CVA Impairments 2: Sensory + Perception

Question 1

Damage to CNII and various regions of the visual tract and visual cortex can result in the following impairments:

Answer 1

• Impaired accommodation
• Visual Field Losses

Question 1

Head Tilt

Answer 1

Common with dysconjugate gaze to align eyes and reduce double vision

Question 2

Cerebellar damage can result in the following visual impairments:

Answer 2

• Impaired pursuits and saccades
• Diplopia w/conjugate gaze dysfunction

Question 3

CNIII, IV, VI, II damage can result in the following visual impairments:

Answer 3

• Ptosis
• Ocular motility disturbance

Question 4

The intracranial optic nerve and optic chiasm are supplied by

Answer 4

• Anterior cerebral A.
• Anterior communicating A.
• Superior Hypophyseal A.

Question 5

Damage to the ACA would result in _______________ visual field loss:

Answer 5

• Monocular blindness
• Bitemporal hemianopsia

Question 6

The optic tract is supplied by

Answer 6

• Posterior communicating A.
• Anterior Chorodial A.

Question 7

If your patient has a PCA stroke they could have the following visual field deficits

Answer 7

CONTRA homonymous hemianopsia

Question 8

The optic radiations are supplied by:

Answer 8

• Middle Cerebral a.
• Posterior cerebral a.

Question 9

Damage to the optic radiations due to MCA/PCA damage can result in ______ visual field loss:

Answer 9

• Superior Quadrantopia
• Inferior Quadrantopia
• Homonymous hemianopsia

Question 10

PCA damage resulting in damage to the Primary visual cortex could result in

Answer 10

Homonymous hemianopsia (w/macular sparing)

Question 11

Tropia

Answer 11

overt deviation of the eye present at all time

Question 12

Phoria

Answer 12

ocular deviation occurring when dissociation occurs

Question 13

Your patient has damage to their abducens nerve - you can expect to see what ocular misalignment?

Answer 13

Esotropia

Question 14

Your patient has damage to their oculomotor nuclei - what ocular misalignment is possible?

Answer 14

exotropia or hypotropia

Question 15

Your patient presents with hypertropia to their right eye. What cranial nerve is damaged?

Answer 15

Trochlear n

Question 16

You notice your patient is having difficulty focusing and is complaining of head and eye pain. This is most consistent with

Answer 16

a subtle ocular misalignment (should be cosmetically normal and might also complain of mental dullness)

Question 17

Your patient presents to therapy today with complaint of dizziness. You believe it is vestibular in nature - what three CNS structures could be involved?

Answer 17

Cortical vestibular regions (PIVC, MST, VIR)
Flocculonodular Lobe of cerebellum
Brainstem vestibular regions (midbrain/pons)

Question 18

Your patient states they had a brainstem stroke but are unsure exactly where it occurred.
You decided to do a VOR exam. When the patient turns their head to the R both eyes track appropriately. When turning their head to the L their R eye tracks appropriately and the L eye does not. Where is the most likely location of the patient’s stroke?

Answer 18

MIDBRAIN (OM nucleus present which controls the medial rectus needed to adduct the eye)

Question 19

T/F somatosensory impairments are typically contralateral and fully involved.

Answer 19

False - while they are typically contralateral, they are usually incomplete and the type and degree varies.

Question 20

Your patient has a stroke in the PONS. What oculomotor eye muscle can you expect to be impaired?

Answer 20

Abducens

Question 21

Hypoesthesia

Answer 21

decreased sensitivity to sensory stimuli

Question 22

Hyperesthesia

Answer 22

increased sensitivity to sensory stimuli

Question 23

Paresthesia

Answer 23

Abnormal sensation response to innocuous stimulus (typically tingling)

Question 24

Dysesthesia

Answer 24

type of paresthesia - unpleasant response to innocuous stimulus (burning, prickling, aching)

Question 25

Allodynia

Answer 25

type of paresthesia, PAINFUL response to innocuous stimulus

Question 26

Analgesia

Answer 26

Complete loss of pain sensitivity

Question 27

Hyperalgesia

Answer 27

Increased sensitivity to pain

Question 28

Atopognosia

Answer 28

inability to localize sensation

Question 29

What are the top three common predictors of fall risk associated with CVA?

Answer 29

Functional impairment
Cognitive deficits
Impaired balance

Question 30

A right hemispheric lesion can result in the following perceptual impairments:

Answer 30

• Body scheme impairments (unilateral neglect, Pusher’s Syndrome, anosognosia, R/L discrimination)
• Spatial difficulties (hand-eye coordination, figure-ground discrimination, position-in-space, depth, distance, etc.)
• Agnosias (visual, auditory, sensory)

Question 31

A left hemispheric lesion can result in the following perceptual deficits

Answer 31

• Apraxia (ideational or ideomotor)

Question 32

Unilateral inattention mostly occurs with a lesion in the __________

Answer 32

R temporoparietal region or posterior parietal lesions
(Also, dorsolateral frontal, cingulate gyrus, thalamic, putamen)

Question 33

You note a patient to be learning to their R side and has L sided deficits. What disorientation is this?

Answer 33

Lateropulsion (lateral lean)

Question 34

A patient has L sided deficits and is leaning to the left - you suspect they have?

Answer 34

R sided lesion (most common) resulting in Pusher’s Syndrome

Question 35

Post-CVA fatigue is most commonly associated with

Answer 35

post-CVA depression

Question 36

What scales are available to assess a post-CVA patient for fatigue?

Answer 36

Fatigue severity scale, fatigue impact scale

Question 37

Cut off score for subluxation of shoulder?

Answer 37

1/2 fingerbreadth or more

Question 37

You are chart reviewing and see your post-stroke patient was just put on fluoxetine - you can likely suspect they have

Answer 37

post-stroke/thalamic pain syndrome