CVA Intro Flashcards
How is stroke defined?
“Sudden loss of neurological function caused by an interruption of blood flow to the brain”
What are the two types of stroke?
- Ischemic
- Hemorrhagic
What is an ischemic stroke?
Occurs secondary to a thrombosis, embolism, or hypoperfusion
How many individuals with strokes have ischemic strokes?
Ischemic strokes affects 80% of individuals with stroke
What is a hemorragic stroke?
Occurs when blood vessels rupture, causing leakage of blood in or around the brain
To be classified as a CVA the deficits must remain for at least _____ _____.
24 hours
What indicates the impairment for a CVA?
Location and early care management
What can happen as swelling reduces with a CVA?
Some spontaneous improvement (reversible ischemic neurological deficit)
Deficits for CVA patients can lead to what?
Lasting disability
What are the three etiological categories of strokes?
- Thrombosis
- Embolus
- Hemorrhage
Where is the vascular territory that most CVAs happen?
- ACA
- MCA
- PCA
There are five “management categories” for CVAs, what are they?
- TIA
- Minor Stroke
- Major Stroke
- Deteriorating Stroke
- Young Stroke
CVAs are the _____ leading cause of death.
5th
CVAs are the _____ cause of long-term disability in the US.
Leading
Who has a lower risk of suffering a CVA but as they get older (85+) has an increased prevalence of CVA?
Younger women
Who has twice the risk for a first stroke?
African Americans
T/F: Stroke incidence increases with age?
True
What accounts for the largest number of deaths? Ischemic or Hemorrhagic strokes?
Hemorrhagic
What are risk factors of CVAs?
- Hypertension (HTN)
- Diabetes Mellitus (DM)
- Disorders of Heart Rhythm
- High Blood Cholesterol and other Lipids
- Smoking/ Tobacco use
- Heart Disease
What are modifiable risk factors of CVA?
- Cigarette Smoking
- Physical Inactivity
- Obesity
- Diet
What is the acronym for early warning signs of stroke?
- 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)
KNOW THE CIRCLE OF WILLIS!
HEY! GO LOOK AT THE CIRCLE OF WILLIS!!
I WAS SERIOUS! GO LOOK AT THE BLOOD FLOW OF THE BRAIN!
SERIOUSLY! GO LOOK! I CANT ADD PICTURES!! (I’m not yelling I promise!)
What kind of signs and symptoms would you see with Anterior Cerebral Artery Syndrome (ACA Stroke)?
- 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
What kinds of signs and symptoms would you see with Middle Cerebral Artery Syndrome (MCA Stroke)?
- 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
What is apraxia?
Difficulty with planning and sequencing movements that cannot be accounted for by any other reason
What is Ideational Apraxia?
Inability of the patient to produce movement either on command or automatically and represents a complete breakdown in the conceptualization of the task
What is Ideomotor Apraxia?
The patient is unable to produce a movement on command, but he or she is able to move automatically
What hemisphere is apraxia more evident with?
More evident with left hemisphere damage
What is Broca’s aphasia?
Expressive, Non-fluent aphasia (they can understand but cant respond), limited vocabulary, slow and hesitant speech (frontal lobe - M1)
What is Wernicke’s aphasia?
Fluent aphasia (cant understand but can respond), impaired auditory comprehension, fluent speech, normal rate and melody (temporal lobe - A1)
What is Global aphasia?
Non-fluent speech with poor comprehension (both wernickes and brocas)
What is Posterior Cerebral Artery Syndrome (PCA Stroke)… in the peripheral territory?
- Contralateral homonymous hemianopsia
- Bilateral homonymous hemianopsia with some degree of macular sparing
- Visual agnosia
- Prosopagnosia
- Dyslexia
- Memory deficit
- Topographic disorientation
What is Posterior Cerebral Artery Syndrome (PCA Stroke)… in the central territory?
- Central post stroke (thalamic) pain syndrome
- Spontaneous pain and dysesthesias, sensory impairments
- Involuntary movements
- Contralateral hemiplegia
- Oculomotor nerve palsy
What are lacunar strokes caused by?
Small vessel disease in the cerebral white matter
Lacunar stroke syndromes are consistent with what?
specific anatomical sites
T/F: Lacunar syndromes can be motor, sensory, etc.
True
What kind of deficits are often NOT seen in lacunar strokes due to the higher cortical areas being persevered?
Consciousness, language, and visual fields
Occlusions causing Vertebrobasilar Artery Syndrome can produce what?
A wide variety of symptoms with both the ipsilateral and contralateral signs
Why do you get both ipsilateral and contralateral signs with vertebrobasilar artery syndrome?
Because some brainstem tracts will have crossed, and some will not have crossed yet
What kind of abnormalities are present with vertebrobasilar artery syndrome?
Cerebellar and cranial nerve abnormalities
Where is damage caused with Lateral Medullary Syndrome/ Wallenberg’s Syndrome?
At the Posterior inferior cerebellar artery
What signs and symptoms will you see with Lateral Medullary Syndrome/ Wallenberg’s Syndrome?
- Loss of pain and temperature on the contralateral side of the body and ipsilateral face
- Dizziness/ vertigo
- Ataxia
- Diplopia
- Dysphagia
- Dysarthria
- Horner’s Syndrome
Where is damage caused with Horner’s Syndrome?
At the sympathetic trunk
Horner’s Syndrome has symptoms of miosis, ptosis, and anhidrosis on the _____ side.
Ipsilateral
What symptoms starting with the letter “D” does horners syndrome present?
- Dysphagia
- Dysphonia
Does horners syndrome create a sensory or motor impairment of the UE, trunk or LE?
Sensory
What is impaired over 50% of the body, and sometimes face contralateral to the lesion with horner’s syndrome?
Impaired pain and thermal sense
What is locked-in syndrome?
Damage caused to the basilar artery affecting the ventral pons
What kind of signs and symptoms might you see with locked-in syndrome?
- Tetraplegia/ quadriplegia
- Bilateral cranial nerve palsy (upward gaze is spared)
- Coma
- Cognition is spared
What kind of medical imaging can be done for CVA based conditions?
- Computed Tomography (CT)
- Magnetic Resonance Imaging (MRI)
- Magnetic Resonance Angiography (MRA)
- Doppler Ultrasound
What kind of acute management approaches can be taken for CVAs?
- Medical
- Pharmacological
- Neurosurgical
What is included in a comprehensive physical therapy examination?
- Patient/ client history
- Systems review
- Test and measures
What is the purpose of an examination?
- 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
What is included in a plan of care?
- Goals
- Expected outcomes
- Prognosis
- Interventions
What is included in a patient history?
- 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
