CVA Stroke 2017 Flashcards
Changes in consciousness Changes in sensation Loss of motor function (hemiparesis or hemiplegia) Changes in cognition Changes in perception Language changes
Symptoms of CVA
What must a CVA have to be sure of diagnosis?
Neurological defects lasting more than 24 hours
The extent of the brain injury The collateral blood flow Early and acute management of the stroke Spontaneous reversal of brain swelling (3 weeks) Type of stroke (thrombosis, embolus, or hemorrhage) Artery affected (anterior cerebral artery, middle cerebral artery, posterior cerebral artery, basilar artery, etc)
Determine CVA recovery/severity
What is the fourth leading cause of death and the most common cause of disability among adults?
CVA
What would be your concern for a female patient that is in her late 80’s?
Increased stroke risk (women over 85)
What patient population has twice the risk of stroke? What are the statistics?
African Americans have 2 times risk than Caucasians
What population does incidence of stroke increase dramatically? What are the statistics?
Over 65 years of age (increased risk doubles)
Should a PTA be concerned that a stroke pt might have another one on their watch? Why/Why Not
Doesn’t happen often, but be cautious.l- 5 - 14% of persons who survive an initial stroke will experience another one within 1 year.
Accounts for the largest number of deaths, with mortality rates of 37 – 38% at 1 month
Hemorrhagic Stroke
___ % of patients with CVA are ______ in a ______ _______.
26%; institutionalized; nursing home
A major contributory factor in cerebrovascular disease.
Atherosclerosis
______ ______ are the result of a thrombus, embolism, or conditions that produce _____ _____ perfusion pressures. The resulting lack of cerebral blood flow deprives the brain of needed oxygen and glucose, disrupts cellular metabolism and leads to injury and death of tissues. A _____ results from platelet adhesions and aggregation on plaques.
Ischemic strokes; Low Systemic; Thrombus
A ______ ______ is composed of bits of matter (blood clot and plaque) formed elsewhere and released into the bloodstream, traveling to the cerebral arteries where they lodge in a vessel, produce occlusion and infarction.
Cerebral Embolus
_____ _____ may also result from low systemic perfusion, the result of cardiac failure or significant blood loss with resulting systemic hypotension. The neurological deficits produced with systemic failure are _____ in nature with _______ neurological deficits.
Ischemic Strokes; Global; Bilateral
_____ _____ that cause abnormal bleeding into the brain are a result of a ruptured vessel or trauma. A _____ _____ is usually the cause…
Hemorrhagic Stroke; Cerebral Aneurysm
_____ _____ occurs from bleeding into the subarachnoid space typically from a saccular or _____ aneurysm affecting large blood vessels. ______ defects that produce weakness in the blood vessel wall are major contributing factors to the formation of an aneurysm. ______ is closely linked to chronic ______.
Subarachnoid Hemorrhage; Berry; Hemorrhage; Hypertension
• Hypertension (increased risk = 6X for patients with a BP of 140/90 mm Hg or more) • Heart Disease (elevated total cholesterol (240 mg/dL) and high LDLs (borderline high 130 – 159 mg/dL and high (160 – 189 mg/dL), additionally patients with marked elevations of hematocrits are at risk of occlusive stroke)(Cardiac disorders such as rheumatic heart valvular disease, endocarditis, or cardiac surgery will increase the risk of embolic stroke)(Atrial fibrillation will increase the risk of stroke 5X) • Diabetes (uncontrolled) • Sleep apnea
Major Risk Factors of Stroke
• Quit smoking (smokers have a 2 – 4 X ↑ risk of stroke) • Lose weight • Start exercising (active patients have a 35% ↓ risk of stroke) • Watch what you eat – decrease transfats, reduce animal fats. • Watch your alcohol consumption. Women, 1 glass a day of wine is good. For men, 2 glasses a day is okay….. more than that is excessive.
Modifiable Risk Factors (pt education)
• Sudden numbness or weakness of the face, arm or leg, especially on one side of the body. • Sudden confusion, trouble speaking or understanding. • Sudden trouble seeing in one or both eyes. • Sudden trouble walking, dizziness, loss of balance or coordination • Sudden, severe headaches with no known cause. • sudden nausea, fever, and vomiting – distinguished from a viral illness by the speed of onset (minutes or hours vs. several days) • Brief loss of consciousness or a period of decreased consciousness.
Early Warning Signs of CVA
With symptoms of a CVA, a patient should __ _______ __ ___ ________ _____. If an ER physician determines that the stroke is ischemic in nature, they can give a clot busting drug (____) within ______ after the event. ***recommendations haves up to _____
Immediately to the emergency room; t-PA; 3 hours; 4.5 hours
Within immediate treatment of CVA, ____ cannot be given with a ________ ______, because the drug will _______ _______.
t-PA; Hemorrhagic Stroke; Worsen bleeding
The immediate area surrounding the damaged brain tissue is ______ ______. Within this are ______ ______. This extension of the infarct in this takes place over a period of _______. Cells in the in this area require a minimum of _______ % blood flow to remain alive.
Ischemic Prenumbra; Lethargic Cells; 3-4 Hours; 20-25%
Ischemic CVAs cause _____ ______. The maximum occurs at day _____. The ______ gradually subsides and disappears by _______ weeks. When significant, it can lead to ______ _______.
Cerebral Edema; 3-4; swelling; 2-3 weeks; brain stem herniation
• decreasing levels of consciousness • widened pulse pressure • increased heart rate • irregular respirations (Cheyne-Stokes respirations) • vomiting • unreacting pupils • papilledema
Clinical signs of elevated intracranial pressure
The most frequent cause of death in acute stroke and is characteristic of large infarcts involving the middles cerebral artery and the internal carotid artery.
Cerebral Edema
________ _______ ________ Symtpoms last from only a _____ _____ to _____ _____. After the attack is over, there is no residual damage. This may result from occlusive episodes, emboli, reduced cerebral profusion (arrythmias, decreased cardiac output, hypotension, over-medication with antihypertensive medications, subclavian steal syndrome) or cerebrovascular spasm. The significance of this is that it is a precursor for both ______ and ________ infarctions.
Transient Ischemic Attack (TIA); few hours; 24 hours; Cerebral; Myocardial
The _____ _____ _____ is the first and smaller of the two terminal branches of the ______ _____ artery. It supplies the medial aspect of cerebral hemisphere (frontal and parietal lobes) and the subcortical structures including the _____ _____, and the anterior 4/5 of the ______ _____. If ischemia resulted here, you would see _______ hemiparesis and sensory loss in the ____ more than the _____.
Anterior Cerebral Artery; Internal Carotid Artery; Basal Ganglia; Corpus Callosum; contralateral; leg; arm
The ______ ______ ______ is the second branch off the _______ ______ ______. It supplies the entire lateral aspect of the cerebral hemisphere (front, parietal, temporal) and subcortical structures including the internal capsule, corona radiate, globus pallidus and most of the caudate nucleus, and the putamen. Occlusion of the proximal portion of this artery causes devastating events, including ______. The most common characteristics of the MCA syndrome are contralateral ______ hemiparesis and sensory loss of the face, upper extremity, and lower extremity, but the ____ and ____are more affected than the ____. Lesions of the _____ hemisphere usually cause _________ aphasia (Wernike’s). Lesions of the right side produce perceptual deficits such as unilateral neglect, anosognosia, apraxia and spatial disorganization. In both sides, __________ _________ is a common finding.
Middle Cerebral Artery; Internal Carotid Artery; Death; spastic; face; arm; leg; left; receptive; Homonymous Hemianopsia
The most common site for a stroke?
Middle Cerebral Artery (MCA)
This supplies both the anterior and middle cerebral arteries. If occluded, and no collateral circulation – death will result.
Internal Carotid Artery Syndrome
The two _______ ______ ______ arise as terminal branches of the _______ _______. Each supplies the corresponding _______ lobe and medical and inferior _______ lobe. These arteries also supply the upper brainstem, midbrain and posterior diencephalons, including most of the thalamus. If the proximal portion is occluded, collateral circulation usually is available –evidencing _______damage. Occlusion of the thalamic branches may produce hemianesthesia or central post-stroke ________ ______. An _______infarction produces homonymous hemianopsia, visual agnosia, prosopagnosia, or if bilateral –cortical blindness. Temporal lobe ischemia results in _______.
Posterior Cerebral Artery; Basilar Artery; Occipital; Temporal; little; thalamic pain: Occipital; Amnesia
Caused by small vessel disease deep in the cerebral white mater and are strongly associated with hypertensive hemorrhage and diabetic microscular disease. There are multiple specific sites: 1) motor 2) sensory 3) dysarthria and clumsy hand syndrome 4) a sensory/motor stroke 5) dystonia/involuntary movements 6) thalamic syndrome
Lacunae Syndromes
Which artery rises from the subclavian arteries and travels into the brain along the medulla where they merge at the inferior border of the pons to form the basilar artery?* supplies the cerebellum and brainstem
Vertibrobasilary Artery
What stroke results from forceful manipulations of the neck. *flexion injury
Vertebral Artery Stroke
Within a medical diagnosis of stroke _____ signs are usually a sign of massive involvement or ______ lesions.
Bilateral; Brainstem
Within a medical diagnosis of stroke ______ of _____ is very important.
Pattern of Onset
Within a medical diagnosis of stroke, An abrupt onset with rapid coma is suggestive of cerebral _______.
Hemorrhage
Within a medical diagnosis of stroke, a history of heart disease and or heart complication in a patient is at risk of ______ suddenly occurring with no warning?
An Embolus
Within a medical diagnosis of stroke, a history of TIA or head trauma in a patient is at risk of a ______ that has a variable and uneven onset.
Thrombosis
What disorder of speech and language presents in 51% of all strokes that can lead to aspirations or dehydrations/compromised nutrition?
Dysphagias (difficulty swallowing)
Difficulties with communication and processing information in a linear manner. Frequently described as cautious, anxious, and disorganized. This makes them more hesitant to try new things. This increases the need for feedback and support. They tend to be realistic in their expectations. The patient with left hemiparesis will have trouble attending to visual clues in a cluttered room.
Left Hemisphere Damage (more Monica)
Difficulty with spatial-perceptual tasks and in grasping the whole idea of a task. Frequently described as quick and impulsive. They tend to overestimate their abilities while acting unaware of their deficits. Safety is one of their biggest issues, due to their poor judgment. Feedback should focus on slowing down the activity, checking sequential steps, and relating them to the whole task.
Right Hemisphere Damage
What should physical therapy know about a patients many months after a stroke.
Patients can have seizures (partial motor type)
Prevention of _______ and _____ are both done via early mobilization of the legs and with use of elastic support stockings.
DVT; Pulmonary Emboli
If a patients CT scan comes up as an area with decreased density 5 after issues , what does it possibly indicate?
Infarction
Can detect the area of infarction within 2 –6 hours after the event.
MRI
______ requires an injected radionuclide. This test detects localized cerebral metabolism. In the sub-acute phase, It is able to delineate the area of infarction.
PET scan (Positron Emission Tomography)
Why would a pt opt for the Merci System (Corkscrew device to remove clots in large vessels)?
Not eligible for t-PA
Suctions and grabs the clot. Can be used within 8 hours of the event.
Prenumbra Sytem
As PTA’s we should Maintain CVA victims integrity of ____ and _____ with protective _______, and a turning schedule every _______ in early PT & OT
Skin; Joints; Positioning; 2 hours
What are heparin and coumadin for?
Anticoagulants (Blood thinner)
What does aspirin do for the blood?
Antiplatelet Therapy
