Epidemiology & Outcome: Stroke
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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.
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| 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
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| 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
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| 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.
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| List three complications and morbidities of CVA | Complications: Deep Vein Thrombosis, Dysphagia, Seizures, CRPS 1
Morbidites: CV Disease, Diabetes Mellitus,
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| 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.
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| 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.
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| 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.
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| 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.
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| What are the five outcome predictors for CVA | Orpington Prognostic Scale (OPS)
Lesion Location
Volume of Lesion
Type of Lesion
Age of Lesion
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| The OPS is a good predictor of function at ___ months post stroke especially if done within _____ hours. | 6 mos. 48 hours.
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| 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
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| 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
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| 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.
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| 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.
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| Which are more common? Ischemic or Hemorrhagic CVA's? | Ischemic CVA's are much more common. 83%
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| 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
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| 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.
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| 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.
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| Which artery is most commonly involved with subarachnoid hemorrhages? What are the red flags? | Anterior Communicating Artery.
=>SEVERE headache and Loss of Consciousness
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| Which type of hemorrhagic CVA has a higher fatality rate? | Subarachnoid Hemorrhage.
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| Complications that include vasospasm (2ยบ ischemic stroke), seizures and hydrocephalous belongs to which type of hemmorhagic CVA? | Subarachnoid Hemorrhage.
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| 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
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| General Rule: when does the best potential for motor recovery occur? | Within first 6 months of injury onset.
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| When do gains for SCI injury plateau? | 9-12 months
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| 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.
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