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PHTY302 NEURO > Introduction to Stroke (Week 1) > Flashcards

Introduction to Stroke (Week 1) Flashcards

1
Q

What is the definition of a stroke?

A
  • previously called cerebrovascular accident (CVA)
  • acute onset of neurological deficit
  • lasting > 24 hrs
  • vascular cause
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2
Q

What is the definition of a transient ischaemic attack (TIA)/mini-stroke?

A
  • acute onset of neurological deficit
  • lasting < 24 hrs
  • vascular cause
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3
Q

List the risk factors of a stroke.

A
  • older age
  • hypertension
  • diabetes mellitus
  • increased blood lipid levels
  • obesity
  • smoking
  • family history
  • male gender
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4
Q

What are the two types of ischemic stroke?

A
  • atherothrombosis (30%)

- embolism (25%)

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5
Q

What causes an atherothrombosis?

A
  • type of ischemic stroke

- build-up of artherosclerosis plaque that blocks blood flow

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6
Q

What causes an embolism?

A
  • type of ischemic stroke
  • most common cause is atrial fibrillation (can form blood clots/embolus in the heart) –> clots travel further up and get caught in one of the cerebral arteries)
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7
Q

What are the two types of haemorrhagic stroke?

A
  • subarachnoid (5%)

- intracerebral (10%)

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8
Q

What causes a subarachnoid stroke?

A
  • bursted aneurysm –> blood in subarachnoid space
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9
Q

What causes an intracerebral stroke?

A
  • infarct (necrosis due to inadequete blood supply)
  • chronic hypertension –> increased pressure –> haemorrhage
  • intracerebral haemorrhage (occurs right inside the brain)
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10
Q

Primary impairments: sensori-motor

A
  • dysphagia (difficulty with swallowing) - likely that stuff will end up down their trachea into their lungs, instead of going down the oesophagus (aspiration pneumonia)
  • dysarthria (difficulty with articulation) - cannot produce comprehensible speech
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11
Q

Primary impairments: non-motor (vision impairment)

A
  • hemianopia - loss of visual field on side of hemiplegia from both eyes
  • quadrantanopia - loss of a quadrant of the visual field
  • loss of conjugate gaze - problem with the coordination of eye movements e.g. double vision
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12
Q

Primary impairments: non-motor (speech/language impairment)

A
  • aphasia/dysphagia - difficulty with the spoken word/can’t put words together
  • receptive aphasia - trouble understanding
  • expressive aphasia - trouble expressing
  • global (both)
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13
Q

Primary impairments: non-motor (perceptual impairment)

A
  • difficulty processing and interpreting sensory info

- includes neglect and agnosia

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14
Q

Primary impairments: non-motor (cognitive impairment)

A
  • inability to process, sort, retrieve and interpret information (cognitive)
  • includes problems with problem solving, motivation, planning, organisation, attention, and memory
  • can require assessment and treatment from trained team members (neuropsychologist, OT, speech pathologist)
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15
Q

Primary impairments: non-motor (dyspraxia/apraxia)

A
  • inability to plan/execute movements
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16
Q

Primary impairments: non-motor (behavioural/emotional impairments)

A
  • lability - rapid, often exaggerated changes in mood e.g. uncontrollable laughing or crying
  • depression
  • anxiety
  • impulsivity
  • disinhibition
  • personality changes - aggressive or passive behaviour
  • decreased insight
  • unrealistic goals
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17
Q

What is the definition of dysarthria?

A
  • decreased intelligibility of speech due to motor cause
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18
Q

What is the definition of dyspraxia?

A
  • impairment of motor planning
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19
Q

What is the definition of hemianopia?

A
  • loss of vision of one half of visual field
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20
Q

What is the definition of aphasia?

A
  • impairment of language
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21
Q

What is the definition of agnosia?

A
  • inability to recognise objects
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22
Q

What is the definition of neglect?

A
  • inattention to part of the environment
23
Q

What is the definition of lability?

A
  • excessive emotion
24
Q

What is the definition of perception?

A
  • ability to perceive and interpret sensory information
25
Q

What are the 4 arterial trunks that supply the brain?

A
  • anterior circulation: internal carotid artery system (internal carotid, external carotid, common carotid artery)
  • posterior circulation: vertebro-basilar system (vertebral artery)
26
Q

Describe the anterior circulation.

A
  • the carotid system supplies the parietal, frontal, and temporal lobes and cortical deep white matter
  • parietal and temporal lobe - impact on motor output, sensations, speech and language, planning, perception
  • frontal lobe - behavioural impairments
27
Q

Describe the posterior circulation.

A
  • the vertebro-basilar system supplies the brain stem, cerebellum and occipital lobes
  • no cortical effects (e.g. language, thought processes, behaviour, personality) [ANTERIOR]
28
Q

What are the possible impairments of an anterior circulation stroke?

A

Sensori-motor:

  • reduced strength
  • reduced coordination
  • reduced sensation
  • spasticity

Non-motor:

  • reduced vision
  • reduced speech/language
  • reduced perceptual function
  • reduced cognitive function
  • apraxia
  • behaviour
  • emotion
29
Q

What are the possible impairments of a posterior circulation stroke?

A

Sensori-motor:

  • reduced strength
  • reduced coordination
  • reduced sensation
  • spasticity
  • dysarthria

Non-motor:
- reduced vision

30
Q

List the differences between a dominant and non-dominant stroke.

A
  • most people have a dominant hemisphere - L) hemisphere dominance (90% of the population)
  • L) hemisphere - language, analytical functions
  • R) hemisphere - body awareness and visuo-spatial skills, attention e.g. neglect
31
Q

What are the possible impairments of a L) dominant hemisphere anterior circulation stroke?

A

Sensori-motor:

  • reduced R) strength
  • reduced R) coordination
  • reduced R) sensation
  • R) spasticity

Non-motor:

  • reduced R) vision
  • reduced R) speech/language
  • reduced R) cognitive function
  • apraxia
  • behaviour
  • emotion
32
Q

What are the possible impairments of a R) non-dominant hemisphere anterior circulation stroke?

A

Sensori-motor:

  • reduced L) strength
  • reduced L) coordination
  • reduced L) sensation
  • L) spasticity

Non-motor:

  • reduced L) vision
  • reduced L) perceptual function
  • reduced L) cognitive function
  • behaviour
  • emotion
33
Q

Behaviour characteristics that may impact learning

A

L) sided stroke / R) hemiplegia:

  • good concentration
  • slow movement time
  • correct performance
  • good carryover effect
  • realistic attitude
  • depressed, anxious, frustrated, can be labile

R) sided stroke / L) hemiplegia:

  • poor/distractible concentration
  • impulsive movement time
  • erratic performance
  • poor carryover effect
  • unrealistic attitude
  • may appear unmotivated, can be labile
34
Q

What is the Bamford classification?

A 
TA = total anterior 
PA = partial anterior 
L = lacunar 
PO = posterior

Code last letter as follows:
S = syndrome (indeterminate pathogenesis, prior to imaging e.g. TACS)
I = infarct e.g. TACI
H = hemorrhage e.g. TACH

35
Q

What is TACS?

A
  • total anterior circulation stroke
  • all of the following three: hemiplegia +/- sensory loss, hemianopia, cortical signs e.g. cognitive, perceptual, aphasia
  • most severe stroke
  • 5% of patients alive and I at 1 yr
36
Q

What is PACS?

A
  • partial anterior circulation stroke
  • two of the following three: hemiplegia +/- sensory loss, hemianopia, cortical signs e.g. cognitive, perceptual, aphasia OR isolated cortical dysfunction OR pure motor or sensory signs less severe than lacunar
  • 55% of patients alive and I at 1 yr
37
Q

What is LACS?

A
  • lacunar stroke
  • hemiplegia +/- sensory loss - affecting at least 2/3 of face/arm/leg
  • no cortical signs
  • 60% of patients alive and I at 1 yr
  • occlusion of deep perforating arteries
38
Q

What is POCS?

A
  • posterior circulation stroke
  • multitude of signs - can include the following: cranial nerve palsies, ips. motor and/or sensory impairments, bilateral motor +/- sensory deficits, eye movement disorders, isolated hemianopia, cerebellar deficits
  • if patients survive the acute event - about 60% of patients alive and I at 1 yr
39
Q

What are the symptoms of a R) TACS?

A

L) sided weakness, no sensory loss, L) hemianopia, L) sided neglect, dysarthria

40
Q

What are the symptoms of a LACS?

A

R) sided weakness, L) sided sensory loss

41
Q

What are the symptoms of a L) PACS?

A

R) sided weakness, aphasia

42
Q

What are the symptoms of a L) TACS?

A

R) sided weakness/sensory loss, R) hemianopia, receptive dysphasia

43
Q

What are the symptoms of a POCS?

A

L) sided weakness/sensory loss, nystagmus, bilateral loss of coordination, diplopia (double vision)

44
Q

What is the interdisciplinary Mx of stroke?

A
  • people with stroke have complex care needs
  • stroke affects the individual and their carers and families
  • ## interdisciplinary teams provide the best evidence-based care for people with stroke
45
Q

What is the interdisciplinary Mx of stroke?

A
  • a stroke unit brings together in one geographically located ward an interdisciplinary team of professionals with an interest and expertise in stroke care
  • stroke team usually includes physicians, nurses, PTs, OTs, speech pathologists
  • often also includes dieticians, social workers, orthoposts
  • referral may be appropriate e.g. to psychology or psychiatry for people with mood disorders, to optometry for people with visual dysfunction
46
Q

What is the role of a physician in stroke Mx?

A
  • physician (usually a neurologist) oversees medical Mx (stable observations = better outcomes)
  • identify cause of stroke
  • attempt to prevent further stroke
  • manage other medical conditions
47
Q

What is the role of a nurse in stroke Mx?

A
  • monitoring of neurological status and vital signs
  • hydration monitoring and intravenous treatment
  • medication
  • assessment/Mx of continence, skin integrity, pain
  • assistance with mobility, falls prevention and personal care
  • prevention of complications
  • info and support to patients and families
  • palliative care for those who are terminally ill
  • education about secondary prevention including smoking cessation
48
Q

How can reperfusion help stroke Mx?

A
  • most strokes are caused by a clot that occludes blood flow to the brain
  • ischaemic penumbra is an area of compromised but still viable tissue surrounding the dead tissue
  • removing the clot can restore blood flow to the ischaemic penumbra and improve patient outcomes
  • options: intravenous thrombolysis, endovascular clot retrieval
  • intravenous thrombolysis - drug that dissolves the clot/blood thinning medication
  • endovascular clot retrieval (thrombectomy) - minimally invasive procedure, catheters goes through the groin blood vessels & advances all the way up into neck vessels and eventually to the brain
49
Q

What is the role of OT in stroke Mx?

A
  • ADLs - self care, RTW

- perceptual/cognitive/behavioural screening and Mx

50
Q

What is the role of speech pathologists in stroke Mx?

A
  • dysphagia

- communication problems

51
Q

What is the role of social workers in stroke Mx?

A
  • financial issues
  • family issues
  • services
  • placement - aged care facilities
52
Q

What is the role of an orthoptist in stroke Mx?

A
  • visual problems
53
Q

What is the role of a neuropsychologist in stroke Mx?

A
  • cognitive assessment

PHTY302 NEURO (2 decks)

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