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6 Neurological Dysfunction > L9 Stroke > Flashcards

L9 Stroke Flashcards

1
Q

Modifiable RF for Stroke

A

HTN
Smoking
Diabetes
Diet high in saturated, trans, and cholesterol
physical inactivity
obesity
high LDL
CAD and PAD
A-fib

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2
Q

Stroke Epidemiology

A

5 cause of death in US

leading cause of disability
up to 80% of strokes are preventable

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3
Q

Non-modifiable RF for strokes

A

age
family history
race (black has higher risk)
gender (female)
prior stroke, heart attack, TIA
rural area

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4
Q

Transient Ischemic Attack

A

sometimes called a mini-stroke
temporary blockage of blood flow to brain
often precede a full stroke

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5
Q

Acute Ischemic Stroke

A

blood vessel supplying blood to the brain is obstructed
accounts for 87% of all strokes

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6
Q

Hemorrhagic Stroke

A

weakened blood vessel ruptures causing bleeding into the brain

accounts for 13% of stroke cases

aneurysms and AVMs two most common causes of HS

most common cause of HS is uncontrolled HBP

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7
Q

BEFAST

A

balance
eyes (visiual field loss, double vision, blurry)
Face
Arm
Speech
Time

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8
Q

FAST

A

Face drooping or numbness

Arm weakness or numbness

Speech difficulty, slurred speech, seem confused

Time to call 911

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9
Q

FAST SPIN/SNOUT

A

SNOUT = 77%
SPIN = 60%

fails to recognize 40% of those with post circulation events and 14% of AIS are missed

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10
Q

BEFAST SPIN/SNOUT

A

SPIN = 85%
SNOUT = 68%

BEFAST helps to reduce the number of patients with AIS

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11
Q

Comprehensive Stroke Center

A

most demanding certification, can receive all stroke cases

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12
Q

Primary Stroke Center

A

hospitals that provide critical elements of stroke care to achieve long-term success in improving outcomes

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13
Q

Thrombectomy-Capable Stroke Center

A

hospitals that are primary stroke center and provide endovascular procedures and post-procedural care

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14
Q

Acute stroke ready hospital

A

hospitals or emergency centers that have dedicated stroke-focused program

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15
Q

ER Tx for AIS

A

-MRI with DWI most sensitivity and specificity
-tissue plasminogen activator, alteplase, within three hours
-Thrombectomy to remove clot within 6 hours

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16
Q

ER Tx of HS

A

Correct imaging, non contrast CT is gold standard

craniotomy to surgically evacuate hematoma and relieve cranial pressure

neurosurgery to perform AVM removal or clip vessel at the base of aneurysm

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17
Q

Medical Treatment for TIA

A

full medical work up to identify cause

brain imaging, ECG, ultrasound of carotid artery, assess and treat risk factors

goal to prevent future stroke

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18
Q

Post ER Care for AIS

A

BP less than 180/105 for first 24 hours

should provide early rehab that is organized and interprofessional

should NOT provide high does very early mob within 24 hours

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19
Q

R MCA Syndrome

A

R gaze deviation
L sided weakness
L neglect

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20
Q

ACA Syndrome

A

contralateral leg weakness
executive dysfunction

(blue in picture)

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21
Q

L MCA Syndrome

A

L gaze deviation
R sided weakness
Aphasia

(yellow in picture)

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22
Q

PCA Syndrome

A

contralateral hemianopsia
confusion, amnesia, disorders of consciousness

(red in picture)

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23
Q

Cerebellar Stroke

A

ipsilateral ataxia
nausea, vertigo, nystagmus, imbalance

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24
Q

Mid-basilar stroke

A

locked-in state
crossed symptoms
ocular palsies

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25
Q

Top of basilar Stroke

A

acute disorders of consciousness or coma

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26
Q

Middle Cerebral Artery Stroke

A

more common than ACA or PCA

will have unique presentation depending on R/L

occlusion of proximal stem will have CP of all 3 divisions

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27
Q

L MCA Clinical Syndrome, Superior Divison

A

R face and arm weakness, nonfluent broca’s aphasia

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28
Q

L MCA Inferior Division

A

fluent or wernicke’s aphasia, R visual field deficit, R cortical sensory loss, some R side weakness

29
Q

Broca’s aphasia

A

non-fluent aphasia

spontaneous speech is diminished

loss of normal grammatic structure, word salad

source fo frustration for patient

30
Q

Wernicke’s Aphasia

A

fluent aphasia
impaired language comphrension

speech has normal rate, rhythm, and grammar

31
Q

R MCA Superior Division

A

left face and arm weakness, L hemineglect, sometimes L face/arm sensory loss

32
Q

R MCA Inferior Divison

A

profound L hemineglect but normal L side strength with spontaneous movements

33
Q

R MCA Deep Territory

A

left pure motor hemiparesis

34
Q

L MCA Deep Territory

A

right pure motor hemiparesis

35
Q

Unilateral Spatial Neglect

A

inattention to the side of body opposite of brain lesion

L inattention in most common, R attention is less severe

usually safety concern because patient could harm self

36
Q

Hemianopsia S/S

A

-difficulty seeing items or finding them
-miss details in one visual field
-locate lost items once cued
-attempt to make eye contact no matter where PT stands
-spontaneously use both UE
-Spontaneously turn head to compensate for vision loss

37
Q

Spatial Neglect S/S

A

-Miss details in one visual field
-walk into things on one side without noticing
-lose track of limbs, doesn’t reposition limbs
-sees to forget position of limbs, drop or spill items

38
Q

Test for unilateral spatial neglect

A

extinction on double simultaneous stimulation

normal sensory function but ignores one side of environment

39
Q

Pusher Syndrome

A

perceptual deficit after some strokes, with active pushing toward hemiplegic side

displayed in 5% of all pts post stroke, impedes functional outcomes

most common in pts with R hemispheric lesions in thalamus

40
Q

Presentation of pusher syndrome

A

patients misbelieve body orientation in space, believing that upright is approx 18° tilted toward hemiplegic side

patient will try to correct by pushing towards their impaired side

41
Q

Anterior Cerebral Artery Stroke

A

presents as UMN weakness and cortical sensory loss affecting contralateral leg more than the arm or face

sometimes motor aphasia is present or frontal lobe dysfunction

42
Q

Frontal lobe dysfunction

A

grasp reflex, impaired judgement, flat affect, apraxia/dyspraxia, abulia, incontinence, perseveration, impaired judgement/logic/abstraction, lacks a filter

43
Q

Perservation

A

difficulty in changing from one task to the next

they will continue the former task continuously

44
Q

Abulia

A

changes to drive, personality and judgement

45
Q

Apraxia

A

inability to perform tasks or naturalistic actions

difficulty with motor conceptualization, planning, and execution

46
Q

Apraxia is found in patients with

A

diffuse lesions of the cortex

focal lesions affecting the frontal or L parietal lobe

pts will present with language comphrension, gross motor, and sensation still intact

47
Q

Apraxia Screen of Tulia

A

MDC = 1.79 points

has a 100% positive predictive value and 92% negative predictive value

48
Q

Cut-off scores of Apraxia Screen of Tulia

A

10-12 = no praxis errors
6-9 = abnormal praxis or mild
5 or less = severe apraxia

49
Q

Posterior Cerebral Artery Stroke

A

causes a contralateral homonymous hemianopia

small branches occluded causes thalamus or posterior limb of IC to be affected

also known as alexia without agraphia

50
Q

S/S of thalamus/post limb of IC stroke

A

contralateral sensory loss
contralateral hemiparesis

dominant hemisphere can cause thalamic aphasia

51
Q

Contralateral homonymous Hemianopia

A

Losing both L visual fields of both L/R eyes

impact on the optic tract, optic radiation, primary visual cortex

52
Q

Alexia

A

inability to read or comprehend written language

remains capable of spelling and writing words, unable to comprehend

seen after stroke affecting dominant hemisphere

53
Q

Agraphia

A

loss of previous ability to write

often occurs concurrently with alexia, apraxia, or hemispatial neglect

54
Q

Stage 1 of Brunnstrom’s Stages of Stroke Recovery

A

Flaccid tone
no motor control/active movement

55
Q

Stage 2 of Brunnstrom’s Stages of Stroke Recovery

A

Mild spasticity
weak synergies and weak associated reactions

56
Q

Stage 3 of Brunnstrom’s Stages of Stroke Recovery

A

Increasing spasticity, may be severe

voluntary movement within basic synergies, demonstrates small determinable joint movement

57
Q

Stage 4 of Brunnstrom’s Stages of Stroke Recovery

A

Spasticity begins to decrease

active movement begins to occur outside of basic limb synergies

58
Q

Stage 5 of Brunnstrom’s Stages of Stroke Recovery

A

Spasticity decreasing

able to perform more difficult isolated movement patterns

59
Q

Stage 6 of Brunnstrom’s Stages of Stroke Recovery

A

no spasticity

movements are generally selective, but may require performance at decreased velocities with diminished coordination

60
Q

Stage 7 of Brunnstrom’s Stages of Stroke Recovery

A

not universally recognized

normal tone returns
normal isolated movements

61
Q

Brunnstrom’s Stages of Stroke Recovery

A

pts may progress through all stages or remain in a stage

severity and length of time in each stage varies on stroke severity and the age of patient

62
Q

Fugl Meyer Assessment

A

motor score
helps to quantify the patient’s recovery through Brunnstrom stages

63
Q

Contemporary PT

A

focusing on neuroplasticity, like repetition and intensity and that it is ok to allow movement synergies during training

with enough repetitions of practice, neuroplasticity and motor learning principles will drive improvements in movement quality

64
Q

Traditional PT

A

focuses on movement quality as primary focus

patients should only practice with movements out of synergistic patterns

65
Q

UE Flexor Synergy

A

Scapula = elevation and retraction

Shoulder = abduction/ER or adduction/IR

Elbow = flexion

Forearm = supination

Wrist/Digits = flexion

66
Q

LE Flexion Synergy

A

Pelvic = Elevation
Hip = Flexion
Knee = Flexion
Ankle = DF
Forefoot = Eversion

unusual pattern to observe after stroke

67
Q

UE Extension Synergy

A

Scapula = downward rotation and protraction

Shoulder = IR and adduction

Elbow = extension

Forearm = pronation

Wrist/hand/digits = position varies

occurs with intentional elevation of arm

68
Q

LE Extension Synergy

A

Pelvic = elevation and. retraction

Hip = adduction and extension

Knee = extension

Ankle = PF

Forefoot = inversion

occurs in late swing with extension

69
Q

Are synergies good or bad?

A

it depends

some people use their synergies to be able to perform functional tasks

but synergies impede ability to perform necessary mobility tasks or ADLs

6 Neurological Dysfunction (16 decks)

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