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Neuromuscular Exam and Rehab Exam 1 > CVA Intro > Flashcards

CVA Intro Flashcards

1
Q

How is stroke defined?

A

“Sudden loss of neurological function caused by an interruption of blood flow to the brain”

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2
Q

What are the two types of stroke?

A
  1. Ischemic
  2. Hemorrhagic
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3
Q

What is an ischemic stroke?

A

Occurs secondary to a thrombosis, embolism, or hypoperfusion

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4
Q

How many individuals with strokes have ischemic strokes?

A

Ischemic strokes affects 80% of individuals with stroke

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5
Q

What is a hemorragic stroke?

A

Occurs when blood vessels rupture, causing leakage of blood in or around the brain

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6
Q

To be classified as a CVA the deficits must remain for at least _____ _____.

A

24 hours

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7
Q

What indicates the impairment for a CVA?

A

Location and early care management

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8
Q

What can happen as swelling reduces with a CVA?

A

Some spontaneous improvement (reversible ischemic neurological deficit)

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9
Q

Deficits for CVA patients can lead to what?

A

Lasting disability

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10
Q

What are the three etiological categories of strokes?

A
  1. Thrombosis
  2. Embolus
  3. Hemorrhage
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11
Q

Where is the vascular territory that most CVAs happen?

A
  1. ACA
  2. MCA
  3. PCA
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12
Q

There are five “management categories” for CVAs, what are they?

A
  1. TIA
  2. Minor Stroke
  3. Major Stroke
  4. Deteriorating Stroke
  5. Young Stroke
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13
Q

CVAs are the _____ leading cause of death.

A

5th

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14
Q

CVAs are the _____ cause of long-term disability in the US.

A

Leading

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15
Q

Who has a lower risk of suffering a CVA but as they get older (85+) has an increased prevalence of CVA?

A

Younger women

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16
Q

Who has twice the risk for a first stroke?

A

African Americans

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17
Q

T/F: Stroke incidence increases with age?

A

True

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18
Q

What accounts for the largest number of deaths? Ischemic or Hemorrhagic strokes?

A

Hemorrhagic

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19
Q

What are risk factors of CVAs?

A
  • Hypertension (HTN)
  • Diabetes Mellitus (DM)
  • Disorders of Heart Rhythm
  • High Blood Cholesterol and other Lipids
  • Smoking/ Tobacco use
  • Heart Disease
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20
Q

What are modifiable risk factors of CVA?

A
  • Cigarette Smoking
  • Physical Inactivity
  • Obesity
  • Diet
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21
Q

What is the acronym for early warning signs of stroke?

A
  • BE FAST
  • B: Balance (loss of balance, headache/ sudden or “thunderclap” headache or dizziness)
  • E: Eyes (blurred vision)
  • F: Face (one side of the face is drooping)
  • A: Arms (arm or leg weakness)
  • S: Speech (speech difficulty)
  • T: Time (time to call for ambulance immediately)
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22
Q

KNOW THE CIRCLE OF WILLIS!

A

HEY! GO LOOK AT THE CIRCLE OF WILLIS!!

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23
Q

I WAS SERIOUS! GO LOOK AT THE BLOOD FLOW OF THE BRAIN!

A

SERIOUSLY! GO LOOK! I CANT ADD PICTURES!! (I’m not yelling I promise!)

24
Q

What kind of signs and symptoms would you see with Anterior Cerebral Artery Syndrome (ACA Stroke)?

A
  • Contralateral hemiparesis (LE is more involved)
  • Contralateral hemisensory loss (LE is more involved)
  • Urinary incontinence
  • Problems with imitation and bimanual tasks, apraxia
  • Akinetic mutism, slowness, lack of spontaneity, motor inaction
  • Contralateral grasp reflex, sucking reflex
25
Q

What kinds of signs and symptoms would you see with Middle Cerebral Artery Syndrome (MCA Stroke)?

A
  • Contralateral hemiparesis (UE and face is more involved)
  • Contralateral hemisensory loss (UE and face is more involved)
  • Motor speech impairment
  • Receptive speech impairment
  • Global aphasia
  • Perceptual deficits
  • Limb-kinetic apraxia
  • Contralateral homonymous hemianopsia
  • Loss of conjugate gaze to the opposite side
  • Sensory ataxia of contralateral limbs
26
Q

What is apraxia?

A

Difficulty with planning and sequencing movements that cannot be accounted for by any other reason

27
Q

What is Ideational Apraxia?

A

Inability of the patient to produce movement either on command or automatically and represents a complete breakdown in the conceptualization of the task

28
Q

What is Ideomotor Apraxia?

A

The patient is unable to produce a movement on command, but he or she is able to move automatically

29
Q

What hemisphere is apraxia more evident with?

A

More evident with left hemisphere damage

30
Q

What is Broca’s aphasia?

A

Expressive, Non-fluent aphasia (they can understand but cant respond), limited vocabulary, slow and hesitant speech (frontal lobe - M1)

31
Q

What is Wernicke’s aphasia?

A

Fluent aphasia (cant understand but can respond), impaired auditory comprehension, fluent speech, normal rate and melody (temporal lobe - A1)

32
Q

What is Global aphasia?

A

Non-fluent speech with poor comprehension (both wernickes and brocas)

33
Q

What is Posterior Cerebral Artery Syndrome (PCA Stroke)… in the peripheral territory?

A
  • Contralateral homonymous hemianopsia
  • Bilateral homonymous hemianopsia with some degree of macular sparing
  • Visual agnosia
  • Prosopagnosia
  • Dyslexia
  • Memory deficit
  • Topographic disorientation
34
Q

What is Posterior Cerebral Artery Syndrome (PCA Stroke)… in the central territory?

A
  • Central post stroke (thalamic) pain syndrome
  • Spontaneous pain and dysesthesias, sensory impairments
  • Involuntary movements
  • Contralateral hemiplegia
  • Oculomotor nerve palsy
35
Q

What are lacunar strokes caused by?

A

Small vessel disease in the cerebral white matter

36
Q

Lacunar stroke syndromes are consistent with what?

A

specific anatomical sites

37
Q

T/F: Lacunar syndromes can be motor, sensory, etc.

A

True

38
Q

What kind of deficits are often NOT seen in lacunar strokes due to the higher cortical areas being persevered?

A

Consciousness, language, and visual fields

39
Q

Occlusions causing Vertebrobasilar Artery Syndrome can produce what?

A

A wide variety of symptoms with both the ipsilateral and contralateral signs

40
Q

Why do you get both ipsilateral and contralateral signs with vertebrobasilar artery syndrome?

A

Because some brainstem tracts will have crossed, and some will not have crossed yet

41
Q

What kind of abnormalities are present with vertebrobasilar artery syndrome?

A

Cerebellar and cranial nerve abnormalities

42
Q

Where is damage caused with Lateral Medullary Syndrome/ Wallenberg’s Syndrome?

A

At the Posterior inferior cerebellar artery

43
Q

What signs and symptoms will you see with Lateral Medullary Syndrome/ Wallenberg’s Syndrome?

A
  • Loss of pain and temperature on the contralateral side of the body and ipsilateral face
  • Dizziness/ vertigo
  • Ataxia
  • Diplopia
  • Dysphagia
  • Dysarthria
  • Horner’s Syndrome
44
Q

Where is damage caused with Horner’s Syndrome?

A

At the sympathetic trunk

45
Q

Horner’s Syndrome has symptoms of miosis, ptosis, and anhidrosis on the _____ side.

A

Ipsilateral

46
Q

What symptoms starting with the letter “D” does horners syndrome present?

A
  • Dysphagia
  • Dysphonia
47
Q

Does horners syndrome create a sensory or motor impairment of the UE, trunk or LE?

A

Sensory

48
Q

What is impaired over 50% of the body, and sometimes face contralateral to the lesion with horner’s syndrome?

A

Impaired pain and thermal sense

49
Q

What is locked-in syndrome?

A

Damage caused to the basilar artery affecting the ventral pons

50
Q

What kind of signs and symptoms might you see with locked-in syndrome?

A
  • Tetraplegia/ quadriplegia
  • Bilateral cranial nerve palsy (upward gaze is spared)
  • Coma
  • Cognition is spared
51
Q

What kind of medical imaging can be done for CVA based conditions?

A
  • Computed Tomography (CT)
  • Magnetic Resonance Imaging (MRI)
  • Magnetic Resonance Angiography (MRA)
  • Doppler Ultrasound
52
Q

What kind of acute management approaches can be taken for CVAs?

A
  • Medical
  • Pharmacological
  • Neurosurgical
53
Q

What is included in a comprehensive physical therapy examination?

A
  • Patient/ client history
  • Systems review
  • Test and measures
54
Q

What is the purpose of an examination?

A
  • Screen for benefit of rehabilitation services and most appropriate care setting
  • Develop a plan of care
  • Measure progress towards goals/ outcomes
  • Determine if referral to another practitioner is needed
  • Plan for discharge
55
Q

What is included in a plan of care?

A
  • Goals
  • Expected outcomes
  • Prognosis
  • Interventions
56
Q

What is included in a patient history?

A
  • Goals
  • Communication and cognition screen
  • Age, sex, race, language, education, etc.
  • Social history
  • Occupation/ employment
  • Living environment/ work barriers
  • Hand dominance
  • General health status
  • Family history
  • Medical/ surgical history
  • Medications
  • Medical/ laboratory test results
  • Premorbid functional activity level

Neuromuscular Exam and Rehab Exam 1 (11 decks)

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