CVA

Question 1

What is a stroke?

Answer 1

The sudden loss of neurological function as the result of a disruption to blood flow resulting in tissue death

Question 2

What percent of strokes are ischemic and what percent are hemorrhagic?

Answer 2

Ischemic- 80%

Hemorrhagic- 20%

Question 3

Ischemic strokes are either ______ or ______.

Answer 3

Thrombotic or Embolitic

Question 4

Thrombotic Strokes

Answer 4

Aggregation of platelets and fibrin in a cerebral artery resulting in occlusion

Gradual onset and patient often awakens with symptoms

Question 5

Embolic Strokes

Answer 5

Thrombus that originates elsewhere breaks away and is carried through bloodstream to a narrowing region

Abrupt onset and often with activity

Question 6

Hemorrhagic Strokes

Answer 6

Sudden onset with decreased consciousness, headache, nausea and vomiting

Can be intracerebral, subdural hematoma, epidural hematoma

Question 7

Intracerebral Hemorrhage

Answer 7

Arterial bleeding into the brain parenchyma (15% of all strokes; HIGH MORTALITY)

Question 8

Subdural Hematoma

Answer 8

Venous bleeding

Question 9

Epidural Hematoma

Answer 9

Arterial bleeding (medical emergency)

Question 10

Controllable Risk Factors for Stroke

Answer 10

Hypertension (> 160/95) mmHg)
Smoking (50% increased risk)
Hyperlipidemia
CD
Diabetes
Obesity
Excessive alcohol consumption (>3-4 drinks/day)
Sedentary lifestyle

Question 11

Uncontrollable Risk Factors for Stroke

Answer 11

Age (risk increase with age)
Sex (female < male)
Family hx
Race (2x greater risk in African Americans)
Geography (southeast U.S. highest death rate from CVA)

Question 12

FAST

Answer 12

Facial droop
Arm weakness
Speech difficulties
Time (tongue deviates)

Question 13

Diagnostic Tests

Answer 13

***Non-contrast CT scan fast, convenient, differentiates between ischemic and hemorrhagic stroke

MRI determines size and extent of infarct

MRA assess arterial stenosis or presence of aneurysm

Question 14

tPA

Answer 14

Tissue plasminogen activator (used with ischemic strokes)

Results in lysis of fibrin

Should be used within 3 hours of stroke to decrease likelihood of post stoke disability

Question 15

Scales for Stroke

Answer 15

University of Oxford ABCD scale predictor of stroke after TIA

NIH stroke scale assess if impairment warrants tPA

Question 16

Ischemic Attacks

Answer 16

Lacunar Infacts

TIA

Question 17

Lacunar Infarcts

Answer 17

evident tissue death resulting from the occlusion of small vessels

Question 18

What is the penumbra

Answer 18

ischemic cells around primary damage that remain viable for a few hours due to collateral arteries

Question 19

TIA

Answer 19

short period of disrupted blood flow with complete recovery of symptoms within 24 hours

Question 20

Aphasia

Answer 20

Difficulties in speaking, listening, reading, and writing, but doesn’t affect intelligence

Broca’s
Wernicke’s
Global

Question 21

What is Broca’s Aphasia?

Answer 21

expressive, non-fluent, some subtle receptive problems, anterior (posterior aspect frontal lobe)

Question 22

What is Wernicke’s Aphasia?

Answer 22

receptive, fluent, poor self monitoring, posterior(temporal to parietal lobe)

Question 23

What is Global Aphasia?

Answer 23

Receptive/expressive—full MCA infarct affection both frontal and parietal lobes

Question 24

Alexia

Answer 24

Impairment in reading–know they are letters but unable to decode

Question 25

Agraphia

Answer 25

impairment in writing

Question 26

Apraxia

Answer 26

the inability to execute a voluntary motor movement despite being able to demonstrate muscle function---- understands requirement---present with & without paresis (frontal & parietal region)

Question 27

Agnosia

Answer 27

loss of ability to perceive auditory, visual, tactile input though sensory systems are intact (i.e. neglect loss of awareness of contralateral side of lesion due to rt parietal lobe lesion)

Question 28

Anosognosia

Answer 28

lack of awareness of illness (parietal lobe lesion)

Question 29

Dysarthria

Answer 29

motor speech disorder affecting respiration, articulation and phonation

Question 30

Dysphagia

Answer 30

inability/difficulty in swallowing due to CN involvement includes CN V & VII, CN IX-CN XII

Question 31

Perserveration

Answer 31

unable to refrain from certain behaviors---NO brakes eg. might not be able to get off a specific topic during conversation

Question 32

Flexor UE Synergy

Answer 32

``` Scap retraction/elevation Shoulder abduction Elbow flexion Forearm supination Wrist/finger flexion ```

Question 33

Flexor LE Synergy

Answer 33

Hip flex/abd/ER Knee flexion Ankle DF/INV Toe DF

Question 34

Extensor UE Synergy

Answer 34

``` Scap retraction Shoulder add/IR Elbow extension Forearm pronation Wrist/finger flexion ```

Question 35

Extensory LE Synergy

Answer 35

Hip ext/add/IR Knee extension Ankle PF/INV Toe PF

Question 36

Homonomous Hemianopsia

Answer 36

loss of half of the field of view on the same side in both eyes left optic tract lesion = loss of right visual fields of both eyes partial right optic tract lesion partial loss of vision in left visual fields of both eyes

Question 37

Bitemporal Hemianopsia

Answer 37

Lesion at midline of optic chiasm

Question 38

Total loss of vision on the affected side

Answer 38

Lesion of the optic nerve

Question 39

Where is the most common site for CVA?

Answer 39

MCA (51%)

Question 40

Pusher Syndrome occurs in what percent of patients?

Answer 40

10.4%

Question 41

Pusher Syndrome symptoms

Answer 41

Perceive their midline as 18 degrees to ipsilateral side Spontaneous body posture---towards side of involvement Increase of pushing force by spreading the non-paretic limbs Resistance to passive correction of posture Treatment combines visual, somatosensory and motor learning