Cerebrovasular Accident (CVA) Flashcards
What is a CVA?
Occurs when the blood supply to the brain is interrupted or reduced resulting in a lack of oxygen supply to a specific area of the brain.
______ strokes occur in 80% of cases.
Ischemic strokes
What are 4 types of ischemic strokes?
Cerebral thrombosis
Cerebral embolism
Hemorrhagic stroke
Transient ischemic attack (TIA)
What is a cerebral thrombosis?
Formation or development of blood clot or thrombus within the cerebral arteries or their branches
What is a cerebral embolism?
Traveling bits of matter (thrombi, tissue, fat, air, bacteria) that produce occlusion and infarction in the cerebral arteries
What is a hemorrhagic stroke?
Abnormal bleeding as a result of rupture of a blood vessel
What is a transient ischemic attack (TIA)?
A temporary period of symptoms resulting from decrease blood supply to the brain; there is no permanent damage
What is a major precursor for stroke in one-third of patients?
Transient ischemic attack (TIA)
List 5 primary risk factors for stroke.
Hypertension Cardiac disease or arrhythmias Diabetes Cigarette smoking Atherosclerosis
What is cerebral anoxia?
Lack of oxygen supply to the brain (irreversible anoxic damage to the brain begins after 4-6 minutes)
What is cerebral infarction?
Irreversible cellular damage
What is cerebral edema?
Accumulation of fluids within the brain; causes further dysfunction; elevates intracranial pressures, can result in herniation and death.
List 8 characteristics of CVA affecting the left hemisphere.
- Weakness, paralysis of the right side
- Increased frustration
- Decreased processing
- Possible aphasia
- Possible dysphagia
- Possible motor apraxia
- Decreased discrimination between left and right
- Right hemianopsia
List 10 characteristics of CVA affecting the right hemisphere.
- Weakness, paralysis of the left side
- Left hemianopsia
- Left in attention
- Decreased attention span
- Decreased awareness and judgement
- Decreased abstract reasoning
- Decreased spatial orientation
- Memory deficits
- Emotional lability
- Impulsive behaviors
List 5 characteristics of CVA affecting the brainstem.
- Unstable vital signs
- Decreased consciousness
- Decreased ability to swallow
- Weakness on both sides of the body
- Paralysis on both sides of the body
List 6 characteristics of CVA affecting the cerebellum.
- Decreased balance
- Ataxia
- Decreased coordination
- Nausea
- Decreased ability for postural adjustment
- Nystagmus
What deficits are expected with a stroke affecting the cortex and internal capsule? (3)
Contralateral hemiplegia
Contralateral hemisensory loss
Homonymous hemianopsia
What areas of the body are spared with an infarct to the MCA versus the ACA?
MCA syndrome = LE more spared
ACA syndrome = UE more spared
What deficits are expected with a stroke affecting the primary visual cortex/occipital lobe (PCA syndrome)?
Contralateral sensory loss
Involuntary movements (choreoathetosis, tremor, hemiballismus)
Transient contralateral hemiparesis
Homonymous hemianopsia
What deficits are expected with a stroke affecting the midbrain? (2)
Contralateral hemiplegia
Possible contralateral CN III palsy
What deficits are expected, ipsilateral to the lesion, with medial inferior pontine syndrome?(4)
Cerebellar ataxia
Nystagmus
Paralysis of conjugate gaze to side of lesion
Diplopia
What deficits are expected, contralateral to the lesion, with medial inferior pontine syndrome? (2)
Hemiparesis UE, LE
Impaired sensation
What deficits are expected, ipsilateral to the lesion, with lateral inferior pontine syndrome? (5)
Cerebellar: ataxia, nystagmus, vertigo Facial paralysis Paralysis of conjugate gaze to side of lesion Deafness, tinnitus Impaired facial sensation
What deficits are expected, contralateral to the lesion, with lateral inferior pontine syndrome? (1)
Impaired pain and temperature sensation half of body
What deficits are expected with locked in syndrome? (5)
Tetraplegia Lower bulbar paralysis (CN V-XII) Mutism Preserved consciousness Preserved vertical eye movements and blinking
What deficits are expected, ipsilateral and contralateral to the lesion, with medial medullary syndrome?
Ipsilateral = paralysis of half of the tongue Contralateral = Hemiplegia of UE/LE and impaired sensation
Describe the position of the UE with a flexor synergy (7).
Scapular elevation and retraction Shoulder abduction and ER Elbow flexion Forearm supination Wrist flexion Finger flexion and adduction Thumb flexion and adduction
Describe the position of the UE with a extensor synergy (7).
Scapular depression and protraction Shoulder adduction and IR Elbow extension Forearm pronation Wrist extension Finger flexion with adduction Thumb flexion and adduction
Describe the position of the LE with a flexor synergy (4).
Hip abduction and ER
Knee flexion
Ankle DF and supination
Toe extension
Describe the position of the LE with a extensor synergy (4).
Hip extension, adduction and IR
Knee extension
Ankle PF and inversion
Toe flexion and adduction
List 4 outcome measures that are used specifically to assess impairments secondary to CVA.
- National Institute of Health (NIH) Stoke scale: assessment of an acute CVA relative to impairment
- Functional Independence Measure (FIM): provides a level of burden through assessment of mobility and ADL management
- Stroke Impact Scale: assessment of physical and social disability or level of impairment secondary to CVA
- Fugl-Meyer Assessment of Physical Performance: motor, sensory, and balance impairment; also assesses pain and ROM
List Brunnstrom’s seven stages of recovery.
Stage 1: No volitional movement initiated, flaccid
Stage 2: Emergence of spasticity, hyperreflexia, synergies
Stage 3: voluntary movement possible, but only in synergies, spasticity increases.
Stage 4: voluntary control in isolated joint movements emerging, decrease in spasticity and synergies
Stage 5: increasing voluntary control out of synergy; coordination deficits present
Stage 6: isolated joint movements are performed with coordination
Stage 7: normal motor function is restored
