CVA (MedBridge) Flashcards
MCA superior division of blood supply
Supplies cortex above the sylvian fissure
**Includes lateral frontal lobe
MCA inferior division of blood supply
Supplies cortex below the sylvian fissure
**Inclues lateral temporal lobe and a variable portion of the parietal lobe
Posterior communicating artery
Connects PCA with internal carotid/MCA (posterior to anterior division)
Anterior cerebral artery
Comes off of internal carotid and connects bilateral vessels via anterior communicating artery
Anterior choroidal artery blood supply
Supplies GP, putamen, thalamus, and posterior limb of internal capsule
L MCA superior infarct deficits
- Contralateral face/arm weakness
- Broca’s aphasia
R MCA superior infarct deficits
- Contralateral face/arm weakness
- L neglect
- May be some sensory impairment in contralateral arm/face
L MCA inferior infarct deficits
- Wernicke’s aphasia
- R visual field deficit
- Contralateral face/arm sensory impairments
- Mild contralateral weakness
R MCA inferior infarct deficits
- PROFOUND L hemineglect with R gaze preference
- L visual field deficits
- Contralateral face/arm sensory impairments
- L motor neglect but typically normal strength
Vertebral-basilar CVA
- Brainstem/cranial nerve damage
- Hemi/tetraplegia
- Locked in syndrome is common
Anticonvulsant use following CVA
Not recommended to be prescribed prophylactically
BP goal for ICH
Less then 130/80
BP goal or post-TPA/fibrinolytic therapy
Less then 180-185/105
Three impairments that predict walking ability
- Sitting balance
- Strength
- Standing balance
SAFE score
<5: Recommend TMS assessment
5-7: predicts notable recovery
>8: predicts complete recovery
Early mobilization with CVA
- Short sessions if mobilizing less then 24 hours
- Poor outcomes with longer bouts of therapy within first 24 hours
- *Ideally begin within first 24-72 hours post-CVA (better follow-up 3 months)
Burkle Lateropulsion Scale
5 items that measures contraversive pushing (rolling, sitting with feet off floor, standing, transfers, walking)
Clinical Scale for Contraversive Pushing
- Based on symmetry of spontaneous body posture, use of non paretic UE, resistance to correction to vertical
- Have to score a 1 in all 3 components to be classified as having contraversive pushing
- Not very sensitive
Mirror box therapy protocol
Recommend 5 sessions per day, 90 minutes per session, with functional tasks