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Neuro E&I

Epidemiology & Outcome: Stroke

QuestionAnswer
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.
Created by: Phillypino