EXAM #2: CVA-Horner's Syndrome Flashcards
what is the leading cause of long term disability?
2nd leading cause of death?
cerebrovascular accident (CVA)
aka stroke
what is the most common type of CVA? what is it?
ischemic
blocked blood flow often due to atherosclerosis
what is a hemorrhagic CVA?
ruptured blood vessel often due to HTN, aneurysms, and arteriovenous malformations
what are non-modifiable risk factors of CVA?
age
african americans > european americans
women
what are modifiable risk factors?
CV disease and HTN
diabetes
lifestyle (SAD, obesity, tobacco use, drugs)
how does a CVA develop?
disrupted blood flow to the brain
true or false. CVA S&S have a sudden onset
true
what are S&S of CVA? (5)
WORST ever - severe headache
multi-segmental hemi face and/or extremity numbness and weakness/paralysis
visual disturbance
speech, swallowing impaired
unexplained dizziness or falls
what should be included in your systems review for CVA?
history and observation
scan:
resisted testing w/ multiple joint weakness
neuro tests –> (+) babinski, clonus, DTRs, & UMN findings (multi-segmental weakness)
what kind of referral for CVA?
emergency referral
what are causes of posterior circulation compromise?
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
in PCC, ischemia of the arteries feeding the inner ear, brain stem, and cerebellum includes:
vertebral artery
basilar and posterior cerebral arteries & their branches
what are affected functions from a PCC?
brain stem houses cranial n. and respiratory center
cerebellum regulates coordination
the basilar artery most frequently supplies what nerve?
trigeminal nerve
PCC S&S –>
5 Ds:
And:
3 Ns:
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
what kind of referral for PCC?
emergency
what is presyncope dizziness?
near fainting/light headedness just before LOC without illusion of spinning
how is presyncope dizziness caused?
cardiovascular or non-cardiovascular (i.e. high stress or medication)
how is presyncope dizziness developed?
reduction of blood flow from heart to brain
what are S&S of presyncope dizziness?
generalized weakness
giddiness
sweating
pallor (pale, not looking well)
5 Ds And 3 Ns
what kind of referral for presyncope dizziness?
emergency referral
what is vertigo?
illusion of spinning or rotary motion caused by asymmetries in the vestibular system
what are the two types of vertigo?
which one is 90% of the cases?
peripheral and central
peripheral
what is the most common type of peripheral vertigo?
benign paroxysmal positional vertigo (BPPV)
what is the primary cause of peripheral vertigo?
unknown
How does peripheral vertigo develop? ____________ becomes free floating in ______________
crystals become free floating in semi circular canals
what is the primary cause of central vertigo?
CVA or tumor
what are secondary causes of central vertigo?
trauma creating a brain injury or upper cervical instability
infection
demyelination (MS)
migraine HAs
how does central vertigo develop? Due to ______ to what 3 structure?
due to ischemia to cerebellum, brainstem or vestibular nuclei
which vertigo presents with UMN signs like 5Ds And 3Ns?
which has severe nausea, possible vomiting?
central
peripheral
which vertigo has severe perception of linear motion? which has greater spinning?
central
peripheral
which vertigo is worsened with head movements? which occurs at rest?
peripheral
central
which vertigo is often with hearing loss? which is severe imbalance?
peripheral
central
which vertigo requires emergency referral? which begin a trial of PT with vestibular specialist?
central
peripheral
what is dysequilibrium dizziness?
unsteadiness without illusion of spinning
what are the 3 primary afferent systems that contribute to postural perception and control and make up the balance triad?
MOSTLY somatosensory system (pressure, P!, position, motion, vibration, temp, joints, skin, etc)
vestibular system
visual pathways
what causes dysequilibrium?
brain degeneration
biomechanical restraints with aging (less ROM and muscle weakness)
progressions of neuromusculoskeletal diseases
how does disequilibrium develop? Dysfunction of __________________
dysfunction of balance triad
what are the two options for referring out or not for disequilibrium?
- begin trial PT
- assess & treat to improve somatosensory function & balance triad - potential urgent referral for vestibular or vision component
what can non-specific dizziness be due to?
psychophysiological or cervical origins
what causes psychophysiological non-specific dizziness?
psychological disorders (anxiety, phobias, depression)
how is psychophysiological non-specific dizziness developed?
vasoconstriction with SNS response
what are S&S of psychophysiological non-specific dizziness?
motion sickness
giddiness
feeling removed from their body
sensations of floating
subjective postural imbalances with normal balance testing
what kind of referral is needed for psychophysiological non-specific dizziness?
urgent referral for psychological consult
what causes cervicogenic dizziness (CGD)?
cervical spine dysfunction, esp. C2-3 segment
how is cervicogenic dizziness (CGD) developed?
abnormal afferent input from the neck to the trigeminocervical nucleus
what are S&S of cervicogenic dizziness (CGD)?
dizziness with neck motion
often accompanied by head and face as well as parasympathetic symptoms
no illusion of spinning or nystagmus
what should your referral process look like for cervicogenic dizziness (CGD)?
begin trial PT to assess and address cervical dysfunction
cervical myelopathy is _______, ________ and often _________ compression on the cord
slow, gradual and often progressive
where is the least common area in the spine for myelopathy?
cervical
what is the most common cause of cervical myelopathy?
degenerative spinal changes
which are:
- lax and buckling ligamentum flavum
- age related joint changes
- age related disc changes
- vertebral body collapse
- pathological instability (spondylolisthesis)
what are two more rare causes of cervical myelopathy?
malignancy (20%)
central disc herniation (rare)
what are S&S of cervical myelopathy?
neuro findings (slow onset)
multiple directions of weak/painful resisted testing
wide based gait
incoordination
cooks CPR (+)
what kind of condition would we consider cervical myelopathy to be?
“do not want to miss” condition
emergency referral
what is meningitis?
infection leading to inflammation of the brain and spinal cord meningeal membranes
although rare,
viral meningitis is most common in _______
bacterial meningitis is most common in ______
adults
young children due to strep
viral meningitis is caused by what?
enteroviruses from GI tract
what is the most common bacterial meningitis?
streptococcus pneumonia
meningeal inflammation causes scar tissue that increases risk of:
- restricted CSF that can lead to hydrocephalus
- decreased blood flow that can lead to stroke
viral meningitis S&S resemble what two system S&S?
bacterial meningitis?
infection and GI S&S
infection and respiratory S&S
what are typical S&S of meningitis?
constitutional and infection S&S
neck P!/stiffness
photophobia
HA
what are S&S of increased intracranial pressure in meningitis?
increased HA with looking down, lifting, bending over
altered mental status
cranial n. deficits
seizures
what is the most sensitive clinical test to rule OUT meningitis?
jolt accentuation of HA test
HA worsened by neck rotation 2-3x in a second
what are the two best clinical tests to rule IN meningitis while supine?
Kernig test: low back and posterior thigh P! with combined hip flexion and knee extension
Brudzinski test: neck flexion produces hip and knee flexion
what type of referral is meningitis?
emergency
mean age for brain tumors:
60 years old
brain tumors:
2nd most common primary tumor in _______
most common intracranial metastatic tumor in ______
children
adults
how do brain tumors develop? (3)
compression of cerebral tissue
at times erosion of bone with growth
leads to edema and increased intracranial pressure
are brain tumors asymptomatic or symptomatic in early stages? due to what?
asymptomatic due to brains ability to adapt to slow growing tumors
what system S&S do brain tumors have?
cancer S&S plus S&S related to area of brain
S&S of brain tumors:
HA this is increased with activities further increasing ICP (looking down, straining, exercise, coughing)
UMN S&S (ataxia)
tinnitus
seizures
speech impairment
what are 3 causes of horner’s syndrome?
-_________ tumor that compresses _________________
-__________ pathology
-_______ artery & _________ sinus
pancoast tumor in apical portion of lung that compresses sympathetic ganglion at cervicothoracic junction
intracranial pathology
conditions influencing carotid artery and venous sinus
how does horner’s syndrome develop?
-interruption of?
interruption of sympathetic nerve supply to the eye
ipsilateral S&S of horner’s syndrome?
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
