Neurology: CVA versus TIA Part 2

Our discussion will focus on the fundamental difference of cerebrovascular accident (CVA) from transient ischemic attack (TIA). In a nutshell, CVA is the absence of oxygen, while TIA is low oxygen. And probably, the most significant difference between the two is the presence of blood clot inside the brain, which is presented by CVA clients.

To explain further, let us look into the pathophysiology of both conditions.

Cerebrovascular Accident

Cerebrovascular accident, also known by many as stroke, is caused lack of oxygen due to the interruption of blood that flows within. A stroke can lead to an aneurysm which is simply a blood vessel that burst inside the brain. Aneurysms can cause a huge leak that will lead to the following signs and symptoms:

  • Increased bleeding
  • Increased intracranial pressure
  • Brain shifting to one side (seen in clients who underwent CAT scans)

Transient Ischemic Attack

On the other side of the spectrum is TIA. Here, there is just narrowing the blood vessels which then cause decreased oxygen going into the brain and various parts of the body. Take note: a transient ischemic attack is very self-limiting.

Plaque buildup is the most common cause of TIA.  Plaque buildup around the walls of the blood vessels is caused by the following:

  • Fried food
  • Sedentary lifestyle
  • Chronic smoking
  • Family history of high cholesterol

Consequences of Plaque Buildup

If clients who have extensive plaque buildup suddenly exerted physical effort or gets stressed due to external factors, blood vessels will react by activating the fight and flight response, which will cause vasoconstriction. This shrinking of the blood vessels will force the plaques to come together, causing decreased blood flow and oxygen.

This scenario can be compared to a freeway accident that led to several cars blocking a couple of lanes; these blockages are the plaques situated in various areas of the blood vessels. Accumulation of plaques cause the shutdown of various lanes; therefore, there won’t be enough room for traffic (blood and oxygen) to pass through to get to vital areas in the body like the brain, heart, and lungs. Narrowing of blood vessels is the main cause of the transient ischemic attack.

Client Stabilization

TIA, which is self-limiting, goes away after management; clients start regaining function of their motor senses like smiling. TIA clients don’t have hemiparesis or weakness experienced on a particular side of the body or aphasia which is language impairment; they can talk and think again. On the other hand, CVA is permanent and detrimental, compromising movement and thinking.

Plan of Care

The plan of care for both CVA and TIA are similar, which are:

  1. Constant neurological checks.

There are a couple of things that you want to check when doing a neurological assessment, which are:

  • Check the grips
  • Check the pushes
  • Check the pulses
  • Check the sensation

Aside from that, the medical team also has to ask their clients pertinent questions about their life, and at the same, asking them to identify what part of the body is being touched. Lastly, circulation is checked by looking at the capillary refill within two seconds.

  1. Re-orientation.

After having a huge brain bleed or having doubts of constricting blood vessels in the brain that leads to low oxygen distribution, re-orientation of the client is essential to check the level of consciousness. Usually, four questions should be answered by the client, namely:

  • What is your name?
  • What is your date of birth?
  • What date and month is it?
  • General, easy questions about the client

Depending on how these questions are answered, the nurse can evaluate the neurological status of the client – whether the condition is getting better or worse.

  1. Check the intracranial pressure.

Aneurysms, as established, cause hemorrhage inside the brain; therefore, it is essential that healthcare providers look for signs and symptoms of increased intracranial pressure.

Treatment Options

For a CVA, since there is a clot, heparin is given to stabilize the clot. Heparin is not a clot buster but an anti-coagulant, which prevents further formation. Tissue plasminogen activator (TPA) is the only way to break or bust blood clots; however, this procedure is quite risky due to bleeding consequences.

Going back to intracranial pressure with clients who suffered from an aneurysm, how do nurses monitor ICP and what are the devices used? To answer this question and more, go to the Simple Nursing website and YouTube channel.

Neurology Review: Identify the Difference between CVA & TIA

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Today, we’ll be focusing on a topic that is quite confusing for some – cerebrovascular accident (CVA) versus transient ischemic attack (TIA).

CVA and TIA are conditions that occur due to lack of oxygen in the brain. To compare, if there’s oxygen depletion or deprivation in the heart, the condition is called a heart attack. On the other hand, if there is decreased oxygen distribution to the extremities, the condition is called deep vein thrombosis (DVT) which is caused by a clot that blocked the veins ceasing or lessening the flow of blood.

Identifying CVA and TIA

Cerebrovascular accident is just a fancy word for stroke which is also sometimes called as a brain attack. On the other hand, the transient ischemic attack is the narrowing of the blood vessels inside the brain, causing a decrease in blood flow and oxygen supply. Therefore, ischemic just means decreased oxygen. Looking at an EKG strip, ischemia is easily identified when there is ST depression.

So remember, TIA is low O2 while CVA is no O2.

CVA and TIA Signs and Symptoms

When a client comes in and complains of weakness on any side of the body, it should alert the nurse for a stroke or CVA.

A CVA, as previously stated, is a clot inside the vessels of the brain that is stopping blood flow and oxygen from being distributed. The clot causes a backing up of blood, pushing the vessels and eventually, the vessels will burst – this is what happens in an aneurysm.

So, if there is a blood clot, the very first indication would be weakness on one side of the body, which is coined as hemiparesis. There would also be signs of aphasia which is a speaking impairment. Stroke will affect facial expressions and motor senses as well.

If a client has a stroke on one side of the body, this means that the opposite side of the brain is affected. Meaning, if the left side of the body has hemiparesis, the right side of the brain is affected.

FAST for Stroke

The Stroke Foundation came up with an acronym to check whether someone has a stroke or not and it’s called F.A.S.T. So, what does FAST stands for?

  • Face – tell the client to smile and notice if there is weakening on one side of the face to check if there is unilateral neglect or hemiparesis.
  • Affect of the face.
  • Sent or grips – have the client raise his or her arms with both eyes closed, and if one arm goes down, you can consider the other side of the brain for a stroke.
  • Talk – ask the client to say a word or phrase, and if they can’t pronounce the word or phrases, and if their speech is all jumbled up, it’s another indication of a stroke.

Nursing Intervention

If a client comes in and the nurse has assessed the condition as hemiparesis and aphasia, the client is to be wheeled directly to the CAT scan room to check the brain for any clots or narrowing. This procedure is essential in knowing whether the client has CVA or TIA. 

So, just remember, the major difference between CVA and TIA is that one is due to decreased oxygen and the other is no oxygen at all.

On our next lecture, we will be tackling the plan of care and implications of the two conditions. Check it out at SimpleNursing.com.