CVA

Question 1

Typical Left CVA

Answer 1

aphasia, apraxia, language memory deficits, slow

Question 2

Typical Right CVA

Answer 2

visual/perception deficits, quick/impulsive, poor judgement, spatial memory deficits

Question 3

ACA syndrome

Answer 3

ACA from internal carotid and supplies medial portions of frontal and parietal lobes. More distal lesions produce more significant defects.

Contra lateral hemiparesis and sensory loss LE>UE

Urinary incontinence

Apraxia, difficulty with bimanual tasks (corpus callosum)

Abulia (motor delay/inaction)

Contra lateral grasp reflex, sucking reflex

Question 4

PCA syndrome

Answer 4

PCA from Basilar artery and supplies the occipital lobe and medial/inferior temporal lobe, as well as upper brainstem. Minimal deficits due to collateral blood supply of post comm artery.

Peripheral:
Contra homonymous hemianopsia or bilateral with macular sparing (occipital pole supplied by MCA)

Visual agnosia, prosopagnosia (faces)

Memory defect

Central:
Thalamic pain

Hemiballismus, intention tremor

Contra hemiplegia

Webers syndrome: oculomotor nerve palsy and contra hemiplegia

Oculomotor deficits

Question 5

MCA

Answer 5

MCA from internal carotid and supplies lateral aspect of frontal, temporal and parietal lobes, as well as subcortical structures. Proximal occlusion very damaging and causes cerebral edema.

Contralateral spastic hemiparesis and sensory loss of face/UE>LE.

Aphasia (brocas, wernickes)

Perceptual deficits (unilateral neglect, anosognosia (unaware of deficit), apraxia, spatial disorganization)

Homonymous hemianopsia (visual field defect)

Loss of opposite side conjugate gaze

Contra limb ataxia

Question 6

Eye deviations:
Down and out
toward intact side
upward
cannot look toward intact

Answer 6

Down and out: cnIII
CORTEX: toward intact side
Upper brainstem: upward
Pontine: cannot look toward intact

Question 7

Spasticity interventions

Answer 7

UE spasticity: wb on UE and weight shift

LE spasticity: bridging

Question 8

LE extensor synergy

Answer 8

hip ext
hip add and IR
knee ext
PF and inversion

Question 9

LE flexor synergy

Answer 9

hip flexion
hip abd and ER
knee flex to 90
DF and inversion

Question 10

UE extensor synergy

Answer 10

retract/elevate shld
ER
ABD 90
elbow flexion
full range supination

Question 11

UE flexor synergy

Answer 11

protraction
IR
adduction
elbow ext
full range pronation

Question 12

Stages of recovery/synergy

Answer 12

1. Flaccid
2. pre-synergy
3. synergy
4. deviation out of synergy
5. relative independence of synergy
6. coordinated movement close to normal
7. Normal