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Aphasia > Lecture 2: Sequelae of TBI 1 > Flashcards

Lecture 2: Sequelae of TBI 1 Flashcards

1
Q

Other names for Stroke

A

brain attack, CVA, mini-stroke, pin stroke, TIA (transient ischemic attack)

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2
Q

Stroke Statistics

A

19% unaware that CVA is preventable; 38% don’t know where in body CVA occurs; 42% can’t identify most common s/s of stroke; 92% don’t know what TIA represents

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3
Q

Most common s/s of stroke

A

weakness/numbness

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4
Q

Stroke Defined

A

clinical consequences of focal or diffuse disruption of brain circulation secondary to ischemic or hemorrhagic event; interruption of blood flow to brain

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5
Q

Who is at risk, generally?

A

50% of general population; >50% of healthcare workers

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6
Q

____ leading cause of death in USA

A

3rd

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7
Q

Heart disease is _____ leading cause of death; cancer is _____ leading cause of death

A

1; 2

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8
Q

How many new stroke cases each year?

A

750,000 (500,000 are preventable)

Roughly 1 every 45 seconds

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9
Q

Every ____ minutes, a person dies from stroke

A

3

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10
Q

What is the leading cause of disability

A

Stroke

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11
Q

What % of stroke survivors have deficits?

A

90

Goal is for functional lifestyle

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12
Q

% of strokes that are ischemic

A

80

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13
Q

% of strokes that are hemorrhagic

A

20

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14
Q

Stroke Epidemiology: Age

A

risk doubles each decade after 55yo

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15
Q

Stroke Epidemiology: Race

A

African Americans: 233/100,000
Hispanics: 196/100,000
Whites: 93/100,000

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16
Q

Stroke Epidemiology: Heredity

A

Paternal Stroke: 2 times as likely

Maternal Stroke: 1.4 times as likely

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17
Q

How many brain cells die each minute during stroke

A

2 millions

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18
Q

How many strokes are preventable

A 
80%
Decrease heavy alcohol use: 34K
Decrease/quit smoking: 90K
Decrease cholesterol: 145K
Decrease HTN: 360K
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19
Q

Hypertension

A

130/85

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20
Q

Atrial Fibrillation

A

risk factor for stroke; type of irregular heartbeat resulting in ineffective pumping of 1 of the heart chambers/heart palpitations; impacts 2 million Americans; 9% of people 65yo+ have it

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21
Q

S/s of Atrial Fibrillation (AF)

A

rapid heartbeat, irregular heartbeat

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22
Q

Tachycardia

A

fast heartbeat

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23
Q

Bradycardia

A

slow heartbeat

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24
Q

Treatment of AF

A

blood thinners; proper tx can prevent stroke

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25
Q

Heart palpitation effects

A

quivering in one of the chambers which facilitates a clot; clot can go to brain, etc.; blood can pool in upper chambers of heart; can be easily treated if identified; causes ischemic stroke

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26
Q

General Stroke Risk Factors

A

diabetes, physical inactivity, obesity/ metabolic syndrome, oral contraceptives, alcohol abuse, illicit drug use, hypercoagulable states, dietary factors, infection/inflammation, hyperhomocysteinemia, vascular inflammation

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27
Q

Hypercoagulable state

A

clotting factor in blood–>tends to overclot

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28
Q

Hypocoagulable states

A

hemophilia, aspirin overuse

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29
Q

Modifiable risk factors

A

DM, HTN, smoking, alcohol consumption, obesity/overweight, AF, high cholesterol

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30
Q

Non-modifiable risk factors

A

age, race, gender, previous CVA/TIA, family history

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31
Q

Primary 5 Stroke Symptoms

A

sudden numbness/weakness; sudden confusion/trouble speaking; trouble seeing in 1 eye; sudden trouble walking, dizziness, etc.; sudden severe headache

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32
Q

FAST acronym & Stroke

A

Face: ask pt. to smile, any drooping?
Arm: ask pt. to raise both arms, any drifting?
Speech: ask pt. to repeat simple sentences, any dysarthria?
Time: Observe any signs, call 911
(keep in mind hypoglycemia)

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33
Q

Stroke Classifications

A

Ischemic & Hemorrhagic (includes SAH, ICH, IVH)

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34
Q

SAH

A

subarachnoid hemorrhage

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35
Q

ICH

A

intracerebral hemorrhage

36
Q

IVH

A

intraventricular hemorrhage (lots of preemies)

37
Q

Ischemic Strokes

A

occur when arteries are blocked by clots or by build up of plaque & other fatty deposits; blood supply insufficient to given area (80%); 2 subtypes: thrombotic, embolic

38
Q

Thrombotic Ischemic Stroke

A

blood clot forms within blood vessel in brain

39
Q

Embolic Ischemic Stroke

A

clot forms in heart or elsewhere, dislodges, travels, & becomes lodged in brain
At some point, embolus will become thrombus; thrombus can become embolus

40
Q

DVT

A

Deep vein thrombosis; usually in calf muscle (gastroc(nemius)); have trouble walking, limp, leg hurts really bad, calf muscle will feel very warm to touch, hurt for them to dorsi-flex (point) foot; at risk for thrombosis to travel as embolis to lungs, heart, brain; can also cause redness in leg

41
Q

PE

A

pulmonary embolism; may cause SOA, sudden pain over area affected; In more severe cases, can cause death

42
Q

Penumbra & Therapists

A

Therapists are protectors of the penumbra; area around affected vessel will start to die (penumbra); hypoprofused area: profusion is ability of blood to get where it needs to go; supply cut off

43
Q

Lacunar Infarct

A

Obstruction of blood flow in the small, deep brain arteries; occur frequently in basal ganglia, internal capsule, thalamus, brainstem; damage isn’t usually as diffuse; often occur in subcortical regions

44
Q

Ischemic Penumbra

A

area of dysfunctional ischemic tissue; suggests a possible lacunar state

45
Q

tPA

A

used only in individuals who have a known ischemic stroke; never used in hemorrhagic type, will make pt. bleed more

46
Q

Hemorrhagic Stroke

A

occurs when blood vessel in brain breaks, leaking blood into brain; accounts for ~15-17% of strokes but are responsible for more than 30% of deaths

47
Q

3 types of hemorrhagic strokes

A

intracerebral (inside cerebral cortex)
subarachnoid (subarachnoid space)
intraventricular (in ventricles)

48
Q

Intracerebral Hemorrhage

A

bleeding inside the brain; results from chronic HTN; often coincides with severe headaches; risk of brain herniation

49
Q

Subarachnoid Hemorrhage

A

Bleeding that occurs within the meninges; (can suck blood out or let body reabsorb); possible rupture of an aneurysm; sudden headaches with LOC; women more than men

50
Q

Intraventricular Hemorrhage

A

Extension of both intracerebral hemorrhages &/or the subarachnoid hemorrhages into the ventricular spaces

51
Q

Aneurysm

A

localized, blood-filled dilation of a blood vessel caused by disease or weakening of vessel wall; Blood circulates within aneurysm before it cycles out; may eventually burst; will resut in hemorrhagic stroke; commonly occur in arteries at the Circle of Willis or aorta (bifurcation of vessel); most common complaint is pain behind the eyes

52
Q

HTN

A

more pressure on blood vessels due to heart having to pump harder to move blood

53
Q

2 Methods of Aneurysm Management

A

Clipping & Coiling

54
Q

Arteriovenous Malformation

A

AVM/ AV Malformations; majority of cases involve congenital disorder comprised of snarled tangles of arteries & veins (@ capillary level); impacts ~300K Americans occurring in males/females of all racial/ethnic backgrounds at equal rates

55
Q

AVMs damage brain &/or spinal cord through 3 basic mechanisms:

A
  1. reducing amt. of oxygen reaching neurological tissue
  2. causing bleeding (hemorrhaging) into surrounding brain tissues
  3. compressing/displacing parts of the brain or spinal cord (violation of Monroe-Kellie Hypothesis)
56
Q

Brainstem Stroke

A

especially devastating; BS controls all involuntary, life-support functions: breathing rate, BP, heartbeat; eye movement, speech, audition, deglutition; pts. may incur paralysis on unilateral or bilateral paralysis of the UE/LE due to cortical pathways; hemorrhagic here particularly devastating

57
Q

Locked-In Syndrome

A

neurological disorder characterized by paralysis of voluntary movements in all body parts except those that control eye movements; may result from TBI, diseases of circulatory system, demyelinating diseases, or meds overdose; pts. conscious w/ intact cognition but are unable to speak or move; leaves pt. completely paralyzed/ mute

58
Q

Cerebellum Jobs

A

Aids in control of our reflexes & assists in maintaining balance & coordination

59
Q

Cerebellar Strokes

A 
May cause abnormal reflexes of head & torso
Coordination & balance problems
Vertigo
Nausea/vomiting
Ataxia (ataxic dysarthria)
60
Q

Medical Management of Hemorrhagic Stroke

A

Prevention is paramount thru reducing modifiable risk factors
Identify s/s early: “Time is Brain”
Control BP
(remember hypoglycemia mimics stroke)
Frequent neurological checks by nurse, neurologist, therapists, etc
Sudden Mental Status changes should be taken to ER

61
Q

Medical Management of Ischemic Stroke

A 
Prevention paramount through reducing modifiable risk factors
Identify s/s early
Identify etiology & reverse if able
Frequent neurological checks
Thrombolytic therapies (tPA)
62
Q

tPA

A

clot buster; tissue plasminogen activator

Extreme criteria must be met before administration

63
Q

tPA administration criteria

A

Must be given (if IV) 180 minutes post onset s/s of stroke
May be given w/in 6hrs if administered via intraarterial catheter
CONTRAINDICATED for hemorrhagic stroke

64
Q

Infarct

A

where tissue has died as result of ischemic stroke; can technically grow without treatment

65
Q

tPA contraindications

A

evidence of intracranial hemorrhage; suspicion of subarachnoid hemorrhage; recent ABI/TBI; history of CVA; history of intracranial hemorrhage; uncontrolled HTN; seizure @ onset of CVA; active internal bleeding; AVM; aneurysm

66
Q

Other Ischemic Therapies

A

Catheter directed tPA

Endovascular retrieval: MERCI System

67
Q

MERCI system

A

endovascular retrieval method; thread thru femoral artery, thread to clot, corkscrew in then suck clot out thru tube

68
Q

Prognostic Indicators related to Stroke

A

Young w/ outgoing personality; tx programs started early; expressive aphasia; pt’s that don’t have perceptual or sensory impairments; ability to self-correct; single lesions; pt whose tx program was initiated before 6mos post stroke; higher intelligence; mild-mod impairments; ability to point to pictures when named; good comprehension; go w/ the flow personality; pt not dependent on SLP

69
Q

When research says most gains will be made

A

within 1st 6 months, but can still make gains after but not as fast

70
Q

Brodmann’s Areas

A

done by Korbinian Brodmann; references #s 1-52 w/ some subdivided areas

71
Q

Brodmann’s area 4 (frontal lobe)

A

primary motor cortex

72
Q

Brodmann’s area 6 (frontal lobe)

A

premotor cortex (supplementary motor cortex)

73
Q

Brodmann’s areas 44 and 45 (frontal lobe)

A

Broca’s area

74
Q

BA 3, 1, 2 (parietal lobe)

A

primary somatosensory cortex

75
Q

BA 39 (parietal lobe)

A

angular gyrus

76
Q

BA 40 (parietal lobe)

A

supramarginal gyrus

77
Q

BA 41 (temporal lobe)

A

primary auditory cortex

78
Q

BA 21 & 22 (temporal lobe)

A

middle & superior temporal gyri; Wernicke’s area

79
Q

BA 17 (occipital lobe)

A

primary visual cortex

80
Q

BA 18-19 (occipital lobe)

A

visual association areas

81
Q

Functional Pathways: connection between Wernicke’s & Broca’s areas mediates:

A

expression of language utterances in speech

82
Q

Functional Pathways: connection b/t Broca’s area & Primary Motor Strip mediates:

A

speech sound production

83
Q

Functional Pathways: connection b/t primary auditory cortex & Wernicke’s area mediates:

A

language comprehension

84
Q

Functional Pathways: connection b/t Wernicke’s area & visual areas mediates:

A

reading ability

85
Q

Functional Pathways: connection between somatosensory perception area & Wernicke’s area would mediate:

A

language reception via tracing letters on skin or reading braille, interpreting sign language, etc.

Aphasia (8 decks)

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