trouble speaking Numbness or weakness of face arm or leg
ABCD2 score for TIA
Predicting CVA risk 2, 7, 30& 90 daus post-TIA Age > 60= 1pt BP: SBP > 140; DBP > 90= 1pt Clinical features (unilateral weak=2; isolated speech impairment= 1) Duration : > 60 minutes = 2 10 -59 minutes =1 <10 minutes =0 DM =1pt point scoring: 0- 3 points: outpatient appropriate 4- 5 points: hospitalization probablyJustified 6- 7 points: hospitalization recommended
