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Adult Neuro > CVA > Flashcards

CVA Flashcards

1
Q

What are the two types of stroke?

A

ischemic (80)

hemmorrhagic (20)

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2
Q

Ischemic stroke

A

Most common

Result from thrombosis (static clot) or emboli (traveling clot, thrombi, tissue, fat, air, bacteria)

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3
Q

Hemorrhagic stroke

A

Bleeding into brain tissue
Can result from HTN, aneurysms, or head injury
Tend to be the MOST FATAL

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4
Q

Risk factors for stroke:

A

atherosclerosis
hypertension
cardiac disease
diabetes, metabolic syndrome

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5
Q

What is a Transient Ischemic Attacks?

A

brief warning episodes of dysfunction

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6
Q

Cerebral anoxia

A

lack of oxygen supply to the brain (irreversible anoxic damage to the brain begins after 4-6 mins)

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7
Q

Cerebral infarction:

A

irreversible cellular damage

death of a portion of the brain

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8
Q

Cerebral edema

A

accumulation of fluids within brain; causes further dysfunction; elevates intracranial pressures, can result in herniation and death

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9
Q

Lacunar infarcts:

A

Small clots located in the deep regions of the brainstem & subcortical structures

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10
Q

Where are lacunar infarcts usually found?

A

Found in deeply penetrating arteries that supply the internal capsule, basal ganglia, and brainstem

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11
Q

What do lacunar infarcts results from?

A

occlusion of smaller branches of larger cerebral arteries

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12
Q

Where do lacunar infarcts usually occur?

A

MCA and PCA

also Anterior Cerebral, Vertebral, & 
Basilar arteries

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13
Q

Emboli

A

Clots that dislodge from their site of origin & travel to a cerebral blood vessel where they become trapped and interrupt blood flow

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14
Q

Aneurysm:

A

Bulge occurring in a blood vessel wall as a result of a clot formation

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15
Q

Where do Berry aneurysms commonly occur?

A

in the Circle of Willis or the junction of 2 vessels

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16
Q

Transient Ischemic Attack (TIA)

A

“Mini strokes”

Characterized by focal ischemic cerebral incidents that last for less than 24 hours

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17
Q

Signs and symptoms of a TIA:

A

Numbness & mild weakness on 1 side of the body
Transient visual disturbances (blurred vision, fading vision)
Dizziness
Falls
Confusion & possible blackout

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18
Q

Common Areas of Arterial Occlusions in the Cortex

A

Middle Cerebral Arterial (MCA) Occlusion
Posterior Cerebral Arterial (PCA) Occlusion
Anterior Cerebral Arterial (ACA) Occlusion

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19
Q

What sensation is lost with ACA stroke?

A

sensation of lower limb

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20
Q

What sensation is lost with MCA stroke?

A

hemianesthesia affecting face and UL more than LL

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21
Q

What sensation is lost with PCA stroke?

A

hemianesthesia

slow pain in preserved

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22
Q

What sensation is lost with Basilar artery stroke?

A

bilateral sensory loss

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23
Q

What motor function is impaired with ACA stroke?

A

apraxia
hemiplegia (LE more affected then UE and face)
impaired gait

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24
Q

What motor function is impaired with MCA stroke?

A

Face and UE more impaired then LE; if striate artery involved additionally LE paresis or paralysis

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25
Q

What motor function is impaired with PCA stroke?

A

hemiparesis

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26
Q

What happens to motor function with a PCA stroke if the lesion is near origin of artery?

A

vertical gaze palsy
oculomotor nerve palsy
loss of medial deviation of the eyes with preserved convergence
vertical skew deviation of eyes

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27
Q

What motor function is impaired with Basilar artery stroke?

A 
tetraplegia
abducens nerve palsy
locked in syndrome
oculomotor nerve palsy
decorticate or decerebrate
paresis or paralysis of muscles of tongue,lips, palate, pharynx and larynx
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28
Q

Cognition with ACA stroke?

A

difficulty with convergent thinking

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29
Q

Cognition with left MCA stroke?

A

aphasia

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30
Q

Cognition with right MCA stroke?

A

difficulty understanding spatial relationships, neglect, impairment of nonverbal communication, dressing apraxia, constructional apraxia

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31
Q

Cognition with PCA stroke?

A

difficulty reading

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32
Q

Cognition with Basilar artery stroke?

A

reduced consciousness

33
Q

Emotions and behavior with ACA stroke?

A

flat affect, impulsiveness, perseveration, confusion, motor inactivity

34
Q

Emotions and behavior with right hemisphere MCA?

A

easily distracted
poor judgement
impulsiveness

35
Q

Emotions and behavior with left hemisphere MCA?

A

apraxia
compulsiveness
overly cautious

36
Q

Emotion and behavior with PCA stroke?

A

memory loss

37
Q

Emotion and behavior with Basilar artery stroke?

A

none

38
Q

Special senses and autonomic function with ACA stroke?

A

no changed

39
Q

Special senses and autonomic function with MCA stroke?

A

homonymous hemianopia

40
Q

Special senses and autonomic function with PCA stroke?

A

homonymous hemianopia, cortical blindness, hallucinations, lack of depth perception, impaired eye movements (except lateral and inferomedial), visual agnosia

41
Q

Special senses and autonomic function with Basilar artery stroke?

A

vertigo, diplopia, vomiting, nausea, nystagmus, hearing loss, pupil contstriction

42
Q

What does the ACA suply?

A

anterior 2/3 of the medial cerebral cortex

43
Q

What does the MCA supply?

A

Supply the lateral cerebral cortex, basal ganglia and large portions of the internal capsule

44
Q

Signs and symptoms of left hemisphere stroke:

A

dysarthria
cautious behavior
language/speech disorders
difficulty understanding and producing language
hemiparesis or hemiplegia and hemisensory loss (R side body and face)

45
Q

Signs and symptoms of right hemisphere stroke:

A

hemiparesis or hemiplegia and hemisensory loss (L side body and face)
left neglect
impulsive behavior (unaware)
unable to produce and comprehend emotional content of speech
do not recognize errors

46
Q

Where does the 2 vertebral arteries arise?

A

arise off the subclavian arteries

47
Q

What do the 2 vertebral arteries supply?

A

supply the ventral surface of the medulla and the posterior inferior aspect of the cerebellum

48
Q

Vertebral artery branches:

A

anterior spinal artery
posterior spinal artery
posterior inferior cerebellar artery

49
Q

Basilar artery branches

A

superior cerebellar artery
pontine arteries
anterior inferior cerebellar artery

50
Q

Posterior cerebral artery

A

central thalamoperforate arteries and thalamogeniculate arteries
choroidal arteries
callosal
cortical branches

51
Q

What does the basilar artery supply?

A

the ventral portion of the pons and terminates in the posterior cerebral artery

52
Q

Medial Medullary Syndrome

A

Occlusion of the vertebral anterior branch of the lower basilar artery

53
Q

What is impaired ipsilateral to lesion in Medial Medullary Syndrome?

A

paralysis of ½ of tongue

54
Q

What is impaired contralateral to lesion in Medial Medullary Syndrome?

A

hemiplegia UE/LE

impaired sensation

55
Q

Lateral Medullary Syndrome

A

occlusion of vertebral posterior inferior cerebellar or basilar artery
Wallenberg’s Syndrome

56
Q

What is impaired ipsilateral to lesion in Lateral Medullary Syndrome?

A

Cerebellar symptoms (ataxia, vertigo, nystagmus)
Loss of pain and temperature face
Sensory loss UE, trunk or LE

57
Q

What is impaired contralateral to lesion in Lateral Medullary Syndrome?

A

Loss of pain and temperature to body and face

58
Q

Horner’s Syndrome:

A

miosis, ptosis, decreased sweating), Dysphagia, impaired speech

59
Q

Basilar Artery Syndrome

A

brainstem signs and symptoms and PCA signs and symptoms

locked in syndrome

60
Q

Locked in syndrome

A

Tetraplegia
Lower bulbar paralysis (CN V-XII) level of Pons
Mutism (anarthria)
Preserved consciousness
Preserved vertical eye movements and blinking

61
Q

Medial Inferior Pontine Syndrome

A

Occlusion of the paramedian branch of the basilar artery

62
Q

What is impaired ipsilateral to lesion in Medial Inferior Pontine Syndrome?

A

Cerebellar ataxia
Nystagmus
Paralysis of conjugate gaze to side of lesion
Diplopia

63
Q

What is impaired contralateral to lesion in Medial Inferior Pontine Syndrome?

A

Hemiparesis UE, LE

Impaired sensation

64
Q

Lateral Inferior Pontine Syndrome

A

Occlusion of the anterior inferior cerebellar artery

65
Q

What is impaired ipsilateral to lesion in Lateral Inferior Pontine Syndrome?

A 
Cerebellar ataxia
Nystagmus
Vertigo
Facial paralysis
Paralysis of the conjugate gaze to the side of the lesion
Deafness, tinnitus
Impaired facial sensation
66
Q

What is impaired contralateral to lesion in Lateral Inferior Pontine Syndrome?

A

Impaired pain and temperature sensation half of body

67
Q

PCA Syndrome

A

PCA and posterior communicating arteries supply the midbrain, temporal lobe, diencephalon, and posterior third of cortex

68
Q

PCA Syndrome effects:

A

Contralateral sensory loss
Involuntary movements-choreoathetosis, tremor
Transient contralateral hemiparesis
Homonymous hemianopsia

69
Q

3 Major symptoms of cerebellar disorders include

A

Incoordination
Ataxia
Intention tremors

70
Q

Cerebellar Arterial Occlusion

A

Posterior Inferior Cerebellar Arterial Occlusion
Anterior Inferior Cerebellar
Superior Cerebellar Occlusion

71
Q

Posterior Inferior Cerebellar Arterial Occlusion supplies:

A

Cerebellar peduncles & medulla

72
Q

What does cerebellar arterial occlusion often involve?

A

the brainstem structures that are supplied by the cerebellar arteries

73
Q

Posterior Inferior Cerebellar Arterial Occlusion

A

Ipsilateral Hypertonicity & Hyperactive Reflexes

Vertigo, Nausea, Nystagmus

74
Q

Anterior Inferior Cerebellar & 
Superior Cerebellar Arterial Occlusion May Result In:

A 
Ipsilateral ataxia
Ipsilateral hypotonicity
Hyporeflexia
Dysmetria
Adiadochokinesia (and Dysdiadochokinesia)
Movement Decomposition
Asthenia
Rebound phenomenon
Staccato voice
Ataxic gait
Intention tremor
Incoordination
75
Q

Anterior Spinal Artery Occlusion supplies:

A

Medulla (pyramids, the vestibular, hypoglossal, glossopharyngeal & vagal nerve nuclei)

76
Q

Anterior Spinal Artery Occlusion

A

Contralateral Hemiplegia
Deviation of tongue to affected side
Dysphagia & loss of Gag Reflex
Nystagmus & Balance Disturbances

77
Q

Vertebral Artery Occlusion supplies:

A

lateral aspect of the low medulla including accessory nuclei

78
Q

Vertebral Artery Occlusion

A

Dysphagia may occur if accessory nerve nuclei are lost

Adult Neuro (26 decks)

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