4] Background And Manage Of CVA Flashcards
What is the stroke risk test?
Face
Arm (decreased range)
Slurred speech
Time (window is closing)
What is an ischemic stroke?
A clot blocks or impairs blood flow
What is an hemorrhagic stroke?
The blood vessel ruptures causing a blood leak in the brain
Majority of strokes are what kind?
Ischemic
WHat is a TIA?
Not a stroke but has similar Sx that resolve within 24 hours
Accounts for 87% of strokes
Ischemic
What is the test for DVT and you DF them and they complain of pain?
Homan sign
Most common type of ischemia stroke
Embolic
Define embolic stroke
Blood clot formed at other location in the circulatory system; blockage breaks off and goes up
Embolic stroke:
Cardiac origin most common; 80% of cardiac emboli include?
MCA
May be paradoxical; congenital such as patent foramen ovale, DVT
Embolic stroke
Define thrombotic stroke
It’s a blood clot that develops at clogged part of the vessel; they are higher up
Typically related to abnormalities within the vessel wall like atherosclerosis, arthritis, dissections and external compression of the vessels
Thrombotic stroke
Common precursor of thrombotic stroke?
HTN
Thrombotic strokes can also be caused by?
Hematologist disorders and/or hypercholesterolemia
With what disease are they likely to have thrombotic stroke?
A-fib
Large vessel thrombosis in carotid and vertebral arteries can lead to severe what strokes?
Thrombotic
Define lacunar strokes
Small vessel stroke that occurs distally; branches off a large artery
What kind of stroke is typically associated with chronic HTN and diabetic microvascular disease?
Lacunar stroke
What kind of pt has lacunar strokes?
Diabetic
Size of infarct 2 mm to 3 cm in size
LACUNAR STROKE
Account for roughly 25% of ischemic strokes
Lacunar strokes
What are the 3 main types of stroke?
Ischemic
Hemorrhagic
TIA (transient ischemic attack)
What are the 3 types of ischemic strokes?
Embolic
Thrombotic
Lacunar
What are the 6 types of lacunar strokes?
Pure motor Pure sensory Sensorimotor Ataxia hemiparesis Dysarthria Clumsy hand syndrome
Ataxic hemiparesis is seen in?
Cerebellum
If a pt has right CVA and pure sensory what do they have?
Neglect
Common causes of this stroke:
- hypertensive bleed
- ICH in the presence of an AVM or tumor
- ruptured aneurysm
Hemorrhagic
75% of hemorrhagic strokes caused by a bleeding blood vessel occur in ppl who have ?
HTN
Anterior cerebral artery (ACA) supplies?
Medial aspect of frontal and parietal lobes
And subcortical structures like basal ganglia
Middle cerebral artery (MCA) supplies?
Entire lateral aspect of cerebral hemisphere
Frontal, temporal, parietal
Posterior cerebral artery (PCA) supplies?
Occipital lobe, medial and inferior temporal lobe, upper brain stem, midbrain, thalamus
DO hemorrhagic strokes follow an artery distribution?
NO
What signs and symptoms can differentiate between hemorrhagic and ischemic?
Vomiting, headache, impaired consciousness
Which brain scan is best to do for strokes?
CT scan
What is the most common hemorrhagic stroke?
Anterior communicating artery aneurysm
WHy would TIA be confused with lacunar strokes?
Because they follow a vascular distribution
Reversible; no infarction of cerebral tissue
TIA
How soon do ppl who have had a TIA, have it again?
Within 3 months but half of these happen within 48 hours
Work up essential to determine the cause and prevent future stroke
TIA
Ischemic infarct may convert into a ?
Hemorrhagic lesion
Thrombi can do what leading to small hemorrhages?
They can migrate, lyse and reperfuse into an ischemic area
In hemorrhagic conversion, what happened to capillaries and small blood vessels?
They get damaged and no longer maintain their integrity
Hemorrhagic conversions are more common in?
Large infarcts such as an occluded MCA
WHat does TPA stand for?
Tissue plasminogen activator
What does TPA do?
It’s a powerful clot buster – does thrombolysis
To use TPA you have to rule out what first?
Hemorrhagic stroke
Personality Behavior Emotions Judgement Planning Problem solving Intelligence Speaking and writing Concentration Self awareness
Frontal lobe
Interpreting language Touch sensation Pain Temperature Vision Hearing Memory Spatial perception
Parietal lobe
Wernicke's area (understanding) Memory Hearing Sequencing Organizing
Temporal lobe
Interprets vision
Light, color, movement
Occipital lobe
What 3 ways do strokes present the same on either side?
Opposite side weakness and sensory deficits
Memory deficits
2 presentations on Left sided stroke
Speech and language deficit
Slow, cautious behavior
2 presentations on right side stroke
Spatial perceptual deficits
Quick, impulsive behavior
Clinical signs of brain stem strokes
Changes in: breathing, movement, mvmt of eye sensation, HR, MP
Clinical signs of cerebellar strokes
Abnormal reflexes of head and torso Impaired coordination Ataxic gait (uncoordinated mvmt) Balance issues Dizzy Vomit
Thalamic pain syndrome clinical signs
Involuntary mvmt
Contra hemiplegia
Vertical eye mvmt weak
Thalamic pain syndrome is occlusion of?
Central territory of PCA
Medial medullary “dejerine” syndrome is an occlusion of?
Vertebral artery, medullary branch
Ipsi signs of dejerine
Paralysis with atrophy of 1/2 of tongue with deviation to paralyzed side
Contra signs of dejerine syndrome
UE and LE paralysis
Impaired tactile and proprioceptive info
Lateral medullary syndrome (Wallenbergs) is an occlusion of?
PICA or vertebral artery
Contra signs of wallenbergs syndrome
Impaired pain and thermal sense over 50% of body
What is the “locked in syndrome”
Occlusion of basilar artery
Clinical signs of basilar artery syndrome
Quad hemiparesis
Bilateral cranial nerve palsy
SPARED conscious and sensation
Pt cant move or speak but is A xO
Lateral inferior pontine syndrome is occlusion of?
AICA
Acute stroke patients on typically on bed rest for how long?
24 to 48 hours
MAP ranges for ischemic
May run up to 130-140
MAP range for hemorrhagic
Needs to be less than 110
WHat does it mean if MAP ranges are too high for pt?
They’re at risk for bleeding
Hemorrhagic strokes may present similar to?
TBI
If pt is moving in synergistic pattern do what?
Gravity minimized, spasticity testing
Reorganization is dependent on?
ENVIRONMENT
How to reduce spasticity for pts with stroke?
PROM and stretching with slow gradual mvmts.
DO NOT DO SUDDEN QUICK MVMTS
What kind of tasks should you do
Variable
