FINAL/CH30- Stroke Flashcards
4 types of CV disease
-coronary heart disease
-heart failure
-hypertension
-stroke
2 types of stroke
-ischemic strokes
-hemorrhagic strokes
scope of strokes
-2nd leading cause of death among CV disease
-5th leading cause of death in US
-occurs every 40 seconds in US
women/men have higher lifetime risk of stroke
women
-mainly due to longer life span + increased risk of CVD associated with menopause
ischemic stroke
loss of blood flow to a region of the brain CAUSED BY buildup of atherosclerotic plaque in cerebrovascular arteries (blocked blood vessel)
most common type of strokw
ischemic stroke
-87%
ischemic stroke pathophysiology
blood flow to brain blocked by clot formation within a vessel
2 categories of ischemic stroke
-thrombotic stroke
-embolic stroke
thrombotic stroke
blood clot (thrombus) locks flow of blood in brain
embolic stroke
fatty plaque or blood clot (embolism) breaks away + flows to brain where it blocks an artery
pathophysiology of stroke
-begins with same pathophysiology as CVD + PAD
1. endothelial injury (chronic or excessive injury)
2. inflammatory response (monocyte, platelet, LDL-C aggregation)
3. endothelial dysfunction (increased wall adhesivness, impaired vasodilation)
4. plaque formation (lesions progress from endothelium to intima)
hemorrhagic stroke
excessive bleeding/swelling in a cerebral artery that prevents blood from flowing to brain cells downstream of the hemorrhage
-less common but GREATER LIKELIHOOD OF DEATH
which stroke type has greater likelihood of death
hemorrhagic stroke
hemorrhagic stroke pathophysiology
blood flow to brain is “blocked” by leak/rupture of vessel
2 categories of hemorrhagic stroke
-subarachnoid hemorrhage
-intracerebral hemorrhage
subarachnoid hemorrhage
outer part of brain
intracerebral hemorrhage
inside brain
stroke risk factors
same as those for CVD + PAD
signs/symptoms of stroke
-memory loss + paralysis are 2 of the more consistent symptoms
-brain damage causes paralysis on OPPOSITE side of body
-right-brain damage
-left-brain damage
right-brain damage
vision problems + awkward/inappropriate behavior
left-brain damage
speed + language issues + cautious behaviors
a pt suffering from ACUTE stroke can have any of the following symptoms
-numbness/weakness of face, arm, or leg
-confusion, speech problems, + cognitive defects
-impaired bilateral/unilateral vision
-impaired coordination + walking
-headache
acronym used for stroke symptoms
BE FAST
B- balance (does pt have sudden loss of balance?)
E- eyes (has the pt lost vision in one or both eyes?)
F- face (does pt’s face look uneven?)
A- arms (is one arm weak or numb?)
S- speech (is pt’s speech slurred? does pt have trouble speaking or seem confused?)
T- time (CALL 911 NOW)
history + physical exam
-assess for hemiplegic gait
-screen for frequently present risk factors for CVD such as hypertension + diabetes
-resting ECG + symptoms of ischemia should be assessed, as coronary artery disease often presents in stroke pts
-psychological assessment may be warranted, as many stroke pts develop mental depression during the post-stroke period
hemiplegic gait
stiff leg on 1 side of body
diagnostic testing
-ultrasound, MRI, + angiography
-noncontrast CT
-diffusion-weight MRI
what is the gold standard of imaging for hemorrhagic stroke
non-constrast CT
diffusion-weighted MRI is used for which type of stroke
ischemic stroke
diffusion-weighted MRI
-assesses restriction to movement of water molecules
-restrictions are detected by MRI + appear as bright white spots on image
DW-MRI image
white areas represent where occlusion (blood floow restriction) has taken place
treatment IF advanced carotid atherosclerosis (70-99% narrowing)
-carotid endarterectomy
-stenting with embolic protection
carotid endarterectomy
removal of plaque inside carotid artery
other forms of treatment
-pharmacologic treatment
-PT, OT, + speech therapy
-may include registered dietitian + psychological counseling
pharmacologic treatement
-anticoagulants (blood thinners, warfarin)
-antiplatelet (clopidogrel)
-ACE-inhibitors (“-prils”)
stroke has a large influence on ____
quality of life (QOL)
of survivors ____% are institutionalized + ____% are unable to walk without assistance 6 months after stroke
26% are institutionalized
30% are unable to walk without assistance 6 months after stroke
primary aim of all rehabilitation for stroke
to restore…
-balance
-movement
-coordination
-QOL
exercise testing
-follow ACSM contraindications
-assess pre-exercise resting BP (remember hypertension is a major risk in hemorrhagic stroke)
-because of high incidence of CAD with ischemic stroke, important to assess for unstable angina
____ is major risk in hemorrhagic stroke
hypertension
important to assess for ____ during exercise testing in pts with ischemic stroke
unstable angina
exercise testing- CV fitness
-not all stroke patients can complete a traditional GXT to assess functional capacity
-modified GXT: self-selected speed with 2% grade increase every 2 min appears appropriate for a stroke patient + may allow detection of undiagnosed CAD
-make sure appropriate mode is selected
exercise testing- resistance training
handgrip dynamometer or 10-RM testing
-use to assess strength differences between affected (paretic) vs unaffected sides of body
major goal of ExRx
improve functional capacity (FC)
average FC of stroke pt
14.4 ml/kg/min
minimum FC for independent living
20 ml/kg/min
____ is highly correlated with FC
reduced muscle mass
-CRITICAL to address muscular strength + endurance in stroke pts
what else is common in stroke pts
loss of flexibility
overall need for what type of ExRx
comprehensive
-muscular strength
-endurance
-flexibility
-CV, etc.
for stroke pts, we want to focus on movements that….
mimic ADLs
ExRx special considerations
flexibility
-give special attention to paretic limbs, especially muscle groups that are experiencing a large degree of muscle spasticity
2 examples of exercise training
-leg lifts +/or marching in place
-knee flexion
