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NCS Prep > 3 Stroke > Flashcards

3 Stroke Flashcards

1
Q

Stroke statistics

A
  • 5th leading cause of death in US
  • leading cause of disability in adults
  • 795,000 Americans each year, 75% first stroke, 25% recurrent
  • in US, stroke every 40 seconds and someone dies every 4 minutes due to stroke
  • 87% ischemic strokes, 13% hemorrhagic
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2
Q

ABCD2 prediction rule

A
  • age >60 years = 1 point
  • BP >140 or >90 = 1
  • unilateral weakness with or without speech impairment = 2
  • speech impairment without weakness = 1
  • > 60 minutes = 2, 10-59 minutes = 1
  • diabetes = 1

Higher score = higher 30 and 90 day stroke risk

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3
Q

CT for stroke

A
  • primary imaging for initial evaluation
  • rule out hemorrhagic stroke and may identify ischemic lesion, but may not see in early hours
  • aids in decision whether to administer tPA
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4
Q

Computed Tomography Angiogram

A
  • inject IV contrast followed by radiography

- clear images of cerebral blood vessels to see stenosis, occlusion, aneurysms, and vascular abnormalities

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5
Q

MRI

A
  • detect edema in sub-acute phase that may not be visible on CT
  • can’t use with pacemakers, some metallic implants
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6
Q

Magnetic Resonance Angiogram

A

-detect high grade atherosclerotic lesions and less common causes of ischemic stroke (carotid and vertebral artery dissection, venous thrombosis, etc.)

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7
Q

Positron emission tomography

A
  • imaging of regional blood flow and cerebral metabolism

- determine areas of tissue where ischemia is reversible

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8
Q

Anticoagulation meds

A
  • Heparin (Lovenox)

- Warfarin (Coumadin)

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9
Q

MCA stroke

A
  • most common location
  • primary motor and sensory cortices, Broca’s, Wernicke’s
  • contralateral weakness (UE and face), sensory impairment
  • aphasia if L
  • neglect if R
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10
Q

Lacunar strokes

A
  • deep branches of MCA (lenticulostriate arteries)
  • high incidence in those with HTN and elderly
  • supplies BG, internal capsule
  • contralateral weakness
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11
Q

PCA stroke

A
  • supplies occipital lobe, inferior part of temporal lobe, deep structures (diencephalon)
  • contralateral homonymous hemianopsia
  • contralateral sensory impairment, weakness
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12
Q

ACA stroke

A
  • rare due to collateral circulation provided by anterior communicating artery
  • supplies motor and sensory cortices (LE), SMA, prefrontal cortex
  • contralateral weakness, sensory impairment (LE)
  • frontal lobe behavioral abnormalities- poor judgment, decreased attention and motivation, difficulty regulating emotions
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13
Q

Watershed strokes

A
  • affect areas of brain supplies by most distal branches of major cerebral arteries
  • results from hypoperfusion (heart disease, cardiac arrest, shock, etc.)
  • proximal arm and leg weakness with preservation of distal strength (“man in a barrel”
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14
Q

PICA stroke

A
  • Lateral medullary syndrome or Wallenberg syndrome
  • supplies cerebellum and medulla
  • loss of pain and temperature on contralateral side of body and ipsilateral face
  • dizziness/vertigo
  • ataxia, diplopia, dysphagia, dysarthria
  • Horner’s syndrome- caused by damage of sympathetic trunk to vertebral bodies. Ipsilateral miosis (pupil constriction), ptosis, decreased sweating
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15
Q

AICA stroke

A
  • lateral pontine syndrome
  • supplies cerebellum, CN VII and VIII
  • ipsilateral ataxia
  • contralateral weakness, sensory impairment (pain and temperature)
  • dizziness/vertigo
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16
Q

Cranial nerve signs opposite long tract signs

A

Brainstem disorder

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17
Q

Loss of pain and temp, vibration, touch, position on different sides of body

A

SCI

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18
Q

Impairment of all sensory modalities on one side of body plus UMN signs

A

Cortical injury

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19
Q

Impairment of all sensory modalities on one side of body plus LMN signs

A

Peripheral nerve injury

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20
Q

Supratentorial

A
  • damage to cerebral cortex or diencephalon

- cognitive, judgment, affect, and/or language deficits

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21
Q

Infratentorial

A
  • damage to brainstem or cerebellum

- abnormal vitals, automatic movement adjustments, posture/gait, and/or breathing patterns

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22
Q

Thalamic pain syndrome

A
  • initially presents as numbness that turns into debilitating burning
  • may be accompanied by allodynia- pain from stimulus that would not normally be painful
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23
Q

Right optic nerve lesion

A

Blindness in R eye

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24
Q

Optic chiasm lesion

A
  • loss of temporal fields in both eyes

- bitemporal hemianopsia

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25
Q

Lesion to uncrossed fibers from R eye

A
  • loss of nasal field of R eye

- R nasal hemianopsia

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26
Q

Right optic tract lesion

A
  • loss of L visual field

- L homonymous hemianopsia

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27
Q

Lesion to R optic radiation projecting directly to occipital lobe

A

Loss of inferior quadrant of L visual field

28
Q

Lesion to R optic radiation in Meyer’s loop

A

-loss of superior quadrant of L visual field

29
Q

Lesion to entire R optic radiation

A
  • loss of left visual field

- L homonymous hemianopsia

30
Q

Lesion to medial surface of R visual cortex

A
  • loss of left visual field with macular sparing

- macular (foveal) representation extends beyond medial surface onto posterolateral surface of hemisphere

31
Q

UE flexion synergy

A

-scapular retraction/elevation, shoulder abduction, shoulder ER, elbow flexion, forearm supination, wrist and finger flexion

32
Q

LE flexion synergy

A

-hip flexion, abduction, ER, knee flexion, ankle dorsiflexion, ankle inversion, toe extension

33
Q

UE extension synergy

A

-scapular protraction, shoulder adduction, shoulder IR, elbow extension, forearm pronation, wrist and finger flexion

34
Q

LE extension synergy

A

-hip extension, adduction, IR, knee extension, ankle plantarflexion, ankle inversion, toe flexion

35
Q

Muscles not involved in synergies

A

-latissimus dorsi, teres major, serratus anterior, finger extensors, ankle evertors

36
Q

Modified Ashworth Scale

A

0- no increase
1- slight increase, catch or min resistance at end ROM
1+- slight increase, catch with minimal resistance through less than half ROM
2- more marked increase through most of ROM, but can easily move
3- considerable increase in tone, passive movement difficult
4- affected parts rigid

37
Q

Decorticate rigidity

A
  • LE extended, UE flexed

- lesions superior to red nucleus of midbrain

38
Q

Decerebrate rigidity

A
  • UE and LE extended

- lesions inferior to red nucleus of midbrain

39
Q

Sogue’s phenomenon

A

-finger extension and abduction when arm is elevated above horizontal

40
Q

Raimste’s phenomenon

A

-resisted hip abduction or abduction elicits abduction or abduction in contralateral limb

41
Q

Unilateral neglect-lesion where?

A

Right posterior inferior parietal lobe

42
Q

Anosagnosia- lesion where?

A

-right posterior insula

43
Q

Somatotopagnosia- lesion where?

A
  • AKA body-image agnosia, lack of awareness of body structure and relationship of body parts to one another in self or others
  • lesion left parietal or posterior temporal lobe
44
Q

Gerstmann syndrome

A
  • damage to parietal lobe in region of angular gyrus
  • R/L discrimination disorder
  • finger agnosia
  • agraphia (writing)
  • acalculia (calculating)
45
Q

Ideomotor apraxia

A

-difficulty planning and completing actions on command, but can do automatically

46
Q

Ideational apraxia

A

-inability to conceptualize and perform tasks, either on command or automatically

47
Q

Spastic vs flaccid dysarthria

A
  • spastic- loud bursts, UMN

- flaccid- soft, breathy, LMN

48
Q

Requirements of CIMT

A
  • 20 degrees wrist extension
  • 10 degrees finger extension
  • no sensory or cognitive deficits
49
Q

Core Outcome Measures CPG

A
  • FTSTS
  • 10MWT
  • 6MWT
  • ABC
  • BBS
  • FGA
50
Q

10MWT

A
  • distance walked 3 trials, average of 2nd and 3rd recorded
  • <0.4 m/s = household ambulatory
  • 0.4-0.8 m/s = limited community ambulator
  • > 0.8 m/s = community ambulator
51
Q

FGA

A

-<23/30 = fall risk

52
Q

ABC

A

-<67% indicates increased fall risk

53
Q

FTSTS

A

-measured from 17-18 inch chair

54
Q

Orpington Prognostic Scale

A
  • scores 1.6-6.8
  • mild to mod deficit <3.2
  • mod to severe deficit 3.2-5.2
  • severe or major deficit >5.2
55
Q

Functional Reach Test

A

-<15 cm = fall risk

56
Q

TUG

A

->14 seconds = falls risk

57
Q

Fugl-Meyer assessment of motor performance

A
  • 5 domains- motor function, sensory function, balance, joint ROM, joint pain
  • max score 226 points
58
Q

FIM

A

-18 (dependent) to 126 (independent)

59
Q

Stroke impact scale

A
  • 59 items in 8 domains (strength, hand function, ADL/IADL, mobility, communication, emotion, memory and thinking, participation/role function)
  • 0 (high impact of stroke, more impairment) to 100 (low impact, less impairment)
60
Q

Goal attainment scale

A
  • 2+ = goal achieved much more than expected
  • 1+ = more than expected
  • 0 = goal achieved
  • 1- = less than expected
  • 2- = much less than expected
61
Q

Motor activity log

A
  • interview to assess arm function

- score from 0 (never used) to 5 (PLOF)

62
Q

Dorsolateral prefrontal damage

A

Dysexecutive function

63
Q

Orbitofrontal damage

A

Distractible
Labile
Disinhibited
Perseverates

64
Q

Medial prefrontal damage

A

Apathetic

Passive

65
Q

Brainstem damage presentation

A

Axial rigidity
Early falls
Early FOG
Similar to PSP

66
Q

Inferior shoulder dislocation stimulation

A

Supraspinatus

Posterior deltoid

NCS Prep (19 decks)

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