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Neuro E&I
Epidemiology & Outcome: Stroke
Question | Answer |
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Along with motor and sensory losses/deficits, why is it possible to see cognitive changes with CVA patients? | Due to the close proximity of the frontal lobe. Primary cognition center. Likewise, a patient may only present with motor control problems if only the motor strip is affected. |
5 Hallmark Signs of CVA | 1. Slurred/Confused Speech 2. Hemiparesis (Unilateral Weakness/Sensory Changes) 3. Severe Headaches 4. Blurred Vision 5. Balance/Gait issues |
Which risk factor is a primary indication that a person will be at the greatest risk for stroke in the next five years? | Prior Stroke |
Discuss "TIA" and how it is a risk factor for stroke | Trans-Ischemic Attack: transient symptoms can resolve within 24 hours. A history shows that pts. with TIA have a 20% greater chance of having a stroke the next year. Only 50% of people that have TIA's report it to their doctor. |
List three complications and morbidities of CVA | Complications: Deep Vein Thrombosis, Dysphagia, Seizures, CRPS 1 Morbidites: CV Disease, Diabetes Mellitus, |
How does stroke impact blood glucose levels and delivery of treatment? | May need insulin temporarily (sometimes only acutely). May have trouble with insulin delivery due to cognitive (not remembering) and mechanical (hemiparesis) effects of stroke. |
Dysphagia (difficulty in swallowin) is common with lesion to what artery? What nosocomial complication can arise from this condition. | Middle Cerebral Artery (supplies motor strip). Patient is at risk for ASPIRATION PNEUMONIA. Negatively compounded with de-conditioned state. |
Depression is a commonly underdiagnosed complication of CVA patients. Differentiate between ORGANIC versus APPROPRIATE depression. | Organic: related to Serotonin (NT) imbalance. More commonly seen in older population. Appropriate: depression due to loss of function. |
Seizure are more commonly seen with what type of CVA? What should you consider during the course of treatment? | Hemorrhagic. Managed pharmacologically however you should check for lethargy and S&S of toxicity from med build up. |
What are the five outcome predictors for CVA | Orpington Prognostic Scale (OPS) Lesion Location Volume of Lesion Type of Lesion Age of Lesion |
The OPS is a good predictor of function at ___ months post stroke especially if done within _____ hours. | 6 mos. 48 hours. |
Who has a better prognosis post-stroke (going home) based on the OPS: Pt. A @2.5 or Pt. B @ 9.0 | The smaller the score the better the prognosis. Grading is based on being: Minimally, Moderately, or Severely affected by stroke. <3.2: 98% chance of going home Middle range: 50% chance High range: 21% chance |
What deficits are seen with a lesion located at each of these lobes 1. Parietal 2. Frontal 3. Temporal | 1. Parietal-sensation/perception 2. Frontal-congition/motor 3. Temporal-communcation |
What region of the CNS does the relationship between lesion volume and functional outcome not hold true? (Smaller lesions impact less brain cells) | Brainstem Lesion-compact structure with large amount of nerve pathways. |
Discuss the midline shift and mass effect | Related to HYDROCEPHALOUS. Theory a one sided lesion can cause enough swelling and bleeding to cause a shift of the ventricles and cause bilateral deficits. |
Which are more common? Ischemic or Hemorrhagic CVA's? | Ischemic CVA's are much more common. 83% |
What are the two types of Ischemic CVA's and what are their common warning signs/red flags? | Thrombotic CVA: results from narrowed artheroscletoric vessels occluded over time Warning Sign: TIA Embolic: results from piece of plaque breaking off and moving into a cerberal vessel (most common is MCA) Warning Sign: Cardiac History |
What intervention can be applied when the early signs of a Thrombotic CVA are recognized? Is it always applied successfully? | t-PA "clot buster" best if given within 3 hours of clot formation. However 2/5 people ignore signs before going to the doctor. |
What are the two types of Hemorrhagic CVA's and what are their common warning signs/red flags? | Intracerebral Hemorrhage: usually due to HTN. Evolves over time. Outcome depends on amount of bleeding. Subarachnoid Hemorrhage:abrupt onset. Usually from burst aneurysm or AVM. |
Which artery is most commonly involved with subarachnoid hemorrhages? What are the red flags? | Anterior Communicating Artery. =>SEVERE headache and Loss of Consciousness |
Which type of hemorrhagic CVA has a higher fatality rate? | Subarachnoid Hemorrhage. |
Complications that include vasospasm (2ยบ ischemic stroke), seizures and hydrocephalous belongs to which type of hemmorhagic CVA? | Subarachnoid Hemorrhage. |
Aneurysm or AVM? 1. Congenital or secondary to standing HTN 2. High Risk of RUPTURE and bleed 3. Majority are benign. 12% can cause CNS signs. 4. Congenital malformation of an artery or vein 5. Risk of embolic clot formation | 1. Aneurysm 2. Aneurysm 3. AVM 4. AVM 5. Aneurysm |
General Rule: when does the best potential for motor recovery occur? | Within first 6 months of injury onset. |
When do gains for SCI injury plateau? | 9-12 months |
What population will receive cognitive and speech therapy for an extended period of time. Sometimes >2 years? | Children. Plastic nature of brain and measurable changes allow for goal setting. |