Cerebrovascular Accident Flashcards

1
Q

What is a cerebrovascular accident (CVA)?

A

Specific event that results in a lack of oxygen supply to a specific area of the brain secondary to either ischemia or hemorrhage

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2
Q

What are the primary risk factors that can lead to CVA?

A
  • Hypertension
  • Cardiac Disease or arrhythmias
  • Diabetes mellitus
  • Cigarette smoking
  • Transient ischemic attacks
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3
Q

What are secondary risk factors of the development of a CVA?

A
  1. Obesity
  2. High Cholesterol
  3. Behaviors related to hypertension (i.e. stress, excessive salt intake)
  4. Physical inactivity
  5. Increased Alcohol consumption
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4
Q

What are the types of CVA’s?

A
  1. Transient Ischemic Attack (TIA)
  2. Completed Stroke
  3. Stroke Evolution
  4. Ischemic Stroke
  5. Hemorrhage
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5
Q

Describe a TIA CVA?

A
  • usually linked to an atherosclerotic thrombosis which causes a temporary interruption of blood upply to an area of the brain
  • symptoms resolve quickly, typically within 24-48 hours
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6
Q

Where does a TIA often occur?

A

Vertebrobasilar arteries and may incite future CVA

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7
Q

What is a completed stroke?

A

A CVA that presents with total neurological deficits at onset

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8
Q

What is a stroke in evolution?

A

CVA usually caused by a thrombus that gradually progresses

Total neurological deficits are not seen for one to tow days after onset

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9
Q

Name the type of Ischemic Strokes.

A

Embolus (20% of Ischemic CVAs)

Thrombus

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10
Q

What is an Embouls Ischemic Stroke associated with?

A

CVD, the embolus may be solid, liquid or gas, and can originate in any part of the body.

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11
Q

Explain what happens with an Ischemic CVA caused by an embolus

A

Embolus travels through the bloodstream to the cerebral arteries causing occlusion of a blood vessel and a resultant infarct

  • occurs rapidly with no warning; often presents with a headache
  • tissues nearest the occlusion sustain higher permanent damage
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12
Q

What artery is most commonly affected in regards to an embolic CVA?

A

Middle cerebral artery (MCA) from the internal carotid artery most commonly affected

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13
Q

what are common cardiac disorders that can lead to embolism?

A
  • valvular disease (i.e. rheumatic mitral stenosis)
  • Ischemic heart disease
  • acute myocardial infarction
  • arrhytmias (i.e. atrial fibrillation)
  • patent foramen ovale
  • cardiac tumors
  • post cardiac cathertizationd
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14
Q

What is a thrombus CVA?

A
  • atherosclerotic plaque develops in an artery and eventually occluded the artery or a branching artery causing an infarct.
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15
Q

T or F: A thrombus CVA is extremely variable in onset where symptoms can appear in minutes or over several days AND typically occurs during sleep or upon awakening after a MI or p/o

A

True

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16
Q

What are the characteristics of a Left CVA?

A
  • Weakness, paralysis of the Right Side
  • increased frustration
  • decreased processing
  • possible aphasia (expressive, receptive, global)
  • possible dysphasia
  • possible motor apraxia (ideomotor and ideational)
  • decreased discrimination b/t left and right
  • Right hemianopsia
17
Q

What are characteristics of a Right Hemisphere CVA?

A
  • Weakness, paralysis of the left side
  • decreased attention span
  • Left hemianopsia
  • decreased awareness and judgement
  • memory deficits
  • Left inattention
  • decreased abstract reasoning
  • Emotional lability
  • Impulsive behaviors
  • decreased station orientation
18
Q

What are the charateristics of a brainstem CVA?

A
  • Unstable vital signs
  • decreased consciousness
  • decreased ability to swallow
  • weakness on both sides of the body
  • paralysis on both sides of the body
19
Q

What are the characteristics of a cerebellum CVA?

A
  • ataxia
  • decreased balance
  • decreased coordination
  • Nausea
  • Decreased ability for posture adjustment
  • Nystagmus
20
Q

What are synergies?

A

Synergy patterns result when the higher centers of the brain lose control and the uncontrolled or partially controlled stereotyped patterns of the middle and lower centers emerge

21
Q

What is a Flexor synergy of the UE?

A
*Flexor synergy is seen when the patient attempts to lift up their arm or reach for an object
Scapula: Elevation and retraction
Shoulder: abduction and ER
Elbow: Flexion
Forearm: supination 
Wrist: Flexion
Fingers: flexion with adduction
Thumb: Flexion and adduction
22
Q

Describe an Extensor Synergy of the UE.

A
Scapula: Depression and protraction
Shoulder: IR and Adduction
Elbow: Extension
Forearm: Pronation
Wrist: Extension
Fingers: Flexion with adduction
Thumb: Flexion and adduction
23
Q

Describe a flexor synergy of the LE?

A

Hip: Abduction and ER
Knee: Flexion
Ankle: DF with supination
Toes: Extension

*flexor synergy is characterized by great toe extension and flexion of the remaining toes secondary to spasticity

24
Q

Describe an Extensor Synergy of the LE.

A

Hip: Extension, IR, and adduction
Knee: Flexion
Ankle: PF with Inversion
Toes: Flexion and adduction

25
Q

What are some CVA tests and outcome measures?

A
  1. National Institute of Health (NIH) stroke scale
  2. Functional Independence Measure (FIM)
  3. Stroke Impact Scale
  4. Fugl-Meyer Assessment of Physical Performance
26
Q

Describe the NIH.

A

Assessment of an acute CVA relative to impairment

27
Q

Describe FIM.

A

Provides a level of burden through assessment of mobility and ADL management

28
Q

Describe the Stroke Impact Scale.

A

Assessment of physical and social disability or levle of impairment secondary to CVA

29
Q

Describe the Fugl-Meyer Assessment of Physical Performance.

A

Motor, sensory, and balance impairment; also assesses pain and ROM