CVA II: Infarct Determination and Direct Impairments Flashcards
What are the 4 signs/symptoms that might produce caution with stroke as dx?
- Gradual onset of symptoms
- No focal neurological signs
- Fluctuating neurological signs
- Unexplained fever
What is the best way to differentiate between a haemorrhagic or ischaemic stroke?
a. History
b. CT scan
c. PT Exam
d. Flipping a coin
b. CT scan b/c hx and exam doesn’t reliably distinguish between the two. Should be done ASAP (within 3 hrs) However, early CT may not show an ischaemic stroke.
What are 6 essential investigations for all suspected stroke pts that should be done?
- Non-contrast CT
- Full Blood count
- ESR.
- Serum glucose.
- ECG
- Chest x-ray
Rationale for doing these tests for CVA pts.
- Non-contrast CT
- Full Blood count
- ESR.
- Serum glucose.
- ECG
- Chest x-ray
- Non-contrast CT (to ID non-vascular lesions, to distinguish ischaemic and haemorrhagic stroke).
- Full Blood count (Anaemia, thrombocytopenia, thrombocytosis)
- ESR (Endocarditis, vasculitis)
- Serum glucose (diabetes)
- ECG (A-fib, MI)
- Chest x-ray (Heart disease)
3 types of medications used in management of Ischaemic Stroke?
- Anticoagulants (Heparin (acutely), aspirin, ticlid, plavix)
- Thrombolytic therapy (t-PA to dissolve clots ONLY for ichaemic stroke (think bout it)).
- Neuroprotective agents (NMDA receptor antagonists to prevent glutamate’s effects)
What type of medication is used in management of Hemorrhagic Stroke?
Calcium channel blockers (Nimodipine) that vasodilate to prevent complications seen with vasospasm.
What 2 things are CT scans used for in potential CVA pts initially? 2 things later on?
- Rule out non-CVA causes (like tumors).
- Determine if there is hemorrhage in brain.
Later… - Edema (within 3 days).
- Infarction (within 2-10 days).
Why are MRI’s better than CT’s for dx of CVA?
Better resolution of structural detail and more sensitive for detecting infarct in first 2-6 hours.
SPECT/PET is used for what purpose?
To allow visualization of local cerebral blood flow/metabolism and good for early identification of lesion.
Cerebral angiography is often used before what procedure for CVA pts?
surgery to open occluded vessels.
Sensory Deficits from CVA from thalamic damage are usually widespread or local? cortical is usually widespread or local?
thalamic = widespread. cortical = local
What are the 4 main ways CVA’s can cause pain?
- Headaches often result.
- Thalamic Sensory Syndrome - severe, supersensitive pain appearing > wks, mos, after CVA.
- Movement Adaptation Syndrome (faulty mvmts causing damage)
- Postural Stress Syndrome (Faulty posture 2° to stroke resulting in dysfunction and pain).
What are the 3 most common visual deficits seen in CVA pts?
- Homonymous hemianopsia (loss of temporal field on 1 side and nasal on other). Can be a factor in neglect.
- Diplopia (Problem c extraocular musculature).
- Conjugate Gaze Paralysis (due to destroyed eye mvmt 1° motor area, CN III nucleus/nerve, gaze centers in pontine-reticular formation).
Signe Brunnstrom’s 6 stages of recovery in hemiplegia. List em’.
- Flaccid period
- Basic limb synergies appear involuntarily + spasticity.
- Basic limb synergies appear voluntarily.
- Mvmt’s that don’t follow BLS’s appear.
- More difficult mvmt’s appear, synergies decrease.
- Adios spasticity, individual joint mvmts become possible. Whoohoo!
Damage to what 2 areas may cause flaccidity to linger in CVA pts?
Motor Cortex
Cerebellum
Spasticity occurs mainly in what type of muscles?
Antigravity
What muscles are typically NOT in synergy (and are therefore difficult to activate in pts)?
Shoulder: Lats, teres maj., serratus ant.
Hand: Finger extensors
Ankle: Ankle inverters
DTR’s usually present as hypo or hyper tonic initially? Later on?
initially: hypo (diaschisis)
post diaschisis: hyper
What is Souques Phenomenon?
Elevating UE with extended elbow above horizontal results in extension of the fingers
What is Raimistes Phenomenon?
Resisted abd. or add. of one LE or UE produces same mvmt in the other.
When there is decreased force production in CVA pts, what muscles are more involved, proximal or distal?
distal
What 3 changes are noted in the muscle and in motor units for stroke pts?
- Decrease in # of functioning motor units
- Abnormal recruitment of motor units.
- Atrophy of fibers (type II fast twitch especially)
5 deficits in CVA pts. that affect balance, gait, and UE functional tasks.
- Inefficient muscle activation
- Inability to maintain a contraction.
- Increase effort required to produce a contraction.
- Increased reaction times
- Increased movement times
What is the big motor programming deficit resulting from LEFT hemisphere damage?
Apraxia: Inability to perform purposeful movements.
