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
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
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
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
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
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.)
7
Q
Positron emission tomography
A
- imaging of regional blood flow and cerebral metabolism
- determine areas of tissue where ischemia is reversible
8
Q
Anticoagulation meds
A
- Heparin (Lovenox)
- Warfarin (Coumadin)
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
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
11
Q
PCA stroke
A
- supplies occipital lobe, inferior part of temporal lobe, deep structures (diencephalon)
- contralateral homonymous hemianopsia
- contralateral sensory impairment, weakness
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
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”
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
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
16
Q
Cranial nerve signs opposite long tract signs
A
Brainstem disorder
17
Q
Loss of pain and temp, vibration, touch, position on different sides of body
A
SCI
18
Q
Impairment of all sensory modalities on one side of body plus UMN signs
A
Cortical injury
19
Q
Impairment of all sensory modalities on one side of body plus LMN signs
A
Peripheral nerve injury
20
Q
Supratentorial
A
- damage to cerebral cortex or diencephalon
- cognitive, judgment, affect, and/or language deficits
21
Q
Infratentorial
A
- damage to brainstem or cerebellum
- abnormal vitals, automatic movement adjustments, posture/gait, and/or breathing patterns
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
23
Q
Right optic nerve lesion
A
Blindness in R eye
24
Q
Optic chiasm lesion
A
- loss of temporal fields in both eyes
- bitemporal hemianopsia
25
Lesion to uncrossed fibers from R eye
- loss of nasal field of R eye
| - R nasal hemianopsia
26
Right optic tract lesion
- loss of L visual field
| - L homonymous hemianopsia
27
Lesion to R optic radiation projecting directly to occipital lobe
Loss of inferior quadrant of L visual field
28
Lesion to R optic radiation in Meyer’s loop
-loss of superior quadrant of L visual field
29
Lesion to entire R optic radiation
- loss of left visual field
| - L homonymous hemianopsia
30
Lesion to medial surface of R visual cortex
- loss of left visual field with macular sparing
| - macular (foveal) representation extends beyond medial surface onto posterolateral surface of hemisphere
31
UE flexion synergy
-scapular retraction/elevation, shoulder abduction, shoulder ER, elbow flexion, forearm supination, wrist and finger flexion
32
LE flexion synergy
-hip flexion, abduction, ER, knee flexion, ankle dorsiflexion, ankle inversion, toe extension
33
UE extension synergy
-scapular protraction, shoulder adduction, shoulder IR, elbow extension, forearm pronation, wrist and finger flexion
34
LE extension synergy
-hip extension, adduction, IR, knee extension, ankle plantarflexion, ankle inversion, toe flexion
35
Muscles not involved in synergies
-latissimus dorsi, teres major, serratus anterior, finger extensors, ankle evertors
36
Modified Ashworth Scale
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
Decorticate rigidity
- LE extended, UE flexed
| - lesions superior to red nucleus of midbrain
38
Decerebrate rigidity
- UE and LE extended
| - lesions inferior to red nucleus of midbrain
39
Sogue’s phenomenon
-finger extension and abduction when arm is elevated above horizontal
40
Raimste’s phenomenon
-resisted hip abduction or abduction elicits abduction or abduction in contralateral limb
41
Unilateral neglect-lesion where?
Right posterior inferior parietal lobe
42
Anosagnosia- lesion where?
-right posterior insula
43
Somatotopagnosia- lesion where?
- 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
Gerstmann syndrome
- damage to parietal lobe in region of angular gyrus
- R/L discrimination disorder
- finger agnosia
- agraphia (writing)
- acalculia (calculating)
45
Ideomotor apraxia
-difficulty planning and completing actions on command, but can do automatically
46
Ideational apraxia
-inability to conceptualize and perform tasks, either on command or automatically
47
Spastic vs flaccid dysarthria
- spastic- loud bursts, UMN
| - flaccid- soft, breathy, LMN
48
Requirements of CIMT
- 20 degrees wrist extension
- 10 degrees finger extension
- no sensory or cognitive deficits
49
Core Outcome Measures CPG
- FTSTS
- 10MWT
- 6MWT
- ABC
- BBS
- FGA
50
10MWT
- 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
FGA
-<23/30 = fall risk
52
ABC
-<67% indicates increased fall risk
53
FTSTS
-measured from 17-18 inch chair
54
Orpington Prognostic Scale
- 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
Functional Reach Test
-<15 cm = fall risk
56
TUG
->14 seconds = falls risk
57
Fugl-Meyer assessment of motor performance
- 5 domains- motor function, sensory function, balance, joint ROM, joint pain
- max score 226 points
58
FIM
-18 (dependent) to 126 (independent)
59
Stroke impact scale
- 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
Goal attainment scale
- 2+ = goal achieved much more than expected
- 1+ = more than expected
- 0 = goal achieved
- 1- = less than expected
- 2- = much less than expected
61
Motor activity log
- interview to assess arm function
| - score from 0 (never used) to 5 (PLOF)
62
Dorsolateral prefrontal damage
Dysexecutive function
63
Orbitofrontal damage
Distractible
Labile
Disinhibited
Perseverates
64
Medial prefrontal damage
Apathetic
| Passive
65
Brainstem damage presentation
Axial rigidity
Early falls
Early FOG
Similar to PSP
66
Inferior shoulder dislocation stimulation
Supraspinatus
| Posterior deltoid
