CVA Flashcards
CVA Description
- Interruption of blood flow to the brain; inadequate supply of oxygen /
nutrients
-any part of the brain, mostly left
Ischemic Stroke
-most common
-blockage
-Thrombotic - blood clot in artery (night)
-Embolic - Clot that broke elsewhere & gets stuck in brain (day)
-Lacunar - small infract (motor deficits)
Hemorrhagic Stroke
- BY aneurysm (vessel rupture)
-Intracerebral hemorrhage -bleeding directly into brain
-Subarachnoid hemorrhage- bleeding around brain (worst headache)
-recover more slowly
Ischemic Stroke Risk factors
History of hypertension
Smoking
Waist-to-hip ratio
Diet risk score
Regular physical activity
Diabetes mellitus
Alcohol intake
Psychological stress
Cardiac problems
Intracerebral hemorrhagic stroke risk factor
Smoking
Hypertension
Diet
Alcohol intake
Waist-to-hip ratio
* Other: TIA’s, oral contraceptives, prior
CVA, infections / inflammation, ethnicity, geographical location, sleep apnea
CVA Incidence and Prevalence
- 4th leading cause of death in US
- 50% - 70% regain functional independence
- 15% - 30% some permanent disability
- Hemorrhagic strokes less frequent (20%)
- Ischemic strokes (80%)
- Depression affects 1/3 of stroke survivors
Peds stroke
-frequent in children younger than 2 CVA is 17 times more common in the perinatal period than later in childhood
1.2 -13 cases / 100,000 children / yr
50% ischemic
50% -90% experience residual neuro deficits
FAST
- Face drooping
- Arm weakness
- Speech difficulty
- Time to call 911
Also - Trouble with balance / coordination
- Severe headache
- Everyone’s different
Left-Sided : Middle Cerebral Artery symptoms
-Loss of voluntary movement and coordination on the right side
-Impaired sensation on right side
-Language deficits, called aphasia
-Blind spots on the right side
- Slow and cautious personality
- Memory deficits for recent or past events
Right-Sided : Middle Cerebral Artery symptoms
-Weakness (hemiparesis) or paralysis (hemiplegia) on the left side
- Impairment of sensation on the
left side
-3. Spatial and perceptual deficits
-Unilateral inattention (neglect), patient neglects the left side of the
body /environment
-Dressing apraxia, unable to relate the articles of clothes to the body
-Defective vision in the left halves of visual fields or left homonymous hemianopsia
-Impulsive behavior, quick
Anterior Cerebral Artery Stroke symptoms
-Paralysis of the lower extremity
-Loss of sensation in the contralateral toes, foot, and leg
- Loss of conscious control of bowel or bladder
-Balance problems in sitting, standing, and walking
-Lack of spontaneity of emotion, whispered speech, or loss of all communication
-Memory impairment
Vertebrobasilar Stroke symptoms
-visual disturbances
-Impaired temperature sensation
-Impaired ability to read and/or name objects
-Vertigo, dizziness
- Paralysis of the face, limbs, or tongue
-Clumsy movements of the hands
- Difficulty judging distance (dysmetria)
-Drooling and difficulty swallowing (dysphagia)
-Localized numbness
- Loss of memory
-Drop attacks
Wallenberg’s Syndrome
-rare, loss of consciousness quickly, usually fatal
-Classic brainstem stroke
Contralateral pain / temperature loss
Ipsilateral Horner’s syndrome
- Sinking of the eyeball, ptosis of the upper eyelid, and a dry, cool face
Ataxia
-Loss of the ability to coordinate
Dysphagia
- Swallowing deficits
Facial sensory loss
Possible Complications
-Seizures
-Thromboembolism -
Infection
Transient Ischemic Attacks (TIA)
- Temporary Blockage to the Brain
Symptoms occur rapidly and last for <24 hours
75% of TIA’s last < 5 min
Symptoms: Fleeting blindness in one eye, Hemiparesis,
Dizziness, Double vision, Staggering
10-15% of clients who experience a TIA will have a CVA within 3 months
Subclavian Steal Syndrome
-narrowing of the subclavian artery
-blood is “stolen” from the brain and is delivered to arm.
Small Strokes
- May last longer than 24 hours
Results in only minor neurological deficits
RIND - A small stroke that completely resolves is called a reversible ischemic neurological deficit (RIND).
- in the morning
PRIND - more than 72 hours and leaves some minor neurological
impairments is called a partially reversible ischemic neurologic deficit (PRIND)
Neural plasticity:
brain’s ability to create new neural pathways through the life span
Medical Management
-Antiplatelet Therapy
-Anticoagulants
-Thrombolytics (tPA)
-Surgical Interventions
CVA Diagnosis
- Computed Tomography (CT)
Magnetic Resonance Imaging (MRI)
Positron Emission Tomography (PET scan) - Invasive Technique
Cerebral angiography
Impact on Occupational Performance: Sensory
-loss of protective tactile functions
-Proprioceptive dysfunction
-Vestibular and postural dysfunction
-Visual Deficits
-Agnosia
- inability to recognize and identify objects or persons
-Astereognosis - can’t tell your holding keys
-Lesions in the left cerebral hemisphere
-Unilateral body inattention (or neglect)
Impact on Occupational Performance: Motor
-cant carry out verbal request
-Abnormal muscle tone spasticity or flaccidity
-Associated Reactions
* Abnormal reflex movements
-Associated movements
* Accompany voluntary movements and are normal
Impact on Occupational Performance: The Brain
-Mental
-communication
-Mood Disorders
-Emotional Deficits
shoulder
-Hemiplegic shoulder -shoulder subluxation, pain, and immobility.
-Painful shoulder: flaccid or spastic muscle tone and with or without subluxation
-Fear of pain
Agnosia
Aphasia
Apraxia
-loss of the ability to identify objects
-trouble reading speaking and writing
-cant make words with mouth
Dysarthria
Dysphagia
-difficulty with speech cause of weak muscle
-difficulty swallowing
Homonymous hemianopsia (hemianopia)
-makes you see only one side of the visual field of each of your eyes.
-easily startled
Hemiparesis
Hemiplegia
Hypotonus
-weakness or partial paralysis on one side of the body
-paralysis on one side of the body
-decreased muscle tone
Infract
localized area of ischemic necrosis
Emotional lability
-exaggerated change on mood
-laugh at inappropriate time
