CVA Flashcards
what is the epidemiology of stroke?
4th leading cause of death
leading cause of long-term disability
of ischemic stroke survivors, 65+ incidences of disabilities observed at 6 months include:
- 50% hemiparesis
- 30% unable to walk w/out AD
- 26% dependent in ADLs
- 19% aphasia
- 35% depression
what is a major contributing factor to stroke?
atherosclerosis
what are modifiable risk factors?
HTN cigarette smoking heart disease disorders of heart rhythm peripheral artery disease diabetes sickle cell disease high blood cholesterol poor diet physical inactivity obesity
what are stroke warning signs (FAST)?
Face drooping/numb
Arm weakness
- ask the person to raise both arms- does 1 drift?
Speech difficulty
- slurred? ask person to repeat a simple sentence m
Time
-call quickly! check the time so you’ll know when symptoms appeared
what are the 3 types of stokes?
1- ischemic stroke
2- hemorrhagic stroke
3- transient ischemic attack
what is an ischemic stroke?
obstruction of BF to the brain
- thrombosis- arterial, venous
- embolism
- or caused by conditions that produce systemic perfusion pressures (cardiac failure, significant blood loss)
80% of strokes are ischemic
what is a hemorrhagic stroke?
rupture of flow of blood to the brain and preventing blood flow to the brain
3 types:
1- intracerebral
2- primary cerebral
3- subarachnoid
what is an intracerebral hemorrhage (ICH)?
release of blood into brain tissue from rupture of cerebral vessel
what is a primary cerebral hemorrhage ?
typically occurs in the small blood vessels weakened by arteriosclerosis producing an aneurysm
what is a subarachnoid hemorrhage?
rupture of an aneurysm primarily affecting large blood vessels causing a bleed into the subarachnoid space
what is a transient ischemic attack (TIA)?
“mini stroke” or “silent stroke” or temporary clot
- can be a precursor to CVA or MI
- don’t last more than 24 hours
what is tPA?
“tissue plasminogen activator”
clot-bursting drug
reversal of stroke symptoms
the number of acute stroke victims in low
1- tPA can only be given w/in 3 hours
- ppl ignore symptoms
- stroke occurs in sleep
2- pts must have a CT scan before receiving the drug
-tPA is only effective in ischemic strokes
3- Dr.s are reluctant to give bc of risks:
-fatal hemorrhaging in 5%
the internal carotid artery produces a massive infarction in :
both MCA and ACA territories
the middle cerebral artery supplies where?
the entire lateral aspect of the cerebral hemispheres (frontal, temporal and parietal lobes) and subcortical structures
where does the anterior cerebral artery supply?
the medial aspect of the cerebral hemispheres (frontal and parietal lobes) and subcortical structures including the basal ganglia
where does the vertebrobasilar artery supply?
the cerebellum and medulla (vertebral artery) as well as the pons, internal ear and cerebellum (basilar artery)
where does the posterior cerebral artery supply?
the corresponding occipital lobe and medial and inferior temporal lobe, upper brainstem, midbrain, posterior diencephalons and most of the thalamus
what are clinical S&S of an infarct in the MCA on the non-dominant side?
(non-dominant: R hemisphere in R handed person)
weakness of L side of face, arm and (to lesser extent) leg
L sensory disturbance
visual disturbance: homonymous hemianopsia
confusion, sensory and/or motor neglect
what are clinical S&S of an infarct in the MCA on the dominant side?
(dominant: L hemisphere stroke on R handed person)
weakness of R side of face and R arm (R leg less affected)
R sensory impairment
speech disturbance (dysphasia), Broca’s or Wernicke’s aphasia, including difficulty in comprehending written words and writing
visual disturbance: homonymous hemianopsia
what are clinical S&S of an infarct in the ACA?
paresis of opposite foot and leg and to a lesser extent the arm *
mental impairments (perseveration, confusion and amnesia)
sensory impairments (primarily in LEs)
urinary incontinence
problems with imitation and bimanual tasks, apraxia
abulia (akinetic mutism), slowness, delay, lack of spontaneity, motor inaction
what are clinical S&S of an infarct of the internal carotid artery?
mixture of MCA and ACA symptoms
what are clinical S&S of an infarct of the veretebrobasilar artery?
location of occlusion determines S&S. Most common are:
1- Lateral medullary syndrome (Wallenberg’s) - occlusion of vertebral, posterior inferior cerebellar and basilar
2- Basilar artery syndrome- “locked in syndrome” - combo of various brainstem syndromes
what are S&S of lateral medullary syndrome (Wallenberg’s)?
ipsilateral to lesion
decreased P&T sensation to face
ataxia of limb, falling to side of lesion
vertigo
nystagmus
Horner’s syndrome (miosis, pitosis, decreased sweating)
dysphagia, hoarseness, paralysis of vocal cord, diminished gag reflex)
sensory impairment and thermal sense over 50% of body, sometimes face
contralateral to lesion:
-impaired pain and thermal sense over 50% of body, sometimes face
what are S&S of basilar artery syndrome (“locked in”)?
paralysis of weakness of all extremities
diplopia, paralysis of conjugate lateral or vertical gaze, internuclear opthalmoplegia, horizontal or vertical nystagmus
blindness, impaired vision
coma
sensation may be intact
thalamic pain syndrome
what are clinical S&S of an infarct of the PCA in the peripheral territory?
contralateral or bilateral homonymous hemianopsia with some degree of macular sparing
prosopagnosia
dyslexia without agraphia, anomia (color naming) and color discrimination problems
memory defect
topographic disorientation
what are clinical S&S of an infarct of the PCA in the central territory?
thalamic syndrome: sensory impairments (all modalities), spontaneous pain and dysethesias
involuntary movements
contralateral hemiplegia
weber’s syndrome (oculomotor nerve palsy and contralateral hemiplegia)
paresis of vertical eye movements, slight mitosis and ptosis, and sluggish papillary light response
L hemisphere strokes present with what common intellectual deficits?
disorganized problem solving
difficulty initiating tasks, processing delays
highly distractible, perseveration
memory impairments
R hemisphere strokes present with what common intellectual deficits?
difficulty with abstract reading, problem solving
difficulty synthesizing info and grasping whole ideas
rigidity of thought, memory impairment
L hemisphere strokes present with what common perception/cognition impairments?
processing and producing language
dominant hemisphere:
Broca’s, Wernicke’s or global aphasia
R hemisphere strokes present with what common perception/cognition impairments?
difficulty processing visual cues
visuospatial disorders
agnosias
L unilateral neglect
disturbance of body image and scheme
L hemispheric strokes typically present with what impairments to academic skills?
reading
performing math calculations
R hemispheric strokes typically present with what impairments to academic skills?
math reasoning and judgement
alignment of numeral in calculations
L hemispheric strokes typically present with what impairments to task performance?
apraxia common; difficulty planning and sequencing movements
ideational, ideomotor
R hemispheric strokes typically present with what impairments to task performance?
sustaining a movement or posture
fluctuations in performance
what are common emotional deficits of a L hemispheric stroke?
expression of positive emotions
what are common emotional deficits of a R hemispheric stroke?
expression of negative emotions
patients with an infarct in the L hemisphere tend to be:
cautious anxious disorganized hesitant to try new tasks realistic
patients with an infarct in the R hemisphere tend to :
be quick and impulsive
overestimate their abilities
be unaware or in denial of deficits
have poor judgement
have poor insight
people with aphasia may:
be disrupted in their ability to use language in ordinary circumstances
have difficulty communicating in daily activities
have difficulty communicating at home, in social situations or at work
feel isolated
what is Broca’s aphasia?
injury of the frontal regions of the L hemisphere causes different kinds of language problems
may have difficulty forming complete sentences
may get out some basic words to get their message across, but leave out words like “is” or “the”
often say something that doesn’t resemble a sentence
can have difficulty understanding sentences
can make mistakes in following directions like “left, right, under, and after”
people with comprehension problems:
know that people are speaking to them
can follow some of the melody of sentences– realizing if someone is asking a question or expressing anger
may have great difficulty understanding specific words
may have great difficulty understanding how words go together to convey a complete thought
what is wernicke’s aphasia?
often say many words that don’t make sense
may fail to realize they are saying the wrong words (“gleeble”)
may string together a series of meaningless words that sound like a sentence but don’t make sense
have challenges bc our dictionary of words is in a similar region of the L hemisphere, near the area used for understanding words
what is global aphasia?
when a stroke affects an extensive portion of the front and back regions of the L hemisphere
may have great difficulty in understanding words and sentences
may have great difficulty in forming words and sentences
may understand some words
get out a few words at a time
have severe difficulties that prevent them from effectively communicating
what is an important distinction to make when someone has aphasia?
the distinction between language and intelligence:
many people mistakenly think they are not as smart as they used to be
their problem is that they can’t use language to communicate what they do know
they can think, just can’t say what they’re thinking
can remember familiar faces
can get from place to place
still have political opinions
may still be able to play chess
what is apraxia?
unable to perform tasks or movements when asked, even though:
- the request or command is understood
- they are willing to perform the task
- the muscles needed to perform the task work properly
- the task may have already been learned
- it may be motor, verbal or perceptual/functional
what is verbal apraxia?
difficulty initiating and executing voluntary movement patterns necessary to produce speech when there is no paralysis or weakness of speech muscles
usually coupled with aphasia
may cause difficulty:
- producing desired speech sound
- using the correct rhythm and rate of speaking
what is buccofacial or orofacial apraxia?
can’t carry out movements of the face on demand, such as licking lips, sticking out tongue, whistling
what is ideational apraxia?
inability of the patient to produce movement either on command or automatically
what is ideomotor apraxia?
pt. is unable to produce movement on command but is able to perform automatically.
for instance, the pt. may fail to walk in a traditional manner. However, if a cup of coffee is placed on a table at the other end of the room and the pt. is told to “please have coffee”, they pt. is likely to walk over and get it
what is limb-kinetic apraxia?
difficulty making precise movements with an arm or leg
what is agnosia?
loss of ability to recognize objects, persons, sounds, shapes, or smells while the specific sense is not defective nor is there any significant memory loss
1- visual
2- auditory
3- tactile
what is visual agnosia called?
simultanagnosia= inability to perceive visual stimulus as a whole
prospagnosia= inability recognize ambiguous stimuli (faces, birds)
color agnosia= inability to recognize colors
what is auditory agnosia?
inability to recognize non-speech sounds (doorbell vs. telephone)
what is tactile agnosia called?
asterognosis
what are 3 types of neglect?
1- visual
- “visual field deficit” or “hemianopsia”
2- sensory
- numbness or loss of feeling in the face, arm or leg. It may be temporary or more severe.
3- perceptual
- impairment of judgement and poor safety awareness.
- The inability to take in info and make sense of the surrounding world.
