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211 exam 1

CVA part 1

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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