TIA vs CVA: A Neurology Review

Cerebrovascular accident (CVA) and transient ischemic attack (TIA) are conditions that occur due to a lack of oxygen in the brain. Therefore, knowing the differences between TIA vs CVA is crucial for patient care (and nursing exams). 

The most significant difference between the two is the presence of blood clots inside the brain. CVA results from the absence of oxygen, while a TIA results from low oxygen.

How to Identify TIA vs CVA

CVA is commonly referred to as a stroke, which is also sometimes called a brain attack. TIA is the narrowing of the blood vessels inside the brain, causing a decrease in blood flow and oxygen supply. Therefore, ischemic (in transient ischemic attack) means decreased oxygen.

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

TIA & CVA Signs and Symptoms

When a patient presents with weakness on any side of the body, it should alert the nurse for a stroke or CVA.

A CVA is a clot inside the brain’s vessels that stops 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.

The first indication of a possible clot is weakness on one side of the body, which is called hemiparesis. There would also be signs of aphasia which is the loss of the ability to understand or express speech. A stroke will affect facial expressions and motor senses as well.

If a patient has a stroke on one side of the body, the opposite side of the brain is affected. So if the left side of the body has hemiparesis, the right side of the brain is affected.

CVA vs Stroke

CVA, also known by many as a stroke. This is caused by lack of oxygen due to the interruption of blood that flows within the brain. A stroke can lead to an aneurysm, a blood vessel that bursts 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 patients who underwent CAT scans)

TIA vs Stroke

On the other side of the spectrum is TIA. Here, there is just a narrowing of the blood vessels, which then causes decreased oxygen to go 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

Consider this scenario; a patient with extensive plaque buildup who suddenly exerts physical effort or gets stressed due to external factors can begin the process of a TIA. In this case, blood vessels will react by activating the fight or 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. You can compare this scenario 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 causes 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. The narrowing of blood vessels is the main cause of the TIA.

Stroke Nursing Mnemonic

The Stroke Foundation came up with an acronym to check whether someone is experiencing or has had a stroke, and it’s called F.A.S.T. 

So, what does FAST stand for?

• Face: Look at their face – is there any drooping of the eyes, mouth, etc.?
• Arms: Can they lift their arms? Can they grip your hands?
• Speech: Is their speech slurred? Can they understand you? Can they repeat information?
• Time: Time is VERY critical. The sooner treatment begins, the better outcome.

TIA & CVA Nursing Interventions

If a patient presents with hemiparesis and aphasia, they will immediately have a CAT (CT) scan to look for clots or any narrowing of the arteries in the brain. This procedure is essential in knowing whether the patient has CVA or TIA. 

REMEMBER: the major difference between CVA is no oxygen being received and TIA has decreased oxygen to the brain.

Patient Stabilization with TIA & CVA

TIA (which is self-limiting), goes away after management; patients will start regaining the function of their motor senses, like smiling. TIA patients don’t have hemiparesis or weakness experienced on a particular side of the body or aphasia.

CVA is detrimental and permanent – compromising movement and thinking.

TIA vs CVA Plan of Care

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

1. Constant neurological checks.

Important assessment skills to remember in a neurological assessment are:

• Grips – How tightly can they squeeze your hand?
• Pushes – How much can they push your hand away?
• Pulses – What is their pulse rate?
• Sensation – What are their reactions to stimuli (shining a light in their eyes, hitting their knee, etc.)?

Aside from that, the health care provider (HCP) will also ask the patient 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.

2. Re-orientation.

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

• What is your name?
• What is your date of birth?
• What is the year, or date, or month?
• Where are you?

General questions that should be easy for the patient to answer.

Depending on how these questions are answered, you can evaluate the patient’s neurological status – whether the condition improves or worsens.

3. Check the intracranial pressure.

Aneurysms, as established, cause hemorrhage inside the brain; therefore, the HCP must look for signs and symptoms of increased intracranial pressure.

So how do nurses monitor increased intracranial pressure (ICP), and what devices are used? 

One of the devices to use is a pressure gauge, which is used to see if there’s been an increase in ICP. If there has been an increase, monitor it closely and adjust the patient’s treatment plan accordingly.

If the patient is in urgent condition (such as showing signs of brain herniation), you’ll need to use a sensor device called a transcranial doppler. This measures blood flow velocity through the brain’s arteries, and it helps determine whether there’s an obstruction in one of those arteries. 

In this case, this would be the cause of increased ICP and possible brain herniation.

TIA & CVA Treatment 

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 risky due to bleeding consequences.

TIA is usually treated with a combination of rest, oxygen therapy, and aspirin. As a nurse, you’ll need to administer prescribed medications to help prevent another stroke from occurring.

Get the Most Out of Your Neurology Learning

Knowing the ins and outs of neurological conditions and their treatments will be a core responsibility as a nurse – AND you’ll be tested on exams like the NCLEX.

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