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NM PCM > CVA > Flashcards

CVA Flashcards

1
Q

Brain attack

A

Sudden loss of neurological function caused by an interruption of the blood flow to the brain (with effects lasting more than 24 hours)

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2
Q

Early warning signs of stroke

A

Sudden:

  • numbness/weakness of face/arm/leg esp on one side of body
  • confusion, trouble speaking or understanding
  • trouble seeing in one eye
  • walking/dizzy/LOB/coordination
  • severe headache with no known cause
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3
Q

Is stroke a leading cause of death?

A

yes.

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4
Q

Which type of stroke is “more survivable”? More prevalent?

A

Ischemic for both.

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5
Q

Thrombolic ischemic stroke

A 
Atherosclerotic plaques form  
Intermittent blockage (cerebral vasospasm) may progress to permanent damage. Often take several hours to occlude the artery
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6
Q

Embolic ischemic stroke

A

From a traveling blood clot into the brain. May come from heart, internal carotid artery, plaque of carotid sinus. Sign of cardiac disease.

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7
Q

What is a hemorrhagic stroke?

A

Usually causes massive bleeding in oval or round mass that displaces midline structures, linked to HTN.

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8
Q

Types of Ischemic stroke

A

Cerebral thrombosis
Cerebral infarction
Cerebral embolis

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9
Q

Types of hemorrhagic stroke

A

Intracerebral hemorrhage
Aneurysm
Subarachnoid hemorrhage
Arteriovenous malformation

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10
Q

What is a TIA?

A

Transient Ischemic Attack: thrombolic build up paired with vasospasm temporarily cuts off the blood supply. Sx

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11
Q

Which artery is most often occluded with an embolic infarction?

A

Middle cerebral artery (direct continuation from internal carotid)

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12
Q

Intracranial hemorrhage

A

rupture of cerebral vessel

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13
Q

Subarachnoid hemorrhage

A

bleeding into subarachnoid space from saccular or berry aneurysm

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14
Q

What is the leading cause of chronic disability?

A

Strroke

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15
Q

What are some factors that make you more at risk?

A

Advanced age, male, AA > Mexican > native american > caucasion, atherosclerosis, hypertension, heart disease/cardiac disorders, diabetes.
high cholesterol, LDL, hematocrit, TIA
Smoking, obesity, sedentary, diet, excess alcohol, family Hx

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16
Q

Ischemic umbra

A

Core area of focal infarction

Irreversible cellular damage

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17
Q

Ischemic penumbra

A

Viable, but metabolically lethargic cells

Potentially damaged by ischemic cascade, thus becoming an area of extension of infarction

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18
Q

When does cerebral edema reach its max? When does it resolve?

A

3-4 days.

2-3 weeks.

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19
Q

What is subclavian seal syndrome?

A

Narrowing of proximal subclavian artery. blood flows up CL vertebral artery –> circle of WIllis –> ipsilateral vertebral artery to distal subclavian artery

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20
Q

Signs/Symptoms of subclavian steal syndrome

A

Dizziness, arm claudication

BP difference > 20 mmHg

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21
Q

What does the anterior cerebral artery supply?

A

Medial aspect of the cerebral hemisphere. (Frontal, parietal lobes, basal ganglia)

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22
Q

What does anterior cerebral artery syndrome cause?

A

Contralateral hemiparesis, ESP LE. Sensory loss greater in LE than UE.

23
Q

What does the middle cerebral artery supply?

A

lateral aspect of the cortex
Frontal, temporal, parietal lobes
Subcortical structures (internal capsule, globus pallidus, caudate nucleus, putamen)

24
Q

What does middle cerebral artery syndrome cause?

A

CL hemiparesis (UE/face > LE), CL sensory loss, Aphasia (type depends on location), Homonymous hemianopsia

25
Q

What does the internal carotid artery supply?

A

both the anterior and middle cerebral arteries. Can cause extensive cerebral infarction, cerebral edema, uncal herniation, death. Really major.

26
Q

What does posterior cerebral artery syndrome cause?

A

CL homonymous hemianopsia, visual agnosia, prospagnosia, dyslexia, memory deficit, topographic disorientation. Central post-stoke (thalamic) Pain (constant, burning, intermittent sharp pain, increased with noxious stimuli)

27
Q

What is involved in a pure motor lacunar stroke?

A

Posterior limb of internal capsule, pons, pyramids

28
Q

What is involved in a pure sensory lacunar stroke?

A

Ventrolateral thalamus or thalamocortical projections

29
Q

What happens in vertebrobasilar artery syndromes?

A

paralysis of UE/LE, impaired tactile/proprioceptive sense, cerebellar or limb ataxia, vertigo/nausea/balance, nystagmus, horners syndrome, involvement of CN V–> XII

30
Q

What does horners syndrome involve?

A

Miosis (constricted pupil), ptosis, anhidrosis

31
Q

What is locked in syndrome?

A

Complete basilar artery thrombosis & bilateral infarction of pons. VERY large stroke.

32
Q

What happens with locked in syndrome?

A

Paralysis (tetra/guadriplegia, lower bulbar paralysis)

Mutism (anarthria)

33
Q

What is preserved in locked in syndrome?

A

Consciousness, sensation, vertical eye movements, blinking

34
Q

What’s the primary goal of medical management of CVA?

A

Prevent ischemic tissue from becoming infarcted tissue.
(maintain BP, CO, fluids etc.)
Control seizures, ICP and herniation

35
Q

What is tPA?

A

Tissue plasminogen activator.

Clot bluster, thrombolytic

36
Q

Types of medical surgical management

A

Neurosurgical: endarterectomy, craniotomy, embolectomy

37
Q

What structures are exposed in a fronto-temporal craniotomy?

A

Optic nerve and internal carotid

38
Q

What is important for PT’s to know post-op a craniotomy?

A

HEAD ELEVATED ~ 30 degrees.

39
Q

What is the major vessel that supplies blood to the brain?

A

Carotid artery (splits into internal and external)

40
Q

Which is better a carotid endarterectomy or stent?

A

Equally effective

41
Q

What is MERCI?

A

Mechanical Embolus Removal in Cerebral Ischemia. Used to remove blood clots from vessels deep inside the brain
Can be used for up to 8 hours after an acute ischemic stroke

42
Q

Types of attention

A

Sustained, selective, divided, alternating

43
Q

Ideational apraxia

A

unable on command/automatically

44
Q

Ideomotor apraxia

A

unable on command

45
Q

Why will there be some spontaneous recovery in these pts?

A

resolution of cerebral edema

46
Q

What improves prognosis?

A 
Minor vs major
initial grade of paresis
less motor/perceptual problems
high social support/motivation
Intensive training with repetition
47
Q

Acute phase rehab

A

Acute care hospital 3-7 days

Early mobilization, edu, support

48
Q

CARF

A

Governing body for INPATIENT rehab. have 3 hour rule, 3 hours must be PT, OT or speech ONLY.

49
Q

What determines where a pt goes after acute phase?

A

Discharge disposition

50
Q

JHACO

A

accredit acute hospitals and inpatient rehab. 2 or more disciplines at lease 5 days a week. Must be able to tolerate 3 hrs per day and need to actively tolerate.

51
Q

What facilities provide less intense rehab services?

A

TCU, SNU, SNF

52
Q

Chronic phase rehab

A

3-6 months or more after onset

Outpatient rehab, outpatient PT, home

53
Q

What is the definition of home bound?

A

you can leave the home to visit your physician but you can’t go grocery shopping, to church, out to dinner, etc.

NM PCM (6 decks)

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