Exam 3- Stroke part 1 Flashcards
A stroke is usually ___ but can be ___
~usually appears suddenly
~can appear slowly
Some of the slow appearing strokes
~TIAs, pin stroke, mini strokes
~hemorrhagic
2 main types of strokes
Ischemic/ Occlusive and Hemorrhagic
what is the most common type of stroke
80% of strokes are occlusive
Hemorrhagic- some details
2 things associated with it
~High blood pressure
~Associated with headaches
Hemorrhagic- Common types
~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.
Hemorrhagic- berry aneurism
an out pouching of the circle of willis
Hemorrhagic- AVM
abnormal connection of the artery and vein
AVM = arteriovenous malformation
Hemorrhagic- 3 courses for an aneurism
~Pick up on a scan when looking for it
~Pick it up on a another scan (looking at something different)
~it pops
2 ways to fix an aneurism
Clip and coil
Clip for an aneurism
~can be used for an aneurism that has or has not been popped
~Need a craniotomy
Coil for an aneurism
~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
Hemorrhagic- Will have cell death
5
~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
Hemorrhagic- will present in therapy
4
~wide spread
~will be hard to decide where their symptoms came from
~will be younger
~rarely will fully recover
Occlusive- 2 types
~thrombolytic
~embolytic
Occlusive- Thrombolytic
Build up of plaque, etc that will cause a blockage in the artery
Occlusive- Embolytic
Blood/plaque/ air/ fat/cancer breaks off and moves
Occlusive- Embolytic- blood
4
~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
Occlusive- Embolytic- fat
can caused post surgery
TIA
symptoms resolve within 24 hours
Some details on how you know it is a Major stroke
6
~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
Some details on how you know it is a minor stroke
3
~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
Some details on how you know it is a shower stroke/ what is it?
(4)
~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
some Diagnosis Tests to test for possible stroke
3
~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
risk factors for stroke
~Birth control ~smoke ~high blood pressure ~diabetes ~high cholesterol ~sedentary ~history of CVA ~A-fib ~age ~postmenopausal ~drinker ~African American
anterior cerebral artery syndrome- symptoms
~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
middle cerebral artery syndrome- symptoms
~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)
posterior cerebral artery syndrome- symptoms
~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
locked in syndrome
~They can feel and hear everything
~They can understand
Stroke on the Right- symptoms
~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
Stroke on the Left- symptoms
~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
Symptoms that appear when there’s a stroke on a right or left
~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
When people are recovering from a stroke, they will often ask…
When am I going to get better?
Recovering from a stroke: what are some things that are going on that are helping
~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
Recovering from a stroke: what are some things that will help if they are flaccid?
~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
Roods techniques- types
***Can be facilitative or inhibitory ~Stretch ~Jt manipulation ~Cutaneous touch ~Ice ~Heat ~Vestibular ~Auditory ~Visual ~Gustatory ~Olfactory
Roods techniques- Facilitative
~To increase the threshold- excitatory inputs
~contraction
Roods techniques- Inhibitory
~To decrease the threshold
~relaxation
Roods techniques- Stretch
~quick
~repetitive
~CMP
~Prolong
Roods techniques- Quick Stretch
~will jar the muscle a little bit to cause a contraction
~facilitative
Roods techniques- repetitive stretch
~Can use a vibratory that is placed on the muscle belly
~>100 Hz- facilitative
~<100 Hz- inhibitory
Roods techniques- CPM stretch
continuous passive motion- is a repetitive passive motion (over 100 Hz)
Roods techniques- prolong stretch
~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
Roods techniques- Jt manipulation types
~traction
~low grade manipulations
~approxiations
Roods techniques- Jt manipulation Traction
relaxation
Roods techniques- Jt manipulation Low grade
relaxation
Roods techniques- Jt manipulation Approximation
contraction
Roods techniques- Cutaneous touch types
~Quick touch
~Maintain touch
Roods techniques- Cutaneous touch quick
over the muscle belly- contracts the muscle
Roods techniques- Cutaneous touch maintained
calmed the muscle- relaxation
Roods techniques- Ice types
~quick strokes
~prolonged
Roods techniques- Ice quick
Facilitative with the quick strokes- contraction
Roods techniques- Ice prolonged
If you leave it over time- relaxes- inhibits
Roods techniques- Heat
Relaxes them
Roods techniques- Vestibular types
~rocking
~spinning
~bouncing on the ball
Roods techniques- Vestibular rocking
relaxes us
Roods techniques- Vestibular spinning
contractions
Roods techniques- Vestibular bouncing on the ball
Bouncing on the ball
~Softly- relaxes
~Hard- contractions (and jt approx.)
Roods techniques- Auditory types
~loud
~soft
Roods techniques- Auditory loud
facultative/ contractions
Roods techniques- Auditory soft
relaxes
Roods techniques- Visual types
~bright
~soft
Roods techniques- Visual bright
Bright loud colors- awake/ contraction
Roods techniques- Visual soft
asleep/ relaxation
Roods techniques- Gustatory types
~sour
~sweet
Roods techniques- Gustatory sour
Sour, etc- wake up/ contraction
Roods techniques- Gustatory sweet
Chocolate, etc- relaxation
Roods techniques- Olfactory types
~bleach
~nice smells
Roods techniques- Olfactory bleach
Bleach, etc- wake up/ contraction
Roods techniques- Olfactory nice
Relaxing smells (coffee :) )
