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Neuro II - Final Content > 10/21 CVA Exam, eval > Flashcards

10/21 CVA Exam, eval Flashcards

1
Q

Transient Ischemic Attack

A

Transient episode of neurological dysfunction

Temporary disturbance in blood supply to the brain, spinal cord or retina without permanent death of tissue.

Symptoms usually last ≤ 1 hour.

3-17% 90-day risk of a completed stroke.
Up to 50% occur within 48 hours of the TIA.

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2
Q

Stroke definition

A

Disruption of the vascular supply to the brain, brainstem or spinal cord that leads to infarction (death) of CNS tissue.

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3
Q

Stroke Classification

A

Ischemic (61 - 87%)
Thrombotic Vs Embolic
Large Vs Small vessel
Arterial Vs Venous

Hemorrhagic
Intraparenchymal Vs Subarachnoid
Primary Vs Secondary (conversion)
Higher proportion of hemorrhage in children

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4
Q

Large vessel thrombotic stroke

A

Slow, stuttering onset due to gradual occlusion +/- collateral circulation
Possibly preceded by TIA

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5
Q

Small vessel thrombotic “lacunar” stroke

A

Associated with longstanding hypertension and diabetes

Basal ganglia, internal capsule and brainstem

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6
Q

Cardioembolic Etiologies of ischemic stroke

A 
Valvular atrial fibrillation 
Nonvalvular atrial fibrillation 
Acute myocardial infarction 
Bacterial endocarditis
DVT with a patent foramen ovale
Mitral valve prolapse
Prosthetic mechanical heart valves
Possible injury in multiple vascular distributions
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7
Q

Cerebral venous thrombosis

A

Relatively rare

Higher risk in peripartum period, OCPs + smoking, coagulopathies

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8
Q

Hemorrhagic Stroke

A

Fast, large volumes of blood
Increased mortality
If survived, decreased morbidity

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9
Q

Signs of hemorrhagic stroke

A

Vomiting, systolic BP >220 mm HG, severe headache, coma, decreased level of consciousness and progression over minutes-hours suggest hemorrhage.
Rapid deterioration in neurological status is common

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10
Q

Intraparenchymal Hemorrhagic Stroke

A

75% of hemorrhagic strokes

Hypertensive hemorrhages or Non-hypertensive hemorrhages

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11
Q

Hypertensive hemorrhage

A

Rupture of micro-aneurysms

Putamen»thalamus, pons, cerebellum and cerebral hemispheres.

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12
Q

Non-hypertensive hemorrhages

A

Sympathomimetic agents
Cavernous angiomas, amyloid angiopathy, intracranial tumors, bleeding disorders, trauma, vasculitis, hemorrhagic conversion, infection

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13
Q

Subarachnoid Hemorrhagic Stroke

A

25% of hemorrhagic strokes
Progressive deficits over minutes to hours
Headache and decreasing consciousness

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14
Q

Subarachnoid Hemorrhagic Stroke Etiology

A

Saccular aneurysms
Most common cause of SAH
45 % risk of death in the 1st 30 days - Most within a few days

Arteriovenous malformations (AVMs)

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15
Q

Emergency Medical Services Management of Stroke

A 
Airway, breathing and circulation (ABC)
Cardiac monitoring 
Intravenous access 
Oxygen, if needed
Rapid identification of stroke/time of onset
Rule out (and treat) stroke mimics
Keep NPO (no food or drink)
Alert receiving ED 
Rapid transport to closest appropriate facility
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16
Q

ED Evaluation During/Following Stroke

A 
General medical examination
Identify contributing factors:
NIH Stroke Scale
Glasgow Coma Scale
Dysphagia screen
Glucose
Cardiac monitoring for 1st 24 hours
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17
Q

Medical Diagnosis of Stroke

A

Non-enhanced brain CT scan (NECT)

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18
Q

What is the gold standard for vascular evaluation during stroke?

A

Conventional angiogram

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19
Q

When is MRI better than NECT better for diagnosing stroke?

A

Acute small cortical strokes
Posterior fossa lesions
Acute vs. chronic lesions
Subclinical satellite lesions

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20
Q

Medical Treatment of Ischemic Stroke

A 
Airway, breathing and circulation (ABC)
Adequate hydration
Treat elevated temperatures
Glucose control
Cardiac monitoring for 1st 24 hours
Cautious initial approach to HTN
Oxygen only if hypoxic
Identify etiology of hypovolemia or hypotension
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21
Q

BP targets following stroke

A

If given TPA, < 185/110

If no TPA, < 220/120

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22
Q

Medical Treatment of Hemorrhagic Stroke

A 
Airway, breathing and circulation (ABC)
Rapid transport
Immediate imaging
Careful blood pressure management 
Normalize fluid balance and electrolytes
Control seizures
Normalize body temperature
Correct any bleeding disorders (specific to the problem)
DVT prophylaxis
Clot evacuation and ventricular drainage as required
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23
Q

Name the likely type and location (if applicable) of stroke:

A 60-year-old woman was brought to the ED leg motor weakness.

A

Right MCA

24
Q

Name the likely type and location (if applicable) of stroke:
33 year old man complains of headache and then loses consciousness at work. Onset of symptoms accompanied by a seizure.

Patient requires intubation in the field and is brought to the ED unresponsive.

A

Hemorrhagic

Intraparenchymal – progressing very quickly, very severe

25
Q

Name the likely type and location (if applicable) of stroke:

A 52-year-old man complained of severe headache prior to loss of consciousness

A

Hemohhragic, subarachnoid - No seizure

26
Q

Name the likely type and location (if applicable) of stroke:
The patient was treated with TPA.

Approximately 10 hours after the TPA, the patient was noted to be much more drowsy

A

Hemorrhagic conversion

27
Q

PT Stroke Exam: History

A 
Age and living situation
Participation and Activity level
Type and location of stroke
How long since stroke
Medications
Blood pressure parameters
Co-morbid, pre-morbid conditions
28
Q

Common impairments of body structure/function following stroke

A 
Lack of adequate force production
Lack of adequate timing
Abnormal synergistic movement patterns
Muscle imbalance
Lack of adequate motor planning
Decreased postural control
Sensory-Perceptual, visual deficits
29
Q

Assessing fall risk: less than one month post-CVA

A

<30 Berg Balance Score
Apraxia
Cognitive deficits
Low Functional Independence Measure (FIM) scores

30
Q

Assessing fall risk: Community-dwelling stroke survivors > 6 months after CVA

A

Self-reported persistent balance problems while dressing is predictive of falls

31
Q

Fall predictors in typical older adults vs. post-CVA

A

While incontinence, medications, and history of falls are predictive of falls in older adults, they are not predictive post-CVA

32
Q

What is apraxia?

A

Loss of ability to execute skilled or learned movement patterns on command in the absence of weakness, sensory loss, comprehension difficulty, abnormality of tone or posture, or intellectual deterioration.

33
Q

What is ideational apraxia?

A

Planning of a movement fails

Patient is unable to conceptualize how a movement pattern must be organized.

34
Q

What is ideomotor apraxia?

A

Plan for the movement is intact, but the execution fails.

Damage within pathways connecting the areas in which the plan is conceived to those responsible for innervating the motor plan

35
Q

What is Aphasia?

A

Impairment of language associated with damage to the language dominant hemisphere.

Nearly always involves damage to the left fronto-temporal and/or temporo-parietal regions.

May affect verbal expressive output, fluency, comprehension, naming, reading, writing and repeating.

36
Q

Broca’s vs. Wernicke’s Aphasia

A

Broca’s tends to be more expressive, Wernicke’s receptive

37
Q

Keys to communicating with someone with aphasia

A

Give them time to speak
Reduce environmental noise
Try other, non-verbal means of communication
Confirm that the pt uses yes and no correctly

38
Q

Hemi-neglect

A

Failure to attend to, respond to, and/or report stimulation that is introduced contralateral to the lesion.

Most often seen with non-dominant parietal association area lesions.

Affects contralesional side.

39
Q

Hemi-neglect as a prognostic factor

A

Persistent neglect is a negative functional outcome predictor

40
Q

Intrapersonal Hemi-neglect

A

Contralateral hemineglect of patient’s own body, associated with anosagnosia (denial of deficit)

41
Q

Peripersonal Hemi-neglect

A

Hemispatial neglect of contralateral stimuli within reaching distance.

42
Q

Extrapersonal Hemi-neglect

A

Hemispatial neglect of contalateral stimuli beyond reaching distance

43
Q

Dysarthria

A

Difficulty producing speech

44
Q

Dysphagia

A

Difficulty swallowing
Difficulty eating
Dealing with secretions

45
Q

StrokEDGE Task Force Top PT Tests and Measures following Stroke

A 
6MWT
10 m walk
Modified Ashworth Scale
Berg Balance Test
Functional Reach Test
Dynamic Gait Index
Fugl-Meyer  (Motor )
Orpington Prognostic Scale
Postural Assessment Scale for Stroke
Stroke Impact Scale
Tardieu Spasticity Scale
Action Research Arm Test (ARAT)
Chedoke-McMasters
46
Q

Fugl-Meyer Motor scale

A

100 point motor domain is reliable, valid and responsive to clinical change

47
Q

Chedoke-McMaster Stroke Assessment

A

Measure of impairments and disability level
Impairments in 6 dimensions: shoulder pain, postural control, arm, hand, leg, foot
Measured on a 7 point scale following Brunnstrom stages

Disability measured by gross motor function and walking
Measured on same 7 point scale as FIM

48
Q

Postural Assessment Scale for Stroke Patients (PASS)

A 
Maintaining a Posture (0-3)
 Sitting without support with feet on floor
 Standing with support
 Standing without support
 Standing on non-paretic leg
 Standing on paretic leg
Changing Posture (0-3)
 Supine to affected side lateral
 Supine to non-affected side lateral
 Supine to sitting EOT
 Sitting on edge of table to supine
 Sitting to standing
 Standing to sitting
 Standing, picking up pencil from floor
49
Q

Stroke Impact Scale (SIS)

A

Questionnaire; 5 point scale - Not Difficult at all to
Extremely Difficult

Physical problems
Memory and thinking
Mood and emotions
Communication
Activities in a typical day
Mobility in home and community
Hand function
Ability to participate in usual, meaningful activities
On a scale of 0=100, how much have you recovered?
50
Q

Action Research Arm Test (ARAT)

A

Total score 0-57

Scored 0-3 on each item

Minimal clinical important difference (MCID) 5.7 points

51
Q

Glasgow Coma Scale (GCS)

A

Assesses EYE OPENING, MOTOR RESPONSE,
VERBAL RESPONSE

TOTAL (3–15): _______

52
Q

Glasgow Coma Scale (GCS) Eye Opening

A

None = 1 Even to supra-orbital pressure
To pain = 2 Pain from sternum/limb/supra-orbital pressure
To speech = 3 Non-specific response, not necessarily to command
Spontaneous = 4 Eyes open, not necessarily aware

53
Q

Glasgow Coma Scale (GCS) Motor Response

A

None = 1 To any pain; limbs remain flaccid
Extension = 2 Shoulder adducted and shoulder and forearm internally rotated
Flexor response = 3 Withdrawal response or assumption of hemiplegic posture
Withdrawal = 4 Arm withdraws to pain, shoulder abducts
Localizes pain = 5 Arm attempts to remove supra-orbital/chest pressure
Obeys commands = 6 Follows simple commands

54
Q

Glasgow Coma Scale (GCS) Verbal Response

A 
None = 1 No verbalization of any type
Incomprehensible = 2 Moans/groans, no speech
Inappropriate = 3 Intelligible, no sustained sentences
Confused  = 4 Converses but confused, disoriented
Oriented  = 5 Converses and oriented
55
Q

NIH Stroke Scale (NIHSS)

A 
Level of Consciousness
Best Gaze
Visual
Facial Palsy
Motor Arm
Motor Leg
Limb ataxia
Sensory
Best Language
Dysarthria
Extinction and Inattention (neglect)
56
Q

Modified Tardieu Scale

A

Velocity One = V1
Slow movement
Goniometric measurement at this joint angle

Velocity Two = V2
Fast movement
Goniometric measurement at this joint angle

May provide more precision in documenting amount of spasticity and amount of contracture

57
Q

Functional Independence Measure (FIM)

A

20 functional items measured on 7 point scale

7 = Independence 
6= Modified Independence 
5= Supervision (subject does 100%)
4= Minimal Assist (subject does 75%)
3= Moderate Assist (subject does 50%)
2= Maximal Assist (subject does 25%)
1= Total Assistance (subject does < 25%)

Neuro II - Final Content (16 decks)

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