CVA Flashcards
ischemia/cerebral infarction
embolism (cardiac/atrial sources)
- blood flow blocked, causing ischemia (lack of 02 in brain)
- due to age, gender, ethnicity, genetics
- hypertension, cardiac disease, glucose metabolism, cigarettes, alcohol, drugs, obesity, diet, exercise, emotional stress
hemorrhage
(subarachnoid or intracerebral types)
- blood vessel bursts in brain, causes pooling, interrupting blood flow
- result in cerebral anoxia & aneurysm
- due to AVM, ANEURYSM, age
- due to HBP, birth control, cigarettes, alcohol, drugs
MCA stroke
MOST COMMON CVA, LARGEST BRANCH TO ICA (supplies frontal, temporal, parietal lobes)
= contralateral hemiplegia: arms, face, tongue
- sensory deficits
- Hemianesthesia
- dominant hemisphere: contralateral homonymous hemianopsia & aphasia
- head deviated towards side with lesion
- anosognosia, visual perception,
- L MCA CVA: Aphasia & apraxia
- R MCA CVA: Unilateral neglect & spatial dysfunction
hemianesthesia
one sided loss of sensation
subarachnoid hemorrhage
bleeding in space surrounding brain
- aneurysm near surface of brain bursts, blood leaks into space between skull & brain
intracerebral hemorrhage
(hemorrhagic)
- ruptured blood vessel inside brain, causing blood to leak into brain tissue
cerebral anoxia
oxygen supply completely interrupted in the brain
embolism
clot, artery obstructed
deep hypertensive intracerebral hemorrhage
- involves ruptured saccular aneurysms, bleeding malformations, or spontaneous lobar hemorrhages
TIA
transient ischemic attack
- blood flow briefly interrupted
- mild, isolated symptoms, repetitive
- lasts few minutes to several hours with symptoms clearing completely
- can be sign of larger CVA
- due to atherosclerotic disease
frontal lobe
- motor control (premotor cortex)
- problem solving (prefrontal cortex)
- planning, behavior reg
- speech production (Broca’s)
temporal lobe
- hearing
- language comprehension (Wernicke’s)
- memory/information retrieval
parietal lobe
- touch perception (somatosensory cortex)
- body orientation
- sensory discrimination
occipital lobe
- sight
- visual reception/interpretation
cerebellum
balance & coordination
brainstem
involuntary responses
which brain artery is part of the circle of wilis?
internal carotid artery
facial analgesia or trigeminal neurologia
painful sensations (electric shock) on one side of face
L hemisphere deficits w/CVA
LOGIC
- receptive/expressive language (aphasia)
- reading & writing (alexia & agraphia)
- learning new info
- apraxia
- math (acalculia)
- R side movement, sensory info processing, visual reception
- bilateral motor praxis
- verbal memory, bilateral auditory reception/processing
is slow, cautious, frustrated & unmotivated
R hemisphere deficits w/CVA
CREATIVITY
- humor
- abstract thinking/information interpretation
- visual spatial/spatial perceptual
- swallowing (dysphagia), slurred speech (dysarthria)
- has short attention span
- prosopagnosia
- no orientation to person, place, time
- depth perception
- can’t hear tonal variations
- unable to attend to L side environment/body (neglect), sensory info, visual reception, motor praxis
- nonverbal memory
- emotional lability
- nonverbal auditory information
is impulsive, denies deficits (anosognosia), inappropriate comments, talks excessively, confabulation, euphoria, constant smiling, overestimates abilities
cerebellum deficits w/CVA
- coordination/balance
- eye movement (nystagmus, ocular dysmetria, poor pursuit)
- reflexes abnormal (head, torso)
- dysarthria
- ataxia
is dizzy, vomiting, nauseous, has headache
internal carotid artery CVA
similar to MCA CVA
- contralateral hemiplegia, hemianesthesia, homonymous hemianopsia
- dominant hemisphere: aphasia, agraphia, acalculia, R/L confusion, finger agnosia
- non dominant hemisphere: perceptual dysfunction, unilateral neglect, anosognosia, attention deficit, topographic memory loss
anterior cerebral artery CVA
FRONTAL LOBES
- contralateral: LE weakness (more severe than UE), hemiplegia
- grasp reflex
- incontinence
- apraxia
- apathy, mute
- mental changes: confusion, disorientation, whispering, slow processing, distractibility, limited verbalizations, amnesia
- primitive reflexes & incontinence
- LE cortical sensory loss
- total artery occlusion: contralateral hemiplegia (face, tongue, prox arm muscle severe weakness), spastic paralysis of distal LE
posterior cerebral artery CVA
TEMPORAL & OCCIPITAL LOBES, BRAINSTEM
- Broad, multiple symptoms
- Sensory motor deficits
- Involuntary movement disorders
- postural tremors
- hemiataxia
- memory loss
- astereognosis
- dysesthesia
- kinesthesia
- contralateral homonymous hemianopsia
- anomia, topographic disorientation, visual agnosia
- thalamic pain (neuropathic pain)
- hemisensory loss
- alexia
cerebellar artery CVA
CEREBELLUM
- Ipsilateral ataxia, facial analgesia
- contralateral loss of sensation of pain and temperature. hemiparesis
- Dysphagia, dysarthria
- nystagmus
what should be prevented following a CVA?
DVT in LEs due to bedrest
- clots can dislodge, travel to lungs, be deadly
when is the most crucial time for improvement after a CVA?
first 3-6 months
complications of a CVA
pneumonia, cardiac disease
cerebral arteriovenous malformation (AVM)
abnormal tangled collections of dilated blood vessels resulting from congenital malformed vascular structures
CVAs occur every
40 seconds
- person dies every 4 minutes
causes of death ranked
- heart disease
- cancer
- CVA
vertebrobasilar system results in
pseudobulbar signs (dysarthria, dysphagia, emotional instability), tetraplegia
modifiable risk factors of a CVA
hypertension, cardiac disease, afib, diabetes mellitus, smoking, alcohol abuse, hyperlipidemia
nonmodifiable risk factors of a CVA
age (increase), gender (more males), race (AA, Latino), heredity
how is CVA dx?
CT scan, PET scan, SPECT, MRI transcranial & carotid doppler, ECG, echocardiography, blood work
immediate medical management for a CVA
airway maintaince, adequate O2, IV fluids/alt feeding routes for nutrition, prevent bed sores, treat underlying cardiac dysfunction
pharmacology following CVA
- antithrombolytics (antiplatelet & anticoagulants- aspirin, heparin): reduce infarction area
- thrombolytics (t-PA) in acute strokes to restore blood flow, open cerebral arteries
Pusher syndrome
- following left or right brain damage in which patients actively push away from the non-hemiparetic side, leading to a loss of postural balance
- if unsupported = loss in lateral posture, falling on to their paretic side
- use mirror to help them orient their body to see whether they are actually upright (they perceive their body as upright when it is in fact tilted towards the side of the lesion)
