CVA Flashcards
What is a stroke?
The sudden loss of neurological function as the result of a disruption to blood flow resulting in tissue death
What percent of strokes are ischemic and what percent are hemorrhagic?
Ischemic- 80%
Hemorrhagic- 20%
Ischemic strokes are either ______ or ______.
Thrombotic or Embolitic
Thrombotic Strokes
Aggregation of platelets and fibrin in a cerebral artery resulting in occlusion
Gradual onset and patient often awakens with symptoms
Embolic Strokes
Thrombus that originates elsewhere breaks away and is carried through bloodstream to a narrowing region
Abrupt onset and often with activity
Hemorrhagic Strokes
Sudden onset with decreased consciousness, headache, nausea and vomiting
Can be intracerebral, subdural hematoma, epidural hematoma
Intracerebral Hemorrhage
Arterial bleeding into the brain parenchyma (15% of all strokes; HIGH MORTALITY)
Subdural Hematoma
Venous bleeding
Epidural Hematoma
Arterial bleeding (medical emergency)
Controllable Risk Factors for Stroke
Hypertension (> 160/95) mmHg) Smoking (50% increased risk) Hyperlipidemia CD Diabetes Obesity Excessive alcohol consumption (>3-4 drinks/day) Sedentary lifestyle
Uncontrollable Risk Factors for Stroke
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)
FAST
Facial droop
Arm weakness
Speech difficulties
Time (tongue deviates)
Diagnostic Tests
***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
tPA
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
Scales for Stroke
University of Oxford ABCD scale predictor of stroke after TIA
NIH stroke scale assess if impairment warrants tPA
Ischemic Attacks
Lacunar Infacts
TIA
Lacunar Infarcts
evident tissue death resulting from the occlusion of small vessels
What is the penumbra
ischemic cells around primary damage that remain viable for a few hours due to collateral arteries
TIA
short period of disrupted blood flow with complete recovery of symptoms within 24 hours
Aphasia
Difficulties in speaking, listening, reading, and writing, but doesn’t affect intelligence
Broca’s
Wernicke’s
Global
What is Broca’s Aphasia?
expressive, non-fluent, some subtle receptive problems, anterior (posterior aspect frontal lobe)
What is Wernicke’s Aphasia?
receptive, fluent, poor self monitoring, posterior(temporal to parietal lobe)
What is Global Aphasia?
Receptive/expressive—full MCA infarct affection both frontal and parietal lobes
Alexia
Impairment in reading–know they are letters but unable to decode
Agraphia
impairment in writing
Apraxia
the inability to execute a voluntary motor movement despite being able to demonstrate muscle function—- understands requirement—present with & without paresis (frontal & parietal region)
Agnosia
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)
Anosognosia
lack of awareness of illness (parietal lobe lesion)
Dysarthria
motor speech disorder affecting respiration, articulation and phonation
Dysphagia
inability/difficulty in swallowing due to CN involvement includes CN V & VII, CN IX-CN XII
Perserveration
unable to refrain from certain behaviors—NO brakes eg. might not be able to get off a specific topic during conversation
Flexor UE Synergy
Scap retraction/elevation Shoulder abduction Elbow flexion Forearm supination Wrist/finger flexion
Flexor LE Synergy
Hip flex/abd/ER
Knee flexion
Ankle DF/INV
Toe DF
Extensor UE Synergy
Scap retraction Shoulder add/IR Elbow extension Forearm pronation Wrist/finger flexion
Extensory LE Synergy
Hip ext/add/IR
Knee extension
Ankle PF/INV
Toe PF
Homonomous Hemianopsia
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
Bitemporal Hemianopsia
Lesion at midline of optic chiasm
Total loss of vision on the affected side
Lesion of the optic nerve
Where is the most common site for CVA?
MCA (51%)
Pusher Syndrome occurs in what percent of patients?
10.4%
Pusher Syndrome symptoms
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
