Exam 3- Stroke part 1

Question 1

A stroke is usually ___ but can be ___

Answer 1

~usually appears suddenly

~can appear slowly

Question 2

Some of the slow appearing strokes

Answer 2

~TIAs, pin stroke, mini strokes

~hemorrhagic

Question 3

2 main types of strokes

Answer 3

Ischemic/ Occlusive and Hemorrhagic

Question 4

what is the most common type of stroke

Answer 4

80% of strokes are occlusive

Question 5

Hemorrhagic- some details

2 things associated with it

Answer 5

~High blood pressure

~Associated with headaches

Question 6

Hemorrhagic- Common types

Answer 6

~berry aneurism
~AVM (arteriosus venous malformation)

MB: I also have intracerebral hemorrhage and cerebral hemorrhage in my notes. I also have subarachnoid hemorrhage as being paired with the berry aneurysm. Don’t have that lecture recorded so unable to verify.

Question 7

Hemorrhagic- berry aneurism

Answer 7

an out pouching of the circle of willis

Question 8

Hemorrhagic- AVM

Answer 8

abnormal connection of the artery and vein

AVM = arteriovenous malformation

Question 9

Hemorrhagic- 3 courses for an aneurism

Answer 9

~Pick up on a scan when looking for it
~Pick it up on a another scan (looking at something different)
~it pops

Question 10

2 ways to fix an aneurism

Answer 10

Clip and coil

Question 11

Clip for an aneurism

Answer 11

~can be used for an aneurism that has or has not been popped
~Need a craniotomy

Question 12

Coil for an aneurism

Answer 12

~for people for not ruptured
~a birds nest of wire that fills the hole
~will cause the body to fill back in the aneurism
~Do not need a craniotomy

Question 13

Hemorrhagic- Will have cell death

5

Answer 13

~cell starved of blood distal to bleed
~pressure on cells right at the site; usually occlude broken artery
~pressure away from the site; can act like a contra coup injury
~other arteries can be occluded
~may have uncal herniation and/or midline shift

Question 14

Hemorrhagic- will present in therapy

4

Answer 14

~wide spread
~will be hard to decide where their symptoms came from
~will be younger
~rarely will fully recover

Question 15

Occlusive- 2 types

Answer 15

~thrombolytic

~embolytic

Question 16

Occlusive- Thrombolytic

Answer 16

Build up of plaque, etc that will cause a blockage in the artery

Question 17

Occlusive- Embolytic

Answer 17

Blood/plaque/ air/ fat/cancer breaks off and moves

Question 18

Occlusive- Embolytic- blood

4

Answer 18

~We can do a good a good job getting rid of blood clots with TPA tissue plasminogen activators- thins blood and gets rid of blood clots
~need to give these to someone within 3 hours
~More than 3 hours, the structures distally already starting to die
~Its not worth the risk to thin the blood that much

Question 19

Occlusive- Embolytic- fat

Answer 19

can caused post surgery

Question 20

TIA

Answer 20

symptoms resolve within 24 hours

Question 21

Some details on how you know it is a Major stroke

6

Answer 21

~Complete paralyze on one side 
~High cortical processes loss
~Has come cognitive loss
~Speak problems
~Visual problems
~Much harder for pt to return to function

Question 22

Some details on how you know it is a minor stroke

3

Answer 22

~Still the same person you were before- personality stays the same
~Steppage gait; foot drop; some limb paresis
~A little sensory or motor deficit; distal portion of the UE or LE

Question 23

Some details on how you know it is a shower stroke/ what is it?
(4)

Answer 23

~Occlusive, but sometimes when a clot breaks off and a lot of little clots will break off too
~Lots of little strokes all over
~Can occur after surgeries when you are trying to prevent/correct for a stroke- endarterectomy (plaque build up in the carotids)
~The plaque can lead to a shower stroke if all the plaque is not sucked up

Question 24

some Diagnosis Tests to test for possible stroke

3

Answer 24

~Echocardiogram- did it happen from a build up of blood settling in the heart
~CT/ MRI
~Carotid US- did it happen form a build up from plaque in the carotids

Question 25

risk factors for stroke

Answer 25

``` ~Birth control ~smoke ~high blood pressure ~diabetes ~high cholesterol ~sedentary ~history of CVA ~A-fib ~age ~postmenopausal ~drinker ~African American ```

Question 26

anterior cerebral artery syndrome- symptoms

Answer 26

~Contralateral issues ~LE more than UE- hemiparesis and hemisensory loss ~More apraxia (inability to perform a task) ~Problems with imitation and bimanual tasks ~Slowness, delay, lack of spontaneity, motor inaction ~High risk of Incontinence issues ~Higher risk of skin break down

Question 27

middle cerebral artery syndrome- symptoms

Answer 27

~80% have MCA ~80% of MCA have occlusive ~UE worse than LE- hemiparesis and hemisensory loss ~Aphasia (problems with speak)- motor speech impairment ~Perception deficits ~Limb-kinetic apraxia ~Homonymous hemianopia (be able to draw this); Unilateral neglect (think of Bob)

Question 28

posterior cerebral artery syndrome- symptoms

Answer 28

~Visual issues *homonymous hemianopsia *can be bilateral homonymous hemianopsia with some degree of macular sparing *visual agnosia *prosopagnosia ~Cerebellar issues- balance and coordination ~Memory defect

Question 29

locked in syndrome

Answer 29

~They can feel and hear everything | ~They can understand

Question 30

Stroke on the Right- symptoms

Answer 30

``` ~Visual problems ~Unilateral defect ~Impulsive ~Poor judgment ~Quick with movements ~Unaware of impairments ~Rigid in their thoughts (stubborn) ~Emotional with negative emotions (and expressing them) and get upset with constructive criticism ~Have problem with time; spatial awareness ```

Question 31

Stroke on the Left- symptoms

Answer 31

~Right motor issues ~Speak issues (know problems with W and B; Express and receptive) ~Local aphasia ~Disorganized ~Slow and cautious; overly aware of their impairments ~They think they are doing horrible/ afraid/ etc; have to talk them into doing something ~Have some processing delays

Question 32

Symptoms that appear when there's a stroke on a right or left

Answer 32

~Visual- homonymous hemianopsia ~Lability- unstable personality (person can be crying and they don’t have a reason to) ~Apathy, irritable, anxiety, depression ~Confusion, short attention span, loss of memory ~Inability to preform executive functions

Question 33

When people are recovering from a stroke, they will often ask...

Answer 33

When am I going to get better?

Question 34

Recovering from a stroke: what are some things that are going on that are helping

Answer 34

~Angiogenesis, plasticity, collateral blood flow helps with recovery ~Thinning the blood, keeping the inflammatory response down ~Pts are going to sleep a lot! ~Neuroplasticity- need stimulus (we will help to cause it) to help cause new connections and strengthen the old ones ~Have to start moving them fast so that something will start to form in the brain

Question 35

Recovering from a stroke: what are some things that will help if they are flaccid?

Answer 35

~go into weight bearing to cause compression in jts ~will get them to have muscle firing ~Be careful to make sure that when you are doing this that the pt is in proper alignment so that they do not have impingements later

Question 36

Roods techniques- types

Answer 36

``` ***Can be facilitative or inhibitory ~Stretch ~Jt manipulation ~Cutaneous touch ~Ice ~Heat ~Vestibular ~Auditory ~Visual ~Gustatory ~Olfactory ```

Question 37

Roods techniques- Facilitative

Answer 37

~To increase the threshold- excitatory inputs | ~contraction

Question 38

Roods techniques- Inhibitory

Answer 38

~To decrease the threshold | ~relaxation

Question 39

Roods techniques- Stretch

Answer 39

~quick ~repetitive ~CMP ~Prolong

Question 40

Roods techniques- Quick Stretch

Answer 40

~will jar the muscle a little bit to cause a contraction | ~facilitative

Question 41

Roods techniques- repetitive stretch

Answer 41

~Can use a vibratory that is placed on the muscle belly ~>100 Hz- facilitative ~<100 Hz- inhibitory

Question 42

Roods techniques- CPM stretch

Answer 42

continuous passive motion- is a repetitive passive motion (over 100 Hz)

Question 43

Roods techniques- prolong stretch

Answer 43

~inhibitory ~Serial casting- you will put the person at the end range, recast and move them farther into the range ~trying to get spasticity to release

Question 44

Roods techniques- Jt manipulation types

Answer 44

~traction ~low grade manipulations ~approxiations

Question 45

Roods techniques- Jt manipulation Traction

Answer 45

relaxation

Question 46

Roods techniques- Jt manipulation Low grade

Answer 46

relaxation

Question 47

Roods techniques- Jt manipulation Approximation

Answer 47

contraction

Question 48

Roods techniques- Cutaneous touch types

Answer 48

~Quick touch | ~Maintain touch

Question 49

Roods techniques- Cutaneous touch quick

Answer 49

over the muscle belly- contracts the muscle

Question 50

Roods techniques- Cutaneous touch maintained

Answer 50

calmed the muscle- relaxation

Question 51

Roods techniques- Ice types

Answer 51

~quick strokes | ~prolonged

Question 52

Roods techniques- Ice quick

Answer 52

Facilitative with the quick strokes- contraction

Question 53

Roods techniques- Ice prolonged

Answer 53

If you leave it over time- relaxes- inhibits

Question 54

Roods techniques- Heat

Answer 54

Relaxes them

Question 55

Roods techniques- Vestibular types

Answer 55

~rocking ~spinning ~bouncing on the ball

Question 56

Roods techniques- Vestibular rocking

Answer 56

relaxes us

Question 57

Roods techniques- Vestibular spinning

Answer 57

contractions

Question 58

Roods techniques- Vestibular bouncing on the ball

Answer 58

Bouncing on the ball ~Softly- relaxes ~Hard- contractions (and jt approx.)

Question 59

Roods techniques- Auditory types

Answer 59

~loud | ~soft

Question 60

Roods techniques- Auditory loud

Answer 60

facultative/ contractions

Question 61

Roods techniques- Auditory soft

Answer 61

relaxes

Question 62

Roods techniques- Visual types

Answer 62

~bright | ~soft

Question 63

Roods techniques- Visual bright

Answer 63

Bright loud colors- awake/ contraction

Question 64

Roods techniques- Visual soft

Answer 64

asleep/ relaxation

Question 65

Roods techniques- Gustatory types

Answer 65

~sour | ~sweet

Question 66

Roods techniques- Gustatory sour

Answer 66

Sour, etc- wake up/ contraction

Question 67

Roods techniques- Gustatory sweet

Answer 67

Chocolate, etc- relaxation

Question 68

Roods techniques- Olfactory types

Answer 68

~bleach | ~nice smells

Question 69

Roods techniques- Olfactory bleach

Answer 69

Bleach, etc- wake up/ contraction

Question 70

Roods techniques- Olfactory nice

Answer 70

Relaxing smells (coffee :) )