CVA Impairments 2: Sensory + Perception Flashcards
Damage to CNII and various regions of the visual tract and visual cortex can result in the following impairments:
- Impaired accommodation
- Visual Field Losses
Head Tilt
Common with dysconjugate gaze to align eyes and reduce double vision
Cerebellar damage can result in the following visual impairments:
- Impaired pursuits and saccades
- Diplopia w/conjugate gaze dysfunction
CNIII, IV, VI, II damage can result in the following visual impairments:
- Ptosis
- Ocular motility disturbance
The intracranial optic nerve and optic chiasm are supplied by
- Anterior cerebral A.
- Anterior communicating A.
- Superior Hypophyseal A.
Damage to the ACA would result in _______________ visual field loss:
- Monocular blindness
- Bitemporal hemianopsia
The optic tract is supplied by
- Posterior communicating A.
- Anterior Chorodial A.
If your patient has a PCA stroke they could have the following visual field deficits
CONTRA homonymous hemianopsia
The optic radiations are supplied by:
- Middle Cerebral a.
- Posterior cerebral a.
Damage to the optic radiations due to MCA/PCA damage can result in ______ visual field loss:
- Superior Quadrantopia
- Inferior Quadrantopia
- Homonymous hemianopsia
PCA damage resulting in damage to the Primary visual cortex could result in
Homonymous hemianopsia (w/macular sparing)
Tropia
overt deviation of the eye present at all time
Phoria
ocular deviation occurring when dissociation occurs
Your patient has damage to their abducens nerve - you can expect to see what ocular misalignment?
Esotropia
Your patient has damage to their oculomotor nuclei - what ocular misalignment is possible?
exotropia or hypotropia
Your patient presents with hypertropia to their right eye. What cranial nerve is damaged?
Trochlear n
You notice your patient is having difficulty focusing and is complaining of head and eye pain. This is most consistent with
a subtle ocular misalignment (should be cosmetically normal and might also complain of mental dullness)
Your patient presents to therapy today with complaint of dizziness. You believe it is vestibular in nature - what three CNS structures could be involved?
Cortical vestibular regions (PIVC, MST, VIR)
Flocculonodular Lobe of cerebellum
Brainstem vestibular regions (midbrain/pons)
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?
MIDBRAIN (OM nucleus present which controls the medial rectus needed to adduct the eye)
T/F somatosensory impairments are typically contralateral and fully involved.
False - while they are typically contralateral, they are usually incomplete and the type and degree varies.
Your patient has a stroke in the PONS. What oculomotor eye muscle can you expect to be impaired?
Abducens
Hypoesthesia
decreased sensitivity to sensory stimuli
Hyperesthesia
increased sensitivity to sensory stimuli
Paresthesia
Abnormal sensation response to innocuous stimulus (typically tingling)
Dysesthesia
type of paresthesia - unpleasant response to innocuous stimulus (burning, prickling, aching)
Allodynia
type of paresthesia, PAINFUL response to innocuous stimulus
Analgesia
Complete loss of pain sensitivity
Hyperalgesia
Increased sensitivity to pain
Atopognosia
inability to localize sensation
What are the top three common predictors of fall risk associated with CVA?
Functional impairment
Cognitive deficits
Impaired balance
A right hemispheric lesion can result in the following perceptual impairments:
- 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)
A left hemispheric lesion can result in the following perceptual deficits
- Apraxia (ideational or ideomotor)
Unilateral inattention mostly occurs with a lesion in the __________
R temporoparietal region or posterior parietal lesions
(Also, dorsolateral frontal, cingulate gyrus, thalamic, putamen)
You note a patient to be learning to their R side and has L sided deficits. What disorientation is this?
Lateropulsion (lateral lean)
A patient has L sided deficits and is leaning to the left - you suspect they have?
R sided lesion (most common) resulting in Pusher’s Syndrome
Post-CVA fatigue is most commonly associated with
post-CVA depression
What scales are available to assess a post-CVA patient for fatigue?
Fatigue severity scale, fatigue impact scale
Cut off score for subluxation of shoulder?
1/2 fingerbreadth or more
You are chart reviewing and see your post-stroke patient was just put on fluoxetine - you can likely suspect they have
post-stroke/thalamic pain syndrome
