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stroke

ncs prep

QuestionAnswer
An acute onset of neurological dysfunction d/t abnormality in cerebral circulation w/resultant signs/symptoms that correspond to involvement of focal areas of the brain. stroke
Which age group are women more likely to have strokes? 35-44
type of stroke with obstructed vessels which result in poor blood flow to a region of the brain Ischemic, 87%
When ruptured blood vessels result in bleeding in the brain it is what type of stroke? Hemorrhagic, 13%
What are the 3 causes of ischemic strokes? cerebral thrombosis and cerebral embolus and conditions resulting in low systemic perfusion pressure (cardiac arrest, shock, watershed strokes)
Where do hemorrhagic strokes occur? intracerebral and subarachnoid space; saccular aneurysm, AVM
What is a result of atherosclerotic plaques that form in the brain over time and blood blood flow? 2 sub-categories cerebral thrombosis: large vessel thrombosis (MCA, carotid aa); small vessel thrombosis (lacunar strokes d/t blockage of lenticulostriate arteries, medullary arteries, etc)
What is a result of a clot that travels to the brain and blocks blood flow? Cerebral embolus: common sources: heart (most common) can be d/t a-fib, valvular disease; internal carotid artery (clot origination at bifurtcation of common carotid artery)
What are the two zones of injury during an ischemic stroke? core ischemic zone-reduced blood flow below 10-25% with death of neurons and glial cells; ischemic penumbra: region surrounding the core ischemic zone with mild to moderate ischemia and the target area for pharmacological mgmt and neuroplasticity
small ischemic strokes with complete resolution of symptoms within 24 hrs transient ischemic attacks
a series of TIAs that build over time and can lead to a full blown stroke; 2 within 24 hrs, 3 within 3 days, or 4 within 2 weeks to meet criteria crescendo TIA
Risk factors for ischemic stroke previous stroke or TIA, HTN, DM, heart disease/a-fib, obesity, hypercholesterolemia, physical inactivity, oral contraceptives, excessive alcohol use
Risk factors for hemorrhagic stroke HTN, alcohol and drug abuse, use of anticoagulants
Where are intracerebral hemorrhages typically found? ruptures of blood vessels within the brain: basal ganglia, cerebellum, brainstem, cortex
These occur when there is a rupture of a blood vessel between the brain and the skull and include sudden, intense headache, neck pain, nausea, vomiting; commonly caused by cerebral aneurysms subarachnoid hemorrhage
Rounded or irregular swellings in arteries that are less resistant to changes in pressure and may rupture; common location: sites of vessel bifurcation where shear force against the arterial wall are greatest; >10mm critical risk for rupture saccular aneurysm
Where are aneurysms commonly located? anterior communicating atery and internal carotid/posterior communicating (30-35%); MCA (20%)
A congenital defect consisting of an abnormal tangle of blood vessels arteriovenous malformation
what type of imaging is used for initial evaluation of stroke? CT: rules out hemorrhagic stroke; ischemic damage may not be detected in the early hours following stroke; determines if tPA can be used
Which type of imaging provides clear images of cerebral blood vessels to allow identification of stenosis, occlusion, anuerysms, and vascular abnormalities with injection of IV contrast followed by radiography? CT Angiogram
Which type of imaging detects edema in the subacute phase of stroke that may not be visible on CT scans? and what are the drawbacks MRI, Take an hour to complete; cannot be used with pacemakers and some metallic implants
What type of imaging can detect high grade atherosclerotic lesions and less common causes of ischemic stroke (carotid and vertebral artery dissection, venous thrombosis)? MRA
What type of imaging highlights regional blood flow and cerebral metabolism and is used to determine areas of tissue where ischemia is reversible? positron emission tomography (PET)
What is the gold standard treatment for ischemic strokes? tPA; administered within 3 hours (4.5 max) and must meet criteria including no signs of hemorrhage
What intervention includes removal of the clot with use of a shape-memory-polymer corkscrew device? mechanical thrombectomy
Heparin (lovenox) and warfarin (coumadin) may be used to reduce the risk of clots and recurrent strokes? They also risk possibility of bleeds. anticoagulation therapy
Aspirin, prevents clotting, inhibit the production of thromboxane, a chemical that signals platelets to stick together or clot at the site of injury antiplatelet therapy
Is BP typically reduced immediately after ischemic stroke? No, what is this called? Permissive hypertension to maintain perfusion
D/c antiplatelet or anticoagulant therapies, normalize BP, decrease intracranial pressure, may surgically clip aneurysm treatments for hemorrhagic stroke
UMN or LMN injury? spastic, no disuse atrophy, increased DTRs, pathological reflexes present, fasciculation and fibrillation absent? UMN
UMN or LMN injury? flaccid, severe atrophy, absent DTRs, pathological reflexes absent, fasciculations and fibrillations may be present LMN
Name the most common location of stroke. and supplies the primary motor and sensory cortices, Broca's and wernicke's areas, head, neck, trunk, arm MCA
Clinical presentation as such indicates stroke in which artery?contralateral weakness UE and face, contralateral sensory impairment UE and face, aphasia (if on L), neglect (if on R) MCA
Clinical presentation: contralateral weakness with basal ganglia and internal capsule involvement; high incidence in people with HTN and elderly lacunar infarcts-deep branches of the MCA (lenticulostriate anteries)
Clinical presentation: contralateral homonymous hemianopsia, sensory impairment, and weakness; supplies the occipital lobe, inferior temporal lobe, and deep structures (diencephalon) posterior cerebral artery
clinical presentation: contralateral weakness and sensory impairment (LE); frontal lobe abnormalities: poor judgment, decreased attention, decreased motivation, difficulty with emotional regulation anterior cerebral artery (rare d/t collateral circulation provided by the anterior communicating artery); supplies the primary motor cortex and sensory cortex (LE); supplemental motor area and prefrontal cortex
These affect areas of the brain supplied by the most distal branches of major cerebral arteries; result from hypoperfusion (heart disease, cardiac arrest, shock) and have clinical presentation: proximal UE and LE weakness/intact distal strength watershed strokes
Clinical presentation: sensory impairments: loss of pain and temp on the contralateral side of the body and ipsilateral face, dizziness, vertigo, ataxia, diplopia, dysphagia, dysarthria, horner's syndrome; AKA Wallenburg's or lateral medullary syndrome Posterior inferior cerebellar artery stroke (cerebellum and medulla)
What is caused by damage to the sympathetic trunk lateral to the vertebral bodies with symptoms on the ipsilateral side including: miosis (pupil constriction, ptosis (drooping eyelid), and decreased sweating? Horner's syndrome
Constellation of symptoms referred to as lateral pontine syndrome: ipsilateral ataxia, contralateral weakness, contralateral sensory impairment (pain and temp), dizziness, vertigo? Anterior inferior cerebellar artery (supplies the cerebellum, cranial nerves VII and VIII
the loss of the ability to detect certain modalities with preservation of others; damage to the spinothalamic tract would result in decreased ability to detect pain and temp with preservation of discriminative touch and proprioception dissociated sensory loss
SCI or brainstem disorder? loss of pain/temp R; loss of touch proprioception L SCI
SCI or brainstem disorder? cranial nerve signs on the opposite side of the body as the long tract signs (dorsal column medial lemniscus and spinothalamic tracts) Brainstem disorder
Damage to the cerebral cortex or diencephalon results in cognitive, judgement, affect, language deficits (what do we call this area) supratentorial
Damage to the brainstem or the cerebellum results in abnormal vital signs, automatic movement adjustments, posture/gait and breathing patterns (what do we call this area?) infratentorial
pain evoked by a stimulus that would not normally be painful allodynia
pain resulting from damage to the thalamus, which initially presents as numbness but progresses to a debilitating burning sensation thalamic pain syndrome
resistance of muscle to passive stretch tone (what are the 2 factors?: intrinsic (mechanical/elastic stiffness of muscle) and neural factors: (reflexive muscle contraction or change in inhibition)
decreased resistance to passive movement, decreased stretch reflexes, immediately after CVA or SCI as a component of a temporary state of spinal shock hypotonia
increased resistance to passive movement hypertonia (3 classifications)
velocity dependent resistance to stretch (faster the movement=more resistance); synergistic movement patterns, in which groups of muscles contract together spasticity
scapular retraction, elevation, shoulder abd/ER, elbow flexion, forearm supination and wrist and finger flexion UE flexion synergy
scapular protraction; shoulder add/IR, elbow ext, forearm pronation, wrist/finger flexion UE extension synergy
hip flex/abd/ER, knee flex, ankle DF/inv, toe ext LE flexion synergy
hip ext, add, IR knee ext, ankle PF, inv, toe flexion LE ext synergy
resistance through the entire ROM independent of velocity rigidity
resistance followed by a giving way in step like movements cogwheel rigidity
constant resistance (independent of velocity) lead pipe rigidity
rigidity with LE extended and UE flexed: and what does it indicate? decorticate rigidity: indicative of lesions superior to the red nucleus of the midbrain
rigidity with UE and LE extension: and what does it indicate? decerebrate rigidity: indicative of brainstem lesions inferior to the red nucleus of the midbrain
repetitive and patterned abnormal muscle contractions; fluctuations of tone in an unpredictable pattern, can result in twisting or writhing movements and abnormal postures dystonia
associated reactions: finger extension and abduction when UE is elevated above the horizontal; may be easier for pt to activate hand with arm elevated. Sougue' phenomenon
associated reaction: resisted hip abduction (adduction) elicit abduction (adduction) in contralateral limb Raimiste's phenomenon
deficit in attention and awareness of one side of the body and or environment; the failure to respond to or process stimuli on one side of the body or environment that is not due to impaired sensation or strength unilateral neglect (types: sensory, motor, representational)
when a person gets their hand caught in the wheelchair but does not feel the pain associated with injury, what type of neglect is it? unilateral sensory neglect
Failure to generate a movement response to a stimulus even though a person is aware of the stimulus or feels it is called? unilateral motor neglect
A person ignores 1/2 of internally generated images it is called? (ask them to draw a person-only draws half; ask them to describe their bedroom at home-only describes one side-when you ask them to turn around and describe the room-they describe opp side unilateral representational neglect
failure to respond to stimuli on affected side when both sides of the body are stimulated concurrenty but able to identify on each side of the body with unilateral stimulus only bilateral simulataneous extinction
5 types of spatial neglect peripersonal (within reaching distance); extrapersonal (outside reaching distance); navigation ( difficulty negotiating correct route-4 Rs vs 1L); construction-difficulty drawing/assembling objects; dressing-inability to correctly orient clothing to body
Damage to which area of the brain typically results in neglect? R posterior inferior parietal lobe (R CVA=L neglect)
name 2 tests for unilateral neglect line bisection test; line cancellation
When unaffected limbs are used to push away from the unaffected side toward the affected side; normal perception of visual vertical; but perceive upright posture when tilted towards the side of the lesion 18 degrees pusher's syndrome
"lack of awareness" agnosia
denial of symptoms, often present with patients with neglect, may deny impairments or even that affected limb is a part of their own body; damage to R posterior insula anosognosia
body image agnosia; autotopagnosia; lack of awareness of body structure and the relationship of body parts to one another in self or others[ damage to L parietal or posterior temporal lobe somatotopagnosia
inability to identify R and L sides of self, others, and the environment R-L discrimination disorder
the inability to recognize, name, select, and differentiate own or another person's fingers, poor hand dexterity finger agnosia; most common in which fingers-middle 3
constellation of symptoms associated with damage to the parietal lobe in the region of the angular gyrus: R/L discrimination disorder, finger agnosia, agraphia, acalculia Gerstmann Syndrome
Name the 4 spatial relations disorders figure ground discrimination, form constancy, spatial relations, topographic disorientation
unable to distinguish between a figure and the background figure ground discrimination (vase and 2 faces-bottom step and ground)
inability to perceive subtle differences in form and shape-ink pen confused with toothbrush form constancy
inability to perceive the relationship between one object in space to another object; difficulty telling time or drawing clock faces; difficulty dressing oneself and positioning body for transfers spatial relations
difficulty in understanding the relationship of one location to another; unable to navigate a familiar territory or learn new routes despite being able to verbalize routes; difficulty recognizing landmarks topographic disorientation
inability to perform purposeful movements despite having adequate strength, coordination, and sensation to carry out the tasks apraxia
difficulty planning and completing actions on command; a breakdown between conceptualizing and performing movement; may be able to verbalize, just can't perform on command; may be able to perform automatic movements ideomotor apraxia
inability to conceptualize and perform tasks either on command OR automatically; more concerning for safety b/c a person is unable to function in an emergency situation ideational apraxia
speech disorder d/t weakness, incoordination, or spasticity of muscles used for speaking (spastic or flaccid) dysarthria
language disorder that impairs the ability to comprehend and or produce language (verbal and written) aphasia
expressive aphasia, non-fluent, impaired language production but normal comprehension, characterized by short, effortful sentences and limited vocabulary, damage to L frontal lobe Broca's aphasia
receptive or fluent aphasia, impaired language comprehension but normal production; inappropriate words in meaningless sequences; paraphasias (word substitutions-cat for hat); neologisms (creating words); damage to L temporal lobe wernicke's aphasia
impaired language comprehension and production, unable to read or write global aphasia
Name types of cognitive impairment. (5) memory, judgement, attention, distractibility, information processing
Created by: metz