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clin med i-ii > EXAM #2: CVA-Horner's Syndrome > Flashcards

EXAM #2: CVA-Horner's Syndrome Flashcards

1
Q

what is the leading cause of long term disability?
2nd leading cause of death?

A

cerebrovascular accident (CVA)
aka stroke

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2
Q

what is the most common type of CVA? what is it?

A

ischemic
blocked blood flow often due to atherosclerosis

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3
Q

what is a hemorrhagic CVA?

A

ruptured blood vessel often due to HTN, aneurysms, and arteriovenous malformations

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4
Q

what are non-modifiable risk factors of CVA?

A

age
african americans > european americans
women

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5
Q

what are modifiable risk factors?

A

CV disease and HTN
diabetes
lifestyle (SAD, obesity, tobacco use, drugs)

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6
Q

how does a CVA develop?

A

disrupted blood flow to the brain

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7
Q

true or false. CVA S&S have a sudden onset

A

true

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8
Q

what are S&S of CVA? (5)

A

WORST ever - severe headache
multi-segmental hemi face and/or extremity numbness and weakness/paralysis
visual disturbance
speech, swallowing impaired
unexplained dizziness or falls

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9
Q

what should be included in your systems review for CVA?

A

history and observation
scan:
resisted testing w/ multiple joint weakness
neuro tests –> (+) babinski, clonus, DTRs, & UMN findings (multi-segmental weakness)

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10
Q

what kind of referral for CVA?

A

emergency referral

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11
Q

what are causes of posterior circulation compromise?

A

CVA
pathological joint instability
atherosclerosis, clot, or embolism - most commonly in internal carotid
sudden arterial dissection (excessive rot/ext/tx stress)
tumors
VBI - vertebrobasilar insufficiency
presyncope

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12
Q

in PCC, ischemia of the arteries feeding the inner ear, brain stem, and cerebellum includes:

A

vertebral artery
basilar and posterior cerebral arteries & their branches

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13
Q

what are affected functions from a PCC?

A

brain stem houses cranial n. and respiratory center
cerebellum regulates coordination

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14
Q

the basilar artery most frequently supplies what nerve?

A

trigeminal nerve

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15
Q

PCC S&S –>
5 Ds:
And:
3 Ns:

A

5 Ds:
- dysarthria (speech)
- dysphagia (swallowing)
- diplopia (double vision)
- dizziness
- drop attacks (w/o loss of consciousness)

And: (2)
- ataxia: incoordination due to cerebellar disorder
- headAche - worst ever

3 Ns:
- nausea
- nystagmus - involuntary rotary eye movement creating spinning sensation
- numbness/paresthesia’s in face/extremities

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16
Q

what kind of referral for PCC?

A

emergency

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17
Q

what is presyncope dizziness?

A

near fainting/light headedness just before LOC without illusion of spinning

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18
Q

how is presyncope dizziness caused?

A

cardiovascular or non-cardiovascular (i.e. high stress or medication)

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19
Q

how is presyncope dizziness developed?

A

reduction of blood flow from heart to brain

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20
Q

what are S&S of presyncope dizziness?

A

generalized weakness
giddiness
sweating
pallor (pale, not looking well)
5 Ds And 3 Ns

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21
Q

what kind of referral for presyncope dizziness?

A

emergency referral

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22
Q

what is vertigo?

A

illusion of spinning or rotary motion caused by asymmetries in the vestibular system

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23
Q

what are the two types of vertigo?
which one is 90% of the cases?

A

peripheral and central
peripheral

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24
Q

what is the most common type of peripheral vertigo?

A

benign paroxysmal positional vertigo (BPPV)

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25
Q

what is the primary cause of peripheral vertigo?

A

unknown

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26
Q

How does peripheral vertigo develop? ____________ becomes free floating in ______________

A

crystals become free floating in semi circular canals

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27
Q

what is the primary cause of central vertigo?

A

CVA or tumor

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28
Q

what are secondary causes of central vertigo?

A

trauma creating a brain injury or upper cervical instability
infection
demyelination (MS)
migraine HAs

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29
Q

how does central vertigo develop? Due to ______ to what 3 structure?

A

due to ischemia to cerebellum, brainstem or vestibular nuclei

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30
Q

which vertigo presents with UMN signs like 5Ds And 3Ns?
which has severe nausea, possible vomiting?

A

central
peripheral

31
Q

which vertigo has severe perception of linear motion? which has greater spinning?

A

central
peripheral

32
Q

which vertigo is worsened with head movements? which occurs at rest?

A

peripheral
central

33
Q

which vertigo is often with hearing loss? which is severe imbalance?

A

peripheral
central

34
Q

which vertigo requires emergency referral? which begin a trial of PT with vestibular specialist?

A

central
peripheral

35
Q

what is dysequilibrium dizziness?

A

unsteadiness without illusion of spinning

36
Q

what are the 3 primary afferent systems that contribute to postural perception and control and make up the balance triad?

A

MOSTLY somatosensory system (pressure, P!, position, motion, vibration, temp, joints, skin, etc)
vestibular system
visual pathways

37
Q

what causes dysequilibrium?

A

brain degeneration
biomechanical restraints with aging (less ROM and muscle weakness)
progressions of neuromusculoskeletal diseases

38
Q

how does disequilibrium develop? Dysfunction of __________________

A

dysfunction of balance triad

39
Q

what are the two options for referring out or not for disequilibrium?

A
  1. begin trial PT
    - assess & treat to improve somatosensory function & balance triad
  2. potential urgent referral for vestibular or vision component
40
Q

what can non-specific dizziness be due to?

A

psychophysiological or cervical origins

41
Q

what causes psychophysiological non-specific dizziness?

A

psychological disorders (anxiety, phobias, depression)

42
Q

how is psychophysiological non-specific dizziness developed?

A

vasoconstriction with SNS response

43
Q

what are S&S of psychophysiological non-specific dizziness?

A

motion sickness
giddiness
feeling removed from their body
sensations of floating
subjective postural imbalances with normal balance testing

44
Q

what kind of referral is needed for psychophysiological non-specific dizziness?

A

urgent referral for psychological consult

45
Q

what causes cervicogenic dizziness (CGD)?

A

cervical spine dysfunction, esp. C2-3 segment

46
Q

how is cervicogenic dizziness (CGD) developed?

A

abnormal afferent input from the neck to the trigeminocervical nucleus

47
Q

what are S&S of cervicogenic dizziness (CGD)?

A

dizziness with neck motion
often accompanied by head and face as well as parasympathetic symptoms
no illusion of spinning or nystagmus

48
Q

what should your referral process look like for cervicogenic dizziness (CGD)?

A

begin trial PT to assess and address cervical dysfunction

49
Q

cervical myelopathy is _______, ________ and often _________ compression on the cord

A

slow, gradual and often progressive

50
Q

where is the least common area in the spine for myelopathy?

A

cervical

51
Q

what is the most common cause of cervical myelopathy?

A

degenerative spinal changes
which are:
- lax and buckling ligamentum flavum
- age related joint changes
- age related disc changes
- vertebral body collapse
- pathological instability (spondylolisthesis)

52
Q

what are two more rare causes of cervical myelopathy?

A

malignancy (20%)
central disc herniation (rare)

53
Q

what are S&S of cervical myelopathy?

A

neuro findings (slow onset)
multiple directions of weak/painful resisted testing
wide based gait
incoordination
cooks CPR (+)

54
Q

what kind of condition would we consider cervical myelopathy to be?

A

“do not want to miss” condition
emergency referral

55
Q

what is meningitis?

A

infection leading to inflammation of the brain and spinal cord meningeal membranes

56
Q

although rare,
viral meningitis is most common in _______
bacterial meningitis is most common in ______

A

adults
young children due to strep

57
Q

viral meningitis is caused by what?

A

enteroviruses from GI tract

58
Q

what is the most common bacterial meningitis?

A

streptococcus pneumonia

59
Q

meningeal inflammation causes scar tissue that increases risk of:

A
  • restricted CSF that can lead to hydrocephalus
  • decreased blood flow that can lead to stroke
60
Q

viral meningitis S&S resemble what two system S&S?
bacterial meningitis?

A

infection and GI S&S
infection and respiratory S&S

61
Q

what are typical S&S of meningitis?

A

constitutional and infection S&S
neck P!/stiffness
photophobia
HA

62
Q

what are S&S of increased intracranial pressure in meningitis?

A

increased HA with looking down, lifting, bending over
altered mental status
cranial n. deficits
seizures

63
Q

what is the most sensitive clinical test to rule OUT meningitis?

A

jolt accentuation of HA test
HA worsened by neck rotation 2-3x in a second

64
Q

what are the two best clinical tests to rule IN meningitis while supine?

A

Kernig test: low back and posterior thigh P! with combined hip flexion and knee extension
Brudzinski test: neck flexion produces hip and knee flexion

65
Q

what type of referral is meningitis?

A

emergency

66
Q

mean age for brain tumors:

A

60 years old

67
Q

brain tumors:
2nd most common primary tumor in _______
most common intracranial metastatic tumor in ______

A

children
adults

68
Q

how do brain tumors develop? (3)

A

compression of cerebral tissue
at times erosion of bone with growth
leads to edema and increased intracranial pressure

69
Q

are brain tumors asymptomatic or symptomatic in early stages? due to what?

A

asymptomatic due to brains ability to adapt to slow growing tumors

70
Q

what system S&S do brain tumors have?

A

cancer S&S plus S&S related to area of brain

71
Q

S&S of brain tumors:

A

HA this is increased with activities further increasing ICP (looking down, straining, exercise, coughing)
UMN S&S (ataxia)
tinnitus
seizures
speech impairment

72
Q

what are 3 causes of horner’s syndrome?
-_________ tumor that compresses _________________
-__________ pathology
-_______ artery & _________ sinus

A

pancoast tumor in apical portion of lung that compresses sympathetic ganglion at cervicothoracic junction
intracranial pathology
conditions influencing carotid artery and venous sinus

73
Q

how does horner’s syndrome develop?
-interruption of?

A

interruption of sympathetic nerve supply to the eye

74
Q

ipsilateral S&S of horner’s syndrome?

A

ptosis (droopy eye lid)
lack of face sweating
sunken eyeball
miosis (constricted pupil)
possibly P! in T2-4 dermatomal region due to shared spinal n. innervation

clin med i-ii (21 decks)

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