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211 exam 1
CVA part 1
| Question | Answer |
|---|---|
| CVA | Sudden, focal neurologic deficit resulting from ischemic or hemorrhagic lesions in the brain. |
| ischemic strokes make up ___ % of all strokes | 87% |
| cerebral thrombosis | 61.5% formation of a blood clot within the cerebral arteries |
| cerebral emboli | 26% Traveling bits of matter (thrombi, tissue, fat, air) that are released into the bloodstream and travel to the cerebral arteries. |
| what does a CVA typically result in? | • Hemiplegia-paralysis • Hemiparesis-weakness |
| penumbra | areas surrounding the infarct that are still partially functional |
| paradoxical embolism | blood clot from a vein (ie leg vein -DVT) most DVTs go to the lungs causing a pulmonary emboli. |
| most common source of emboli | Afib, small clots can form on valve leaflets and break off during Afib |
| hemorrhage is the cause of ___% of strokes | 13 |
| primary hemorrhage | spontaneous bleeding |
| secondary hemorrhage | trauma, impaired coagulation, toxin exposure, anatomic lesion |
| what type of stroke is most deadly? | hemorrhagic - but if survive have better overall recovery |
| subarachnoid hemorrhage tends to have a ___ component | genetic |
| subdural hematoma | Hematoma This is a collection of blood on the surface of your brain. It’s typically the result of your head moving rapidly forward and stopping |
| who is subdural hematoma more common in | older people and alcoholics. |
| what symptom precedes a subarachnoid hemorrhage? | sudden sharp headache |
| most common type of intracranial hemorrhage | intracerebral hemorrhage - bleeding within the brain, usually not a result of injury |
| CVA classification by WHO | Acute neurologic dysfunction of a vascular origin. Occurs in 72% of the population over 65 |
| RIND classification by WHO (reversible ischemic Neurological defect) | Precursor to a CVA. Reversible ischemic neurologic Deficits last longer than 24 hours but full recovery. |
| TIA classification by WHO | temporary interruption of blood supply to the brain. Neurologic S & Sx disappear within 24 hours. Full recovery. |
| comorbidities that can lead to stroke | DM, CAD, BK amp – chances of Indep. |
| prognostic indicators for stroke | comorbidities Premorbid activity Rate of early recovery Degree of cognitive language deficits Age Site and size of lesion |
| vascular syndromes | Dysfunction due to disrupted blood flow in specific areas od blood based on arterial supply (can be partial or complete, proximal vs distal occlusion, collateral circulation possible) |
| vasculature affected by vascular syndromes | Anterior Cerebral Artery Middle Cerebral Artery Posterior Cerebral Artery Internal Carotid Artery Vertebrobasilar Artery |
| ACA stroke results in what impairments generally | Contralateral hemiparesis-mostly LE -Sensory loss-Greater involvement of the LE than the UE -Memory and behavioral impairments -R hemisphere - Unilateral neglect |
| what occurs with an ACA stroke in the dominant hemisphere | Dominant hemisphere- Aphasia and Apraxia |
| most common site of stroke | MCA |
| MCA stroke generally results in what impairments? | Contralateral hemiparesis-mostly UE Sensory loss- face, arm and leg- Face and arm more involved than leg Homonymous hemianopsia |
| L hemisphere MCA results in | aphasia |
| R hemisphere MCA results in | neglect, apraxia |
| internal carotid artery stroke | Massive in both ACA and MCA |
| internal carotid artery stroke can result in | Coma or death |
| PCA stroke results in | Sensory –Hemianesthesia or Thalamic sensory syndrome unpleasant hemibody sensation Agnosia Prosopagnosia Cortical blindness Memory loss |
| agnosia | inability to recognize objects |
| prospagnosia | -inability to recognize faces |
| what lobe of the brain is affected by an ACA stroke? | frontal lobe |
| vertebrobasilar artery stroke results in | Fatal/coma Hemi or quadriplegia Locked in syndrome Drop attacks |
| signs and symptoms of VA stroke | occipital headache, diplopia |
| locked in syndrome | pt cannot move or speak but are alert and orientated, have vertical gaze only (use that for communication) |
| how does a stroke affect sensation | Crossed anesthesia (face opp limbs) – brainstem lesion Proprioception loss |
| how does a stroke affect motor function | Alterations in Tone assessed by passive movement Flaccidity-immediately after stroke limb feels dead Spasticity Pts lack ability to stabilize proximal joints and trunk appropriately |
| what % of strokes have spasticity | 90% of cases, antigravity muscles |
| ___ is affected more than ___ with hemiparesis | UE, LE - recovery better in LE than UE |
| ____ weakness is greater than ___ weakness with hemiparesis | distal, proximal |
| if loss of most ___, prognosis is poor | sensation |
| synergy patterns | primitive movement patterns associated with the presence of spasticity |
| flexion upper extremity synergy | scapular retraction/elevation or hyperextension, shoulder abduction, ER, elbow flexion, forearm supination, wrist and finger flexion |
| upper extremity extensor synergy | scapular protraction, shoulder add, IR, elbow extension, forearm pronation, wrist and finger flexion |
| lower extremity flexion synergy | hip flexion, abd, ER, knee flexion, ankle dflex, inversion, toe dflex |
| lower extremity extension synergy | hip ext, add, IR, knee extension, ankle pflex, inversion, toe pflex |
| initial reflexes after stroke | Flaccidity-immediately after stroke limb feels dead |
| later reflexes after stroke | hypertonus clonus/Babinski |
| STNR | Flex of neck → flexion of UE and ext. of LE; Ext of neck→ext of UE and flex of LE |
| ATNR | head rotation to L causes ext of L UE and LE and flex of R UE and LE; rot to R causes opposite effect |
| STLR | Symmetric tonic labyrinthine reflex |
| STLR in supine | increase extensor tone |
| STLR in prone | increase flexor tone |
| positive supporting reaction | pressure on ball of foot produces extension rigidity of LE |
| associated interactions | yawn, cough |
| righting reactions | mouth and eyes stay horizontal in response to change in body position |
| Equilibrium reactions | change of center of mass over base of support may cause person to lose balance |
| how does stroke affect protective extension | fails with hemiside involvement |
| incoordination | cerebellar or basal ganglia involvement; Ataxia |
| motor programming deficits | difficulty sequencing tasks, takes longer –apraxia |
| nonfluent aphasia (expressive) | difficulty getting words out |
| global aphasia | severe, poor prognosis need to use a lot of gestures and physical cues. |
| dysphagia | swallowing dysfunction Need to know diet: thicks vs thins |
| cognitive and behavioral changes from stroke | Impulsiveness/ safety Lability Depression Denial/lack of awareness Distractibility – internal (fidgeting, perseverate) and external Personality changes – magnified existing traits |
| what lobe of the brain is affected by an MCA anterior division stroke | frontal lobe |
| what lobes of the brain are affected by an MCA posterior division stroke | parietal and temporal lobe |
| what lobes of the brain are affected by PCA stroke stroke | occipital lobe |
| affects of ACA stroke | contralateral LE weakness abulia (absence of willpower or inability to act decisively) |
| affects of MCA anterior division stroke on dominant hemisphere | expressive aphasia contralateral hemiparesis ipsilateral gaze deviation |
| affects of MCA anterior division stroke on non dominant hemisphere | aprosodia contralateral hemiparesis ipsilat gaze deviation |
| affects of MCA posterior division stroke on dominant hemisphere (parietal lobe) | conduction aphasia Grestmans syndrome HH contral hypoesthesia |
| affects of MCA posterior division stroke on nondominant hemisphere (parietal lobe) | anosognosia apraxia contralateral neglect hypoesthesia HH |
| affects of MCA posterior division stroke on dominant hemisphere (temporal lobe) | receptive aphasia contralateral HH |
| affects of MCA posterior division stroke on nondominant hemisphere (temporal lobe) | contralateral hemianopia |
| affects of PCA stroke in dominant hemisphere | alexia without agraphia contralateral HH contralateral hemianopia |
| etiology of ischemic CVA | lack of blood flow to brain from embolism of thrombosis |
| onset symptoms of ischemic CVA | sudden onset of neuro sx |
| tx for ischemic CVA | tPA within 3-4.5 hours antiplatelets (asprin) |
| etiology of hemorrhagic IPH CVA | typically due to HTN |
| onset symptoms of hemorrhagic IPH CVA | focal deficit that worsens over minutes, headache |
| tx for hemorrhagic IPH CVA | stop the bleed reverse anti-coagulant therapy |
| etiology of subarachnoid hemorrhage CVA | bleeding into subarachnoid space due to aneurysm, AVM, or other vascular anomaly |
| onset symptoms for subarachnoid hemorrhage CVA | sudden onset worst headache of life |
| what diagnostic test may be used with subarachnoid stroke but not others? | lumbar puncture (looking for blood in CSF) |
| treatment for subarachnoid CVA | aneurysm coiling or clipping |
Created by:
bdavis53102
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