CVA Pathophysiology Flashcards
What percentage of ACUTE stroke patients will have a recurrence?
25-35%
What is the percentage risk for recurrence within 5 years? And who is at higher risk?
40%
Men
Race and risk for stroke
_____>_____>_____
African Americans>Hispanic Americans>Caucasian
Identify 8 risk factors for stroke.
Hypertension, High serum cholesterol, Heavy alcohol use, obesity, smoking, cocaine use, diabetes mellitus, Heart disease
What are the 3 stroke classifications and which 2 are most common?
Thrombotic, embolic, and cerebral hemmorrhage
Thrombotic and embolic
What 2 things can cause a thrombotic CVA?
ASCHD and HTN
Other names for thrombotic CVAs?
“Stroke in progress”, mini stroke, transient ischemic attack.
What 3 things can a TIA indicate?
thrombolytic disease, possible vasospasm, and transient systemic arterial hypotension.
Medical management of thrombotic CVA and TIA includes:
Prevention, improving circulation ASAP, surgery ( thromboendarterectomy of the carotid or subclavian), pharmaceuticals (TPA under 3 hrs, anticoagulants, antiplatelets)
Embolic CVAs can orginate from _____, _____, and _____.
heart, internal carotid artery, carotid sinus
Which arteries are most commonly affect by embolic CVAs?
Branches of the MCA, poorer outcomes
Embolic CVAs are signs of ______.
Cardiac disease
Embolic CVA medical management includes: ____, ____, and _____.
Prevention, surgery, or long term anticoagulant therapy
3 possible causes of hemorrhagic stroke include:
HTN, ruptured saccular aneruysm (berry), and AV malformation (age 10-35 years most common)
What is a defining characteristic of a hemorrhagic stroke?
Displacement of midline structures
How long does it take to resorb blood from a hemorrhagic stroke?
6-8 months
Medical management of hemorrhagic strokes include:
prevention and HTN management if it is caused by HTN
if it is a ruptured aneurysm, then surgery is indicated
Post surgery: HOB restrictions, 4-6 weeks of limited activity, and anti-seizure medication.
Right side paralysis, speech and memory deficits, and cautious and slow behavior are indicative of a stroke on the ____ side of the brain.
Left
Left side paralysis, perceptual and memory deficits, and quick and compulsive behaviors are indicative of a stroke on the ______ side of the brain.
Right
Movement dysfunctions post CVA include:
decreased force production, decreased force regulation, abnormal synergistic movement, altered muscle contraction timing, decreased force regulation, delayed responses, abnormal tone
Post CVA sensory dysfunctions include:
awareness, interpretation, any sensory modality, visual disturbances are common.
Secondary impairments from CVA include:
changes in alignment, mobility, muscle and soft tissue length, pain and edema
The ________ is stroke specific and should be used in the initial eval.
Orpington prognostic scale
True/False: the OPS should be used for acute prognosis.
False. Should only be used when neurologically stable., Optimal predictive power at 2 weeks post stroke, scores range from 1.6-6.8.
What range of scores on the OPS indicates moderate deficits?
3.2-5.2
> 5.2 on the OPS indicates possible _____
dependent with increased liklihood of institutionalization
Initial functional gains in recovery are attributed to:
reduced cerebral edema, absorption of damaged tissue, and improved vascualr flow. Followed by neuroplasticity.
Motor function may take ______.
Years
Initial UE movement return in first ____ weeks is predictive of full arm recovery.
2
Failure to recover grip strength by _____ days is predictive of no UE recovery at ____ months.
24, 3
What percentage of patients have no arm recovery?
30%
How much functional recovery is predictable at 1 month?
86%
