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Neurology II Test 1 CVA > CVA II: Infarct Determination and Direct Impairments > Flashcards

CVA II: Infarct Determination and Direct Impairments Flashcards

1
Q

What are the 4 signs/symptoms that might produce caution with stroke as dx?

A
  1. Gradual onset of symptoms
  2. No focal neurological signs
  3. Fluctuating neurological signs
  4. Unexplained fever
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2
Q

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

A

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.

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3
Q

What are 6 essential investigations for all suspected stroke pts that should be done?

A
  1. Non-contrast CT
  2. Full Blood count
  3. ESR.
  4. Serum glucose.
  5. ECG
  6. Chest x-ray
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4
Q

Rationale for doing these tests for CVA pts.

  1. Non-contrast CT
  2. Full Blood count
  3. ESR.
  4. Serum glucose.
  5. ECG
  6. Chest x-ray
A
  1. Non-contrast CT (to ID non-vascular lesions, to distinguish ischaemic and haemorrhagic stroke).
  2. Full Blood count (Anaemia, thrombocytopenia, thrombocytosis)
  3. ESR (Endocarditis, vasculitis)
  4. Serum glucose (diabetes)
  5. ECG (A-fib, MI)
  6. Chest x-ray (Heart disease)
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5
Q

3 types of medications used in management of Ischaemic Stroke?

A
  1. Anticoagulants (Heparin (acutely), aspirin, ticlid, plavix)
  2. Thrombolytic therapy (t-PA to dissolve clots ONLY for ichaemic stroke (think bout it)).
  3. Neuroprotective agents (NMDA receptor antagonists to prevent glutamate’s effects)
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6
Q

What type of medication is used in management of Hemorrhagic Stroke?

A

Calcium channel blockers (Nimodipine) that vasodilate to prevent complications seen with vasospasm.

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7
Q

What 2 things are CT scans used for in potential CVA pts initially? 2 things later on?

A
  1. Rule out non-CVA causes (like tumors).
  2. Determine if there is hemorrhage in brain.
    Later…
  3. Edema (within 3 days).
  4. Infarction (within 2-10 days).
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8
Q

Why are MRI’s better than CT’s for dx of CVA?

A

Better resolution of structural detail and more sensitive for detecting infarct in first 2-6 hours.

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9
Q

SPECT/PET is used for what purpose?

A

To allow visualization of local cerebral blood flow/metabolism and good for early identification of lesion.

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10
Q

Cerebral angiography is often used before what procedure for CVA pts?

A

surgery to open occluded vessels.

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11
Q

Sensory Deficits from CVA from thalamic damage are usually widespread or local? cortical is usually widespread or local?

A

thalamic = widespread. cortical = local

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12
Q

What are the 4 main ways CVA’s can cause pain?

A
  1. Headaches often result.
  2. Thalamic Sensory Syndrome - severe, supersensitive pain appearing > wks, mos, after CVA.
  3. Movement Adaptation Syndrome (faulty mvmts causing damage)
  4. Postural Stress Syndrome (Faulty posture 2° to stroke resulting in dysfunction and pain).
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13
Q

What are the 3 most common visual deficits seen in CVA pts?

A
  1. Homonymous hemianopsia (loss of temporal field on 1 side and nasal on other). Can be a factor in neglect.
  2. Diplopia (Problem c extraocular musculature).
  3. Conjugate Gaze Paralysis (due to destroyed eye mvmt 1° motor area, CN III nucleus/nerve, gaze centers in pontine-reticular formation).
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14
Q

Signe Brunnstrom’s 6 stages of recovery in hemiplegia. List em’.

A
  1. Flaccid period
  2. Basic limb synergies appear involuntarily + spasticity.
  3. Basic limb synergies appear voluntarily.
  4. Mvmt’s that don’t follow BLS’s appear.
  5. More difficult mvmt’s appear, synergies decrease.
  6. Adios spasticity, individual joint mvmts become possible. Whoohoo!
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15
Q

Damage to what 2 areas may cause flaccidity to linger in CVA pts?

A

Motor Cortex

Cerebellum

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16
Q

Spasticity occurs mainly in what type of muscles?

A

Antigravity

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17
Q

What muscles are typically NOT in synergy (and are therefore difficult to activate in pts)?

A

Shoulder: Lats, teres maj., serratus ant.
Hand: Finger extensors
Ankle: Ankle inverters

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18
Q

DTR’s usually present as hypo or hyper tonic initially? Later on?

A

initially: hypo (diaschisis)

post diaschisis: hyper

19
Q

What is Souques Phenomenon?

A

Elevating UE with extended elbow above horizontal results in extension of the fingers

20
Q

What is Raimistes Phenomenon?

A

Resisted abd. or add. of one LE or UE produces same mvmt in the other.

21
Q

When there is decreased force production in CVA pts, what muscles are more involved, proximal or distal?

A

distal

22
Q

What 3 changes are noted in the muscle and in motor units for stroke pts?

A
  1. Decrease in # of functioning motor units
  2. Abnormal recruitment of motor units.
  3. Atrophy of fibers (type II fast twitch especially)
23
Q

5 deficits in CVA pts. that affect balance, gait, and UE functional tasks.

A
  1. Inefficient muscle activation
  2. Inability to maintain a contraction.
  3. Increase effort required to produce a contraction.
  4. Increased reaction times
  5. Increased movement times
24
Q

What is the big motor programming deficit resulting from LEFT hemisphere damage?

A

Apraxia: Inability to perform purposeful movements.

25
Q

2 types of Apraxia and difference between them.

A

Ideomotor: cannot perform mvmt on command but may be able to automatically
Ideational: nope nada on command or auto.

26
Q

What is the big motor programming deficit resulting from RIGHT hemisphere damage?

A

Motor Impersistence: Inability to sustain a mvmt or a posture.

27
Q

3 types of Aphasia

A
  1. Fluent (Wernicke’s): bad comprehension.
  2. Nonfluent (Broca’s): bad expression.
  3. Global: bad everything.
28
Q

What is Dysarthria and what type of problem is it? What damaged areas can cause it?

A

Impaired coordination of speech production
Motor problem
Motor cortex, sensory cortex, cerebellum.

29
Q

What is dysphagia and damage to what areas can cause it?

A

Difficulty swallowing

Damage to Brainstem (IX and X) and Motor Cortex

30
Q

What is the most common problem with dysphagia?

A

Delays in swallowing reflex

31
Q

Aspiration from dysphagia can result in what two serious problems?

A

Acute respiratory distress

Pneumonia

32
Q

How is Aspiration treated (3 things)

A

Thickening fluids
Pills given in thick substances
NG tubes (short term), G tube (long), TPN via IV.

33
Q

Perceptual dysfunctions are seen primarily from lesions in what hemisphere?

A

Right

34
Q

What is the difference between Body Scheme and Body Image Disorders?

A

Scheme: disorders of person’s internal model of the relationship of their body parts to each other and to the environment
Image: changes in the FEELINGS about one’s body image.

35
Q

What are 3 specific disorders of body scheme/image?

A
  1. Unilateral neglect
  2. Anosagnosia - lack of awareness/denial of paretic extremities.
  3. Pusher Syndrome - pt pushes toward hemi side constantly, more common in R hemisphere lesions.
36
Q

In pts with declarative memory loss, PT should concentrate on what type of activity?

A

Repetitive, giving same directions in same way every time.

37
Q

What is Perseveration?

A

Continued repetition of words or acts, even if the acts are not useful or are not related to current context.

38
Q

Lesions in what hemisphere are more likely to produce emotional lability? depression?

A

Lability: Right
Depression: Left (direct impairment, not psychological reaction to stroke).

39
Q
  1. Communication problems happen in lesions to what hemisphere?
  2. Spatial-perceptual tasks and neglect?
  3. Difficulty understanding whole idea of task?
  4. Difficulty processing information sequentially?
  5. “Cautious, anxious, disorganized”
  6. “Quick impulsive”, “overestimate abilities”
A
  1. Left
  2. Right
  3. Right
  4. Left
  5. Left
  6. Right
40
Q

What are the hallmark signs of DVT’s?

A
  1. Rapid onset of unilateral leg swelling c dependent edema.
  2. Painful/tight feeling.
  3. Positive Homan’s sign (NOT always present)
41
Q

What are 3 ways to prevent DVT’s?

A
  1. Contraction of LE muscles (ankle pumps!)
  2. Intermittent pneumatic compression & stockings.
  3. Low-dose heparin as prophylactic.
42
Q

What are 6 ways to prevent skin breakdown in CVA pts?

A
  1. Positioning to avoid pressure on bony prominences.
  2. Turning schedule maintenance.
  3. Avoid shearing to skin.
  4. Keep skin DRY.
  5. Inspection of skin.
  6. Use of pressure-limiting devices.
43
Q

What are 3 ways to prevent decreased flexibility in CVA pts?

A
  1. Daily ROM exercises
  2. Positioning
  3. Resting splints
44
Q

What are 4 causes of shoulder subluxation in CVA pts by caregivers?

A
  1. Pulling on shoulder
  2. Improper positioning of pt & failure to teach pt.
  3. Improperly performed ROM
  4. Allowing slouched postures to go unchecked.

Neurology II Test 1 CVA (4 decks)

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