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2) Patho 2 > 11) Stroke > Flashcards

11) Stroke Flashcards

1
Q

CVA

A

Sudden loss of neurological fxn as the result of a disruption to blood flow resulting in tissue death

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2
Q

Ischemia

A

Decr blood flow resulting in tissue death

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3
Q

Thrombosis

A

Aggregation of platelets & fibrin in a cerebral artery resulting in occlusion

*Has a gradual onset & pt often awakes w/sx’s

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4
Q

Embolus

A

Thrombus originates elsewhere, breaks off, & travels through the bloodstream to a narrowing region

*Onset is abrupt & happens w/activity

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5
Q

Lacunar Infarct

A

Occlusion of small vessels

*Gradual onset

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6
Q

What is lacunar infarct associated w/?

A

HTN or DM

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7
Q

TIA

A

Sx’s are gone w/in24hrs

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8
Q

Ischemic Penumbra

A

Rim of mild-moderate ischemic tissue around the area of infarct

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9
Q

How long can an ischemic penumbra remain viable for & why?

A

Several hours bc of collaterals

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10
Q

What happens if reperfusion isn’t quickly established w/a penumbra?

A

Necrosis

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11
Q

What % of normal blood flow does the brain need to survive?

A

20-25%

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12
Q

Antiplatelet drugs

A

Aspirin, Plavix, & Aggrenox

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13
Q

Anticoagulants

A

Heparin, Coumadin, & Lovenox

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14
Q

What are statins?

A

Block the enzyme that produces LDL

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15
Q

Hypertensives

A

Beta-blockers & Ace-inhibitors

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16
Q

How to differentiate a beta-blocker from an ace-inhibitor

A

Beta-blockers end in “ol”

Ace-inhibitors end in “il”

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17
Q

Intercerebral Hemorrhage

A

Arterial bleeding into the brain

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18
Q

Does an intercerebral hemorrhage have a high or low mortality rate?

A

High

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19
Q

What accounts for 15% of all CVA?

A

intercerebral hemorrhage

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20
Q

Etiology of intercerebral hemorrhage

A
  • Atherosclerosis weakens small arterial walls
  • Sudden BP incr
  • > 65y/o
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21
Q

Clinical manifestations of intercerebral hemorrhage

A

*Specific to region
*Sx’s incr as hematoma enlarges
Seizure activity is possible

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22
Q

What does intercerebral hemorrhage result in?

A
  • Structural distortion
  • Incr ICP
  • Devo of severe edema causing a midline shift
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23
Q

Subarachnoid Hemorrhage

A

Blood in the subarachnoid space

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24
Q

Sx’s of subarachnoid hemorrhage

A

Sudden onset of:

  • Severe HA
  • Nausea
  • Vomiting
  • Syncope
  • Neck pain
  • Confusion
  • Lethargy
  • Coma
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25
Q

Causes of subarachnoid hemorrhage

A
  • AVM
  • Age
  • Trauma
  • Neoplasm
  • Infection
  • HTN
  • Vascular malformation
  • Smoking
  • Alcohol
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26
Q

Subdural Hematoma

A

Tearing of bridging veins between the brain & dura bc of truma

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27
Q

Who is subdural hematoma especially common in?

A

The elderly

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28
Q

How do elderly pt’s w/subdural hematoma present?

A

W/cognitive decline

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29
Q

Management of subdural hematoma

A

Small gets absorbed by the body; Large needs to be evacuated

30
Q

Epidural Hematoma

A

Traumatic tearing of meningeal arteries

31
Q

Describe epidural hematoma

A

Medical emergency requiring evacuation

32
Q

What happens if an epidural hematoma is not evacuated quickly?

A

Can cause brainstem compression

33
Q

Risk factors for CVA

A
  • HTN
  • Smoking
  • Hyperlipidemia
  • Cardiac disease
  • DM
  • Abdominal obesity
  • Sedentary lifestyle
  • Excessive alcohol consumption
  • Age
  • Sex
  • FHx
  • Race
  • Geography
34
Q

What is the gene associated w/CVA

A

NOTCH3

35
Q

What are the warning signs of CVA?

A
  • Sudden numbness/weakness in face, arm, or leg
  • Sudden difficulty w/speech or comprehension
  • Confusion
  • Sudden vision problems
  • Sudden trouble amb
  • Sudden balance/coordination problems
  • Sudden HA w/no known cause
36
Q

Who less disability 3 months post-CVA?

A

Pt’s who get to the ER w/in 3hrs

37
Q

Diagnostic Tests for CVA

A
  • Non-contrast CT
  • MRI
  • MRA
  • EKG
  • Echo w/bubble
  • TEE
  • Telemetry
  • Carotid Doppler
38
Q

Tissue Plasminogen Activator (tPA)

A

Used w/ischemic strokes to lyse fibrin

39
Q

Mechanical Embolus Retrieval for Cerebral Ischemia (MERCI)

A

Has 8hr window for larger occluded arteries

40
Q

Diagnostic Scales

A
  • Oxford ABC Scale

* NIH Stroke Scale

41
Q

Oxford ABC Scale

A

Done in MD’s office to predict risk of stroke after TIA

42
Q

NIH Stroke Scale

A

Standardized tool to assess impairment & if pt needs tPA

43
Q

Medical management of CVA

A
  • CT/MRI
  • Angiogram
  • Tox screen
  • Monitor INR time
  • Monitor & maintain BP
  • Seizure prophylaxis
  • Induced coma
  • Medically induced hypothermia
  • Hyperventilation
  • Diuretics
  • Surgical drainage
44
Q

What lobes do the carotid arteries supply?

A
  • Frontal–>Reasoning, planning, speech, movement, emotions, & problem-solving
  • Parietal–>Movement, orientation, recognition, stimulus perception
  • Temporal–>Perception & recognition of auditory stimuli, memory, & speech
  • Basal Ganglia–>Regulates movement
  • Internal Capsule–>Where large #’s of motor & sensory fibers travel to & from the cortex
45
Q

What is the most common location of lacunar infarcts?

A

Internal Capsule

46
Q

What happens if a CVA occurs in the ACA?

A
  • Hemiplegia/Paresis
  • Hemisensory Deficits
  • Difficulty w/bimanual tasks or imitation
  • Aphasia if in dominant hemisphere
  • Apraxia if in non-dominant hemisphere
  • Personality/behavioral changes
  • Urinary incontinence
47
Q

What is the most common region for CVA’s?

A

MCA

48
Q

What is the common cause of MCA CVA?

A

Internal carotid thrombus

49
Q

What can happen as the result of a vertebrobasilar artery CVA?

A

Wallenberg Syndrome & Horner’s Syndrome

50
Q

Wallenberg Syndrome

A
  • Dysphagia
  • Dysphonia
  • Vertigo
  • Nystagmus
  • Ipsilateral Ataxia
  • Dyskinesia
  • Intention Tremor
  • Impaired sensation
51
Q

Horner’s Syndrome

A
  • Ptosis of eyelids
  • Pupillary constriction
  • Loss of ipsilateral facial sweating
  • Dysphagia/Dysphonia
  • Loss of pain/temp sensation in contralateral torso/extremities
52
Q

What is the result of a complete basilar artery occlusion?

A

Locked-in Syndrome

53
Q

What is the prognosis for locked-in syndrome?

A

High mortality rate; Those that survive are severely disabled

54
Q

What happens as a result of locked-in syndrome

A
  • Tetraplegia
  • Bilateral CN palsy so horizontal eye movement
  • Mute
  • Cognition is spared
55
Q

Complications associated w/stroke

A
  • Altered consciousness & cognition
  • Speech & swallowing problems
  • Motor deficits
  • Tone changes
  • Reflex problems
  • Balance & coordination deficits
  • Emotional changes
56
Q

Pusher Syndrome

A

Equitable split between L & R hemisphere so pt perceives their midline as 18 to the ipsilesional side

57
Q

Sx’s of Pusher Syndrome

A
  • Spontaneous body posture towards the involved side
  • Incr pushing force by spreading the non-paretic limbs
  • Resistance to passive posture correction
  • Noted in sitting & standing
58
Q

Tx for Pusher Syndrome

A

Combines visual, somatosensory, & motor learning

  • Allow pt to “fall: from pushing
  • Use vision to attain posture to mimic vertical objects
  • Sitting weight shifts progressed to STS
  • Single-leg activities
  • Fxnl training to uninvolved side
  • BW-supported gait training
59
Q

What device is good for training a pt w/pusher syndrome?

A

A mirror w/a line down the middle

60
Q

Aphasia

A

Difficulties w/expression &/or language comprehension

61
Q

Broca’s Aphasia

A

Difficulty w/expression

62
Q

Wernicke’s Aphasia

A

Difficulty w/understanding

63
Q

Global Aphasia

A

Combo; Happens w/full MCA infarct through the frontal & parietal lobes

64
Q

Alexia

A

Reading impairment; Pt doesn’t know what letters mean

65
Q

Agraphia

A

Writing impairment

66
Q

Agnosia

A

Can’t perceive auditory, visual, & tactile input even though sensory systems are intact

67
Q

Apraxia

A

Inability to execute voluntary motor tasks despite having muscle fxn & understanding the task

68
Q

Anosognosia

A

Lack of awareness of illness; Means parietal lobe lesion

69
Q

Dysarthria

A

Motor speech disorder affecting respiration, articulation, & phonation

70
Q

Dysphagia

A

Inability/difficulty w/swallowing bc of CN involvement (5,7, 9-12)

71
Q

Perseveration

A

Unable to refrain from certain behaviors

72
Q

Spatial Perception

A

Ability to sense the size, shape, movement, distance, & orientation of objects & awareness of oneself in space & in relation to other objects

2) Patho 2 (20 decks)

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