Cerebrovascular Accident (CVA) Flashcards
1
Q
What is a CVA?
A
sudden or gradual onset of neurological symptoms cause by diminished supply of blood to the brain
2
Q
What is the 2nd leading cause of death and the third leading cause of disability in the world; 5th leading cause of death in the US?
A
Stroke
3
Q
Risk factors for stroke
A
race
age
region
4
Q
2 major subtypes of stroke
A
Ischemic and hemorrhagic
majority are ischemic
hemorrhagic are more severe
5
Q
What are the layers of the skull/brain from superficial layers to deep layers?
A
skin of scalp periosteum bone of skull dura matter (periosteal and meningeal) subdural space arachnoid matter subarachnoid space (containing blood vessels) Pia matter
6
Q
What happens if there is bleeding in subdual and subarachnoid space?
A
may result from an injury and causes pressure and swelling to the brain
7
Q
What are the meninges of the brain?
A
- dura matter
- arachnoid matter
- pia matter
8
Q
What are the extracranial vessels?
A
- 2 carotid arteries; located front of neck
- Vertebral arteries; located C6 – C2
9
Q
What are the intracranial vessels?
A
- Carotid siphon
- Middle cerebral arteries
- Basilar artery
- Occipital lobes
- Temporal lobes
10
Q
What are the communicating arteries?
A
- Anterior / posterior
- Circle of Willis
- Protects brain if blockage occurs
11
Q
What functions/skills does the frontal lobe control?
A
- Movement
- Intelligence
- Reasoning
- Behavior
- Memory
- personality
12
Q
What functions/skills does the cerebellum control?
A
- balance
- coordination
- fine muscle control
13
Q
What functions/skills does the insular cortex control?
A
- pain perception
- speech production
- temperature sensation
- memory
- processing of social emotions
14
Q
What functions/skills does the temporal lobe control?
A
- hearing
- language
- word recognition
- smell
- memory
- emotions
15
Q
What functions/skills does the parietal lobe control?
A
- intelligence
- reasoning
- telling right from left
- language
- sensation
- reading
16
Q
What functions/skills does the brain stem control?
A
- breathing
- blood pressure
- heartbeat
- swallowing
17
Q
What functions/skills does the occipital lobe control?
A
vision
18
Q
What may be seen in a patient with a cerebellar stroke?
A
-abnormal reflexes of the head and torso
-coordination and balance problems
-dizziness, nausea and vomiting
-Difficulty moving or feeling sensation in all four limbs.
-Clumsiness in an arm or leg, or unsteady walking or movement.
-Difficulty forming words.
-Eyes may look in different directions, gaze may be shaky, may be
unable to see in one or more directions
19
Q
What may be seen in a patient with a brain stem (midbrain, pons, medulla) stroke?
A
Since all brain activity in both halves of the brain must go through the brain
stem on their way to the arms and legs, patients with a brain stem stroke
may not be able to move part or all of their bodies
20
Q
Major types of ischemic strokes
A
- Cryptogenic stroke
- cardiogenic embolic stroke
- small penetrating artery thrombosis (lacunar stroke)
- large artery thrombosis (atherosclerotic disease)
21
Q
Major types pf primary hemorrhagic strokes
A
- subarachnoid hemorrhage
- intracerebral hemorrhage
22
Q
What is an ischemic stroke?
A
- Thrombotic; blood clot (thrombus) gradually builds, blocking artery
- Embolic; clot in artery moves up bloodstream; formed elsewhere, occur during daytime activity
- Lacunar (aka small strokes); small infarcts occurring in deep brain structures; small tertiary arteries in brain get blocked and lose blood supply to small part of brain
23
Q
What is a hemorrhagic stroke?
A
- Rupture in blood vessel (aneurysm)
- Bleeding into or around cerebral tissue (Intracerebral & subarachnoid)
24
Q
Signs and symptoms of a stroke
A
BEFAST: Balance issues, eyes, facial droop, arm weakness, speech difficulty, and time
sudden confusion or severe headache w/ no known cause
25
Do patients who survive ischemic strokes or hemorrhagic strokes have better outcomes?
hemorrhagic
26
What is Arteriovenous Malformation?
Arteries and veins usually terminate in capillaries but in av, there is a direct connection btwn arteries and veins causing high pressure which can cause it to burst- causes stroke
27
What are the nonmodifiable risk factors for strokes?
- Age-Stroke risk doubles after the age of 55 in both men and women
- Gender- more common in women
- Race/heredity- most common in African American and Hispanic b/c of their predisposition to issues like heart disease, etc
- Prior stroke
28
What are the modifiable risk factors for strokes?
- high blood pressure- bp 160/90 are 10x more likely to have a stroke than those with 120/80
- smoking- 2-3x more likely
- diabetes- triples ridk
- high cholesterol
- inactivity
- obesity
- artery disease
- TIAs
- atrial fibrillation/heart disease- 5x more likely to have stroke
- some blood disorders
- alcohol intake
- stress
29
What condition affects 1/3 of stroke survivors?
depression
30
Which pediatric age group is stroke more common?
younger than 2 years of age
50% ischemic
50-90% experience residual neuro deficits
31
What are the signs and symptoms of a left-sided cerebral injury: middle cerebral artery?
- right hemiplegia
- Right side loss of voluntary movement / coordination (right side of face, trunk, extremities)
- Impaired sensation (pain, temp, proprioception r. side)- hemianesthesia
- Blind spots (usually right side of visual field)
- Aphasia: language issue; speech, vocab issues
- Dysarthria: coordination of mouth and tongue
- Memory deficits, recent / past events
- Slow, cautious, disorganized personality
32
What are the signs and symptoms of a right-sided cerebral injury: middle cerebral artery?
- Hemiparesis – weakness- left side of body
- Hemiplegia – paralysis- left side of body
- Impairment of sensation (touch, pain, temp, proprioception left side)
- Spatial / perceptual deficits
- Unilateral inattention- neglect
- Dressing apraxia
- Impaired left half of visual field in both eyes–(left homonymous hemianopsia )
- Impulsivity – disorganized
- overconfident
- Impaired learning
33
What are the signs and symptoms of an anterior cerebral artery stroke?
- Paralysis of the lower extremity, (contralateral)
- Can have UE paralysis as well, but less severe
- Loss of sensation (contralateral)- toes, foot, leg
- Loss of conscious control of bowel or bladder
- Balance problems
- Memory impairment
- Whispered speech, or loss of all communication
- Lack of spontaneity of emotion
- May speak in whispered speech or lose al communication
34
What are the signs and symptoms of a vertebrobasilar stroke?
- Impaired coordination of the eyes
- Loss of memory
- Impaired temperature sensation
- Clumsy movements of the hands
- Vertigo, dizziness
- Impaired ability to read and/or name objects
- Dysphagia, drooling
- Paralysis of the face, limbs, or tongue
35
What are the signs and symptoms of Wallenberg’s Syndrome?
- Brainstem stroke; occlusion of a vertebral or cerebellar artery
- Impacts contralateral pain / temperature loss
- Ipsilateral Horner’s syndrome: disruption of a nerve pathway from the brain to the face and eye on one side of the body; results in a decreased pupil size, a drooping eyelid and decreased sweating on the affected side of your face
- Ataxia: degenerative disease of the nervous system
- Dysphagia: inability to manage swallowing food
- Facial sensory loss
36
What are the signs and symptoms of Transient Ischemic Attacks (TIAs)?
- Symptoms occur rapidly and last for <24 hours
- 75% of TIA’s last < 5 min
- High chance of having a major stroke within 5 years
- Fleeting blindness in one eye
- Hemiparesis
- Dizziness
- Double vision
- Staggering
37
What are the signs and symptoms of small strokes?
- TIAs but last longer
- May last longer than 24 hours
- Results in only minor neurological deficits
- RIND- Reversible Ischemic Neurological Deficit
- PRIND- Partially Reversible Ischemic Neurological Deficit
38
What is RIND- Reversible Ischemic Neurological Deficit?
A small stroke that will completely resolve and deficits
39
What is PRIND- Partially Reversible Ischemic Neurological Deficit?
A small stroke episode lasting more than 72 hours leaving minor neurological impairments
40
Prognosis following a stroke?
- Depends where blood supply was lost and duration
- May be Irreparable / permanent
- Plasticity = recovery
- ~ 90% of neuro recovery occurs within 3 months
- Hemorrhagic strokes recover more slowly
- Recovery of function greater in young clients
- Possible spasticity, shoulder subluxation, depression, abnormal muscle tone, contractures
- 3/4s of people who have a stroke will have one physical or cognitive issue w/in one year
41
Techniques used to diagnose a stroke?
- Computed Tomography (CT)
- Magnetic Resonance Imaging (MRI)
- Positron Emission Tomography (PET scan)
42
Why is a Computed Tomography (CT) used to detect a stroke?
- Radiographic
- Differentiate between hemorrhagic and ischemic stroke
- Can clarify location, mechanism and severity, but does not detect subtle changes
- Most common tool used to diagnose CVA caused by hemorrhage
43
Why is a Magnetic Resonance Imaging (MRI) used to detect a stroke?
- More sensitive that CT and no radiation exposure
- Better detection of ischemic areas (than CT)
- Can distinguish between acute and chronic hemorrhage
44
Why is a Positron Emission Tomography (PET scan) used to detect a stroke?
- Not readily used to manage acute CVA
| - Can help assess CVA progression to determine management
45
What invasive technique is used to detect a stroke?
Cerebral angiography: Dye injection/ radiography of vascular system
46
What kind of medical/surgical managements are used in stroke patients?
-Antiplatelet Therapy (aspirin therapy;
Low doses as preemptive therapy found to help prevent cardiovascular disease)
-Anticoagulants (Heparain- short term; Warfarin-longer term)
-Thrombolytics Therapy (tPA) (Used for dissolution of occluding thrombi;
Used acutely for MI and CVA; Acute CVA within 3 hours of onset)
- Carotid artery stenting (CAS)
- Surgical clipping or coiling (Effective for ruptured aneurysms or AVMs)
- Superficial temporal artery bypass (Challenging to perform)
47
What occurs in stage 1 of stroke recovery?
flaccidity; no voluntary movement
48
What occurs in stage 2 of stroke recovery?
spasticity appears; minimal voluntary movement w/ synergistic pattern
49
What occurs in stage 3 of stroke recovery?
increase in spasticity; patients gains voluntary control over synergy
50
What occurs in stage 4 of stroke recovery?
decrease in spasticity; some movement outside synergy appears, but synergy dominates
51
What occurs in stage 5 of stroke recovery?
further decrease in spasticity; more complex movement combinations are learned; synergies lose their dominance
52
What occurs in stage 6 of stroke recovery?
Disappearance of spasticity; individual joints movements possible; coordination approaches normal
53
What occurs in stage 7 of stroke recovery?
normal function
54
What kind of impact can a CVA have on occupational performance?
Grooming
Bathing
Driving
Maintaining employment
Loss of leisure participation
Reading
Attention to task
Remembering important dates, people, time
Social engagement
Education / play
Sensory Functions: Protective Tactile, Proprioceptive, Visual field deficits, Perceptual deficits
Motor Functions: Abnormal tone
Mental Function
Emotional Function
55
What are the 3 most common types of aphasia following a stroke?
global aphasia; speech isnt fluent, cannot comprehend spoken messages, cannot repeat words or phrases
broca'a aphasia: speech isnt fluent, can comprehend spoken messages, cannot repeat words or phrases
wernicke's aphasia: fluent speech, cannot comprehend spoken messages, cannot repeat words or phrases
