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Neuro Clinic > CVA > Flashcards

CVA Flashcards

1
Q

what is the epidemiology of stroke?

A

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
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2
Q

what is a major contributing factor to stroke?

A

atherosclerosis

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3
Q

what are modifiable risk factors?

A 
HTN
cigarette smoking
heart disease
disorders of heart rhythm
peripheral artery disease
diabetes
sickle cell disease
high blood cholesterol
poor diet
physical inactivity
obesity
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4
Q

what are stroke warning signs (FAST)?

A

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

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5
Q

what are the 3 types of stokes?

A

1- ischemic stroke

2- hemorrhagic stroke

3- transient ischemic attack

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6
Q

what is an ischemic stroke?

A

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

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7
Q

what is a hemorrhagic stroke?

A

rupture of flow of blood to the brain and preventing blood flow to the brain

3 types:
1- intracerebral
2- primary cerebral
3- subarachnoid

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8
Q

what is an intracerebral hemorrhage (ICH)?

A

release of blood into brain tissue from rupture of cerebral vessel

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9
Q

what is a primary cerebral hemorrhage ?

A

typically occurs in the small blood vessels weakened by arteriosclerosis producing an aneurysm

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10
Q

what is a subarachnoid hemorrhage?

A

rupture of an aneurysm primarily affecting large blood vessels causing a bleed into the subarachnoid space

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11
Q

what is a transient ischemic attack (TIA)?

A

“mini stroke” or “silent stroke” or temporary clot

  • can be a precursor to CVA or MI
  • don’t last more than 24 hours
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12
Q

what is tPA?

A

“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%

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13
Q

the internal carotid artery produces a massive infarction in :

A

both MCA and ACA territories

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14
Q

the middle cerebral artery supplies where?

A

the entire lateral aspect of the cerebral hemispheres (frontal, temporal and parietal lobes) and subcortical structures

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15
Q

where does the anterior cerebral artery supply?

A

the medial aspect of the cerebral hemispheres (frontal and parietal lobes) and subcortical structures including the basal ganglia

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16
Q

where does the vertebrobasilar artery supply?

A

the cerebellum and medulla (vertebral artery) as well as the pons, internal ear and cerebellum (basilar artery)

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17
Q

where does the posterior cerebral artery supply?

A

the corresponding occipital lobe and medial and inferior temporal lobe, upper brainstem, midbrain, posterior diencephalons and most of the thalamus

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18
Q

what are clinical S&S of an infarct in the MCA on the non-dominant side?

(non-dominant: R hemisphere in R handed person)

A

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

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19
Q

what are clinical S&S of an infarct in the MCA on the dominant side?

(dominant: L hemisphere stroke on R handed person)

A

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

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20
Q

what are clinical S&S of an infarct in the ACA?

A

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

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21
Q

what are clinical S&S of an infarct of the internal carotid artery?

A

mixture of MCA and ACA symptoms

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22
Q

what are clinical S&S of an infarct of the veretebrobasilar artery?

A

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

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23
Q

what are S&S of lateral medullary syndrome (Wallenberg’s)?

A

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

24
Q

what are S&S of basilar artery syndrome (“locked in”)?

A

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

25
Q

what are clinical S&S of an infarct of the PCA in the peripheral territory?

A

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

26
Q

what are clinical S&S of an infarct of the PCA in the central territory?

A

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

27
Q

L hemisphere strokes present with what common intellectual deficits?

A

disorganized problem solving

difficulty initiating tasks, processing delays

highly distractible, perseveration

memory impairments

28
Q

R hemisphere strokes present with what common intellectual deficits?

A

difficulty with abstract reading, problem solving

difficulty synthesizing info and grasping whole ideas

rigidity of thought, memory impairment

29
Q

L hemisphere strokes present with what common perception/cognition impairments?

A

processing and producing language

dominant hemisphere:

Broca’s, Wernicke’s or global aphasia

30
Q

R hemisphere strokes present with what common perception/cognition impairments?

A

difficulty processing visual cues

visuospatial disorders

agnosias

L unilateral neglect

disturbance of body image and scheme

31
Q

L hemispheric strokes typically present with what impairments to academic skills?

A

reading

performing math calculations

32
Q

R hemispheric strokes typically present with what impairments to academic skills?

A

math reasoning and judgement

alignment of numeral in calculations

33
Q

L hemispheric strokes typically present with what impairments to task performance?

A

apraxia common; difficulty planning and sequencing movements

ideational, ideomotor

34
Q

R hemispheric strokes typically present with what impairments to task performance?

A

sustaining a movement or posture

fluctuations in performance

35
Q

what are common emotional deficits of a L hemispheric stroke?

A

expression of positive emotions

36
Q

what are common emotional deficits of a R hemispheric stroke?

A

expression of negative emotions

37
Q

patients with an infarct in the L hemisphere tend to be:

A 
cautious 
anxious
disorganized
hesitant to try new tasks
realistic
38
Q

patients with an infarct in the R hemisphere tend to :

A

be quick and impulsive

overestimate their abilities

be unaware or in denial of deficits

have poor judgement

have poor insight

39
Q

people with aphasia may:

A

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

40
Q

what is Broca’s aphasia?

A

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”

41
Q

people with comprehension problems:

A

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

42
Q

what is wernicke’s aphasia?

A

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

43
Q

what is global aphasia?

A

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

44
Q

what is an important distinction to make when someone has aphasia?

A

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

45
Q

what is apraxia?

A

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
46
Q

what is verbal apraxia?

A

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
47
Q

what is buccofacial or orofacial apraxia?

A

can’t carry out movements of the face on demand, such as licking lips, sticking out tongue, whistling

48
Q

what is ideational apraxia?

A

inability of the patient to produce movement either on command or automatically

49
Q

what is ideomotor apraxia?

A

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

50
Q

what is limb-kinetic apraxia?

A

difficulty making precise movements with an arm or leg

51
Q

what is agnosia?

A

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

52
Q

what is visual agnosia called?

A

simultanagnosia= inability to perceive visual stimulus as a whole

prospagnosia= inability recognize ambiguous stimuli (faces, birds)

color agnosia= inability to recognize colors

53
Q

what is auditory agnosia?

A

inability to recognize non-speech sounds (doorbell vs. telephone)

54
Q

what is tactile agnosia called?

A

asterognosis

55
Q

what are 3 types of neglect?

A

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.

Neuro Clinic (14 decks)

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