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PHTY302 > Intro Stroke (1a) > Flashcards

Intro Stroke (1a) Flashcards

1
Q

What was stroke previously called?

A

CVA

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2
Q

What is the most common cause of neurological disability in adults?

A

Stroke

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3
Q

Correct way to refer to someone who has had a stroke

A

Stroke survivor

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4
Q

What is the definition of a stroke?

A

Acute onset of neurological deficit lasting greater than 24 hours or leading to death with no apparent cause other than a vascular cause

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5
Q

What is the definition of a TIA

A

Transient Ischaemic Attack - neurological defecit lasting less than 24 hours with a vascular aetiology

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6
Q

What are the 2 major groups of stroke? (and their prevalence)

A

Ischaemic (85%)

Haemorrhagic (15%)

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7
Q

What are the types of ischaemic stroke and their prevalence (of all strokes)?

A

Artherothrombosis - 30%
Embolism - 25%
Small vessel disease - 20%
Watershed infarction - 10%

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8
Q

What is a watershed infarction?

A

Ischaemic infarct where 2 major supplies are intersecting.

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9
Q

What are the types of haemorrhagic stroke and their prevalence (of all strokes)?

A

Subarachnoid - 5%

Intracerbral - 10%

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10
Q

What is an intracerebral stroke?

A

Bleed inside the cerebral tissue

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11
Q

What is the ischaemic penumbra?

A

An area of vulnerable brain tissue surrounding the ischaemic brain tissue

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12
Q

Why is timely medical intervention important when considering an ischaemic penumbra?

A

If blood flow can be restored

  • The exten of the damage caused by secondary and delayed mechanisms can be limited
  • The ischaemic penumbra may be salvaged
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13
Q

What are the risk factors for stroke?

A 
Hypertension
Diabetes melitis
Heart disease
Increased blood lipid levels
Obesity 
Smoking
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14
Q

Acronym for stroke first aid/potential stroke

A

F -face
A - arms
S- speech
T- time

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15
Q

What supplies the anterior circulation?

A

Internal carotid artery system

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16
Q

What supplies the posterior circulation?

A

Vertebro-basilar system

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17
Q

What are the primary impairments after a stroke?

A 
Hemiplegia or hemiparesis
Spasticity 
Sensory impairments 
Visual impairments
Impairments of higher cortical function
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18
Q

What is hemiplegia/hemiparesis

A

unilateral paralysis/paresis on the side of the body conntralateral to the brain lesion

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19
Q

What are the prominent motor impairments following a stroje?

A

loss of strength (weakness)

loss of dexterity

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20
Q

How can loss of movement vary after a stroke and why?

A

Varies with size and site of lesions

Ranges from total paralysis to loss of selectivity of distal movements

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21
Q

Describe steps to loss of strength and dexterity after a stroke

A 
Lesions of cortical motor areas and their projections 
>
Decreased descending input to spinal motor neurons
> 
Reduced activation of motor units
>
Impaired muscle activation 
>
Loss of strength and dexterity

( If inactive also get disuse atrophy)

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22
Q

Effect of stroke on ipsilateral body

A

General also weakness on the side of the body ipsilateral to the brain lesion

Strength ipsilateral side: 65% - 89% of normal

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23
Q

How does MCA stroke affect movement?

A

Worse in UL than LL

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24
Q

How does ACA stroke affect movement?

A

Worse in LL than UL

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25
Q

What is spasticity?

A

A velocity dependent increase in the tonic stretch reflex?

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26
Q

When may spasticity become evident after a stroke?

A

4-6 weeks

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27
Q

Which side is affected by sensory impairments after a stroke?

A

Typical stroke:
anterior circulation = contralateral
posterior = ipsilateral and contralateral

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28
Q

What are the different sensory impairments after a stroke?

A

Tactile (light touch localisation, pressure, texture)
Proprioception (/joint position sense, passive movement sense, vibration)
Pain
Temperature

Visual impairments

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29
Q

What is hemianopia?

A

loss of visual field on the side of the hemiplegia

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30
Q

What is the loss of a quadrant of the visual field?

A

Quadrantanopia

31
Q

What is loss of conjugate gaze?

A

Loss of ability to move eyes together

32
Q

What do impairments of higher cortical function affefct?

A 
Language
Motor planning
Perception
Cognition
Emotion and behaviour
33
Q

What is aphasia/dysphasia?

A

Difficulty with the spoken word (NOT related to weakness of the mouth)

  • Receptive
  • Expressive
  • Global (both)
34
Q

What is dyslexia

A

Difficulty with reading

35
Q

What is dysgraphia?

A

Difficulty with writing

36
Q

What are motor planning impairmentss?

A

Dyspraxia/Apraxia

37
Q

What are some of the cognitive impairments after a stroke?

A

General intellectual function
Memory
Attention

Executive functions:
problem solving
motivation
planning
organisation
38
Q

Emotional problems after a stroke

A

Lability
Depression
Anxiety

39
Q

What are some behavioural changes after a stroke?

A

Impulsivity
Disinhibition
Personality changes (agressive or passive behaviour)
Decreased insight (unrealistic goals, failure to see the relevance)

40
Q

What is dysarthria

A

Physical production of speech, difficulty with articulation

41
Q

What is dysphagia?

A

Difficulty with swallowings

42
Q

What are secondary impairments that affect the muscle after a stroke?

A

Disuse weakness
Length changes
Atrophy
Increased muscle stiffness

43
Q

What are some general secondary impairments after a stroke?

A 
Adaptive motor patterns (overactivity)
Changes in joint mobility (Stiffness) 
Decreased neural length
Decreased bone density (decreased WB/load)
Decreased cardiorespiratory endurace
Pain
Learned non use
44
Q

what is a TAC

A

Total anterior circulation stroke

45
Q

What is a PAC?

A

Partial anterior circulation stroke

46
Q

What is a POC?

A

Posterior circulation stroke

47
Q

What is a LAC?

A

Lacunar stroke

48
Q

What does S mean in bamford/oxfordshire classification?

A

Syndrome- inderterminate pathogenesis, prior to imaging eg TACS

49
Q

What does I mean in bamford/oxfordshire classification?

A

Infarct eg TACI (most often)

50
Q

What does H mean in bamford/oxfordshire classification?

A

Haemorrhage

51
Q

In the Bamford 0r Oxfordshire Classification, what must be present to be classifed as Total anterior circulation syndrome (TACS)?

A

All of the following three features:

  • Hemiplegia involving at least two thirds of face, arm and leg +/- hemisensory loss contralaterally
  • Homonymous Hemianopia contralaterally
  • Cortical signs (dysphasia, neglect etc)
52
Q

Bamford or Oxfordshire classification for posterior anterior circulation syndrome (PACS)

A

2 out of 3 features present in a TACS or
Isolated cortical dysfunction such as dysphasia or;
Pure motor/sensory signs less sever thanin lacunar syndromes (eg monoparesis)

53
Q

The Bamford or Oxfordshire classicfcation for Lacunar Syndromes (LACS)

A

Features include motor +/- sensory deficits adffecting at least two thirds of the face, arm, leg and ataxic hemiparesis in the absence of visual field deficits and cortical signs

54
Q

Bamford or Oxfordshire classification Posterior Syndromes (POCS)

A

Heterogenous group of strokes
Brainstem or cerebellar dysfucntion:
- Cranial nerve palsies with contralateral moto and/or sensory deficits
Biolaterral motor and/or sensory deficits
Conjugate eye movement disorders
Isolated homonymous hemianopia
Cortical blindness ( can see things but not interpret)
Cerebellar deficits without ipsilateral motore/sensory signs.

55
Q

Bamford or Oxfordshire classification Posterior Syndromes (POCS)

A

Heterogenous group of strokes
Brainstem or cerebellar dysfucntion:
- Cranial nerve palsies with contralateral moto and/or sensory deficits
Biolaterral motor and/or sensory deficits
Conjugate eye movement disorders
Isolated homonymous hemianopia
Cortical blindness ( can see things but not interpret)
Cerebellar deficits without ipsilateral motore/sensory signs.

56
Q

What is the frequency of subtypes of infarct (most to least)

A

PACS
LACS & POCS
TACS

57
Q

Which type of stroke has the worst prognosis?

A

TACS - 60 dead one year later, ~35 dependent, ~ 5 independent

58
Q

What is the left hemisphere mainly responsible for?

A

Langauge and analytical activity

59
Q

What is the right hemisphere mainly responsible for?

A

visuo-spatial functions and attetnion

60
Q

What side of the brain is usually dominant?

A

Left

61
Q

What is typical of a dominant sided stroke?

A 
Aphasia
Dysgraphia 
Dyscalculia
Apraxia:
- ideomotor
- ideational
- constructional
Preservation (motor and speech)
62
Q

What is typical of a non dominant stroke?

A

Unilateral neglect
Inattention/extinction
Agnosis (trouble remembering faces)
Body image impairment
Other impairments of visuo-spatial awareness
Motor impersistance (inability to sustain a movement)

63
Q 
Left sided stroke:
Concentration:
Movement time:
Performance:
Carryover effect
Attitude:
Mood:
A 
Concentration: good
Movement time: slow
Performance: correct
Carryover effect: good
Attitude: realistic
Mood: depressed, anxious, frustrated, can be labile
64
Q 
Right side stroke:
Concentration:
Movement time:
Performance:
Carryover effect
Attitude:
Mood:
A 
Concentration: poor/distractible 
Movement time: Impulsive
Performance: Erratic
Carryover effect: poor
Attitude: Unrealistic
Mood: May appear unmotivated. Can be labile
65
Q

What type of treatment environment and professionals has shown the best results?

A

People treated in a dedicated stroke unit - brings togehter in one geographically located ward an interdisciplinary team of professionals with an interest and expertisein stroke care

66
Q

who is part of the treatment team for stroke?

A 
Physicians
Nurses
Physios
OT
speech pathologists

Often also includes:
dieticians
social worker
orthoptists

referral may be appropriate
eg psychiatry/psychology or optometry

67
Q

Roles and responsibilites of stroke management team

A
  • immediate management of stroke and secondary complications
  • physical, psychosocial, spiritual and bereavement needs of both the patient and the carer/family
  • meeting information needs of pt/family
  • Coordinated discharge home/rehab
  • End of life care
68
Q

What are the different levels of stroke care?

A

Acute care
Rehab
Community-based rehab

69
Q

Where could acute care of stroke occur?

A

Neurological ward
Acute stroke unit
Mixed medical ward
Neurological unit

70
Q

Where could rehab of a stroke occur?

A

Mixed rehab unit
Stroke unit
Slow stream rehabilitation

71
Q

Where could community based rehab occur?

A 
Hospital outpatient/day therapy
Community centre
Private practice
Home based
Residential care.
72
Q

Where to look for evidence on stroke treatmnet

A

Australian Clinical Guidelines for Stroke Management

73
Q

What is the evidence for physio after a stroke

A 
Strong evidence:
Early rehab
Task related practice
Increased intensity of practice
potential for improvement may exist for many years
74
Q

What are the key aspects of physio management of stroke?

A

Address primary impairments
Increase strength and train dexterity in context of everyday acticvites
Prevent and manage secondary impairments

PHTY302 (9 decks)

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