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Integrative Exam > CVA > Flashcards

CVA Flashcards

1
Q

What is a stroke?

A

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

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2
Q

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

A

Ischemic- 80%

Hemorrhagic- 20%

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3
Q

Ischemic strokes are either ______ or ______.

A

Thrombotic or Embolitic

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4
Q

Thrombotic Strokes

A

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

Gradual onset and patient often awakens with symptoms

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5
Q

Embolic Strokes

A

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

Abrupt onset and often with activity

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6
Q

Hemorrhagic Strokes

A

Sudden onset with decreased consciousness, headache, nausea and vomiting

Can be intracerebral, subdural hematoma, epidural hematoma

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7
Q

Intracerebral Hemorrhage

A

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

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8
Q

Subdural Hematoma

A

Venous bleeding

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9
Q

Epidural Hematoma

A

Arterial bleeding (medical emergency)

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10
Q

Controllable Risk Factors for Stroke

A 
Hypertension (> 160/95) mmHg)
Smoking (50% increased risk)
Hyperlipidemia
CD
Diabetes
Obesity
Excessive alcohol consumption (>3-4 drinks/day)
Sedentary lifestyle
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11
Q

Uncontrollable Risk Factors for Stroke

A

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)

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12
Q

FAST

A

Facial droop
Arm weakness
Speech difficulties
Time (tongue deviates)

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13
Q

Diagnostic Tests

A

***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

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14
Q

tPA

A

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

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15
Q

Scales for Stroke

A

University of Oxford ABCD scale predictor of stroke after TIA

NIH stroke scale assess if impairment warrants tPA

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16
Q

Ischemic Attacks

A

Lacunar Infacts

TIA

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17
Q

Lacunar Infarcts

A

evident tissue death resulting from the occlusion of small vessels

18
Q

What is the penumbra

A

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

19
Q

TIA

A

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

20
Q

Aphasia

A

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

Broca’s
Wernicke’s
Global

21
Q

What is Broca’s Aphasia?

A

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

22
Q

What is Wernicke’s Aphasia?

A

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

23
Q

What is Global Aphasia?

A

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

24
Q

Alexia

A

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

25
Q

Agraphia

A

impairment in writing

26
Q

Apraxia

A

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

27
Q

Agnosia

A

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)

28
Q

Anosognosia

A

lack of awareness of illness (parietal lobe lesion)

29
Q

Dysarthria

A

motor speech disorder affecting respiration, articulation and phonation

30
Q

Dysphagia

A

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

31
Q

Perserveration

A

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

32
Q

Flexor UE Synergy

A 
Scap retraction/elevation
Shoulder abduction
Elbow flexion
Forearm supination
Wrist/finger flexion
33
Q

Flexor LE Synergy

A

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

34
Q

Extensor UE Synergy

A 
Scap retraction
Shoulder add/IR
Elbow extension
Forearm pronation
Wrist/finger flexion
35
Q

Extensory LE Synergy

A

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

36
Q

Homonomous Hemianopsia

A

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

37
Q

Bitemporal Hemianopsia

A

Lesion at midline of optic chiasm

38
Q

Total loss of vision on the affected side

A

Lesion of the optic nerve

39
Q

Where is the most common site for CVA?

A

MCA (51%)

40
Q

Pusher Syndrome occurs in what percent of patients?

A

10.4%

41
Q

Pusher Syndrome symptoms

A

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

Integrative Exam (12 decks)

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