FINAL/CH30- Stroke Flashcards by Tara Track

4 types of CV disease

-coronary heart disease
-heart failure
-hypertension
-stroke

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2 types of stroke

-ischemic strokes
-hemorrhagic strokes

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scope of strokes

-2nd leading cause of death among CV disease
-5th leading cause of death in US
-occurs every 40 seconds in US

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women/men have higher lifetime risk of stroke

women
-mainly due to longer life span + increased risk of CVD associated with menopause

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ischemic stroke

loss of blood flow to a region of the brain CAUSED BY buildup of atherosclerotic plaque in cerebrovascular arteries (blocked blood vessel)

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most common type of strokw

ischemic stroke
-87%

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ischemic stroke pathophysiology

blood flow to brain blocked by clot formation within a vessel

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2 categories of ischemic stroke

-thrombotic stroke
-embolic stroke

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thrombotic stroke

blood clot (thrombus) locks flow of blood in brain

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embolic stroke

fatty plaque or blood clot (embolism) breaks away + flows to brain where it blocks an artery

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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)

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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

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which stroke type has greater likelihood of death

hemorrhagic stroke

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hemorrhagic stroke pathophysiology

blood flow to brain is “blocked” by leak/rupture of vessel

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2 categories of hemorrhagic stroke

-subarachnoid hemorrhage
-intracerebral hemorrhage

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subarachnoid hemorrhage

outer part of brain

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intracerebral hemorrhage

inside brain

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stroke risk factors

same as those for CVD + PAD

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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

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right-brain damage

vision problems + awkward/inappropriate behavior

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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