MOD 4.1 Stroke Classifications and PT Continuum of Care Flashcards
What is infarct tissue?
damaged tissue that is lost and cannot be recovered
What is the penumbra?
reversible injured brain tissue that is around an infarct
What are the 3 mechanisms that can cause the regeneration of brain cells?
- neurogenesis
- synaptogenesis
-axogenesis
What percentage of strokes are ischemic?
85%
What percentage of strokes are hemorrhagic?
- 15%
What are hemorrhagic strokes caused by?
- hypertension
- aneurysm
- arteriovenous
- malformation (AVM)
- trauma
What causes ischemic strokes of large vessels?
- thrombus or embolus
What causes small vessel ischemic strokes?
- HTN
- smoking
- diabetes
- cholesterol
What structures are most likely to be affected by small vessel ischemic strokes?
- basal ganglia
- internal capsule
- pons
What is a thrombotic infarction?
local obstruction due to atherosclerotic plaques
Where do thrombotic plaques tend to form first?
major branching of the cerebral arteries
What is an embolic infarction?
traveling clot that usually comes from the heart
What is a transient ischemic attack?
indication of presence of thrombotic disease with symptoms of a stroke lasting 2-30 minutes
can be indication of future ischemic strokes
What is lacunar syndrome (small vessel)?
small subcortical lesions caused by occlusion of penetrating artery from a large cerebral artery
What patients tend to have lacunar strokes?
HTN and diabetes mellitus
What are the common brain sites affected by lacunar strokes?
basal ganglia, pons, internal capsule, corona radiata
What deficits would you experience if you had a lacunar stroke of the posterior limb of the internal capsule?
pure motor deficit
What deficits would you experience if you had a lacunar stroke of the anterior limb of the internal capsule?
weakness of face an dysarthria
What deficits would you experience if you had a lacunar stroke of the posterolateral thalamus?
pure sensory deficit
What deficits would you experience if you had a lacunar stroke of the pons?
ataxia
clumsiness
weakness
What vessels are part of the anterior circulation of the brain?
internal carotid artery splitting to middle cerebral artery and anterior cerebral artery
What are the effects of MCA syndrome?
- contralateral hemiplegia (affecting face and UE more)
- contralateral hemianesthesia
- homonymous hemianopia
What happens when someone suffers from a right MCA stroke?
- left neglect
- impulsiveness
- decreased spatial awareness
What happens when someone suffers from a left MCA stroke?
- aphasia
- apraxia
- compulsiveness
What are the effects of ACA syndrome?
- contralateral hemiplegia and hemianesthesia affecting the LE more than UE
- profound abulia: lack of willpower for movement
- apraxia
- urinary incontinence
- flat affect
- perseveration
What arteries supply the posterior circulation of the brain?
- basilar
- PCA
- PICA and AICA
What are the symptoms of PCA syndrome?
- thalamic sensation: abnormal pain sensation, temp, touch, proprioception
- sensations may be exaggerated and perceived as painful stimuli
- vertical gaze palsy
- homonymous hemianopia
- cortical blindness
what is cortical blindness?
inability of the brain to record an image although optic nerve is intact
What are the symptoms of basilar stroke?
- bilateral sensory loss
- locked in syndrome
If the basilar artery is occluded in the brainstem symptoms are ______
bilateral
If a branch of the basilar artery is occluded you have _______ cranial nerve sensory and motor impacted
unilateral
What may patients with a basilar stroke have?
- decorticate or decerebrate rigidity
What other symptoms may someone have with a basilar stroke?
vertigo, diplopia, vomiting, nausea, nystagmus, hearing loss
What are the symptoms of unilateral cerebellar strokes?
- same side of the body
- ataxia, unsteadiness
- vertigo
- nausea/vomiting
- tremors
- coordination issues
What are the symptoms of superior cerebellar stroke?
- severe ipsilateral ataxia
- nausea and vomiting
- dysarthria
- contralateral loss of pain and temp
- ipsilateral UE dysmetria
What are the symptoms of anterior inferior cerebellar artery stroke?
- ataxia
- ipsilateral deafness
- facial weakness
- vertigo
- nausea and vomiting
- nystagmus
- contralateral loss of pain and temp
What are the symptoms of posterior inferior cerebellar artery stroke?
- Wallenberg syndrome
- ipsilateral ataxia
- ptosis
- ipsilateral sensory impairment on face
- contralateral sensory impairment on torso and extremities
What is Wallenberg’s syndrome?
- difficulty swallowing
- hoarseness
- dizziness
- nystagmus
What are epidural hemorrhages?
- meningeal arterial bleeding causes by head trauma or skull fracture
What are subdural hemorrhages?
- damage to bridging veins
- common in elderly
due to head trauma
What is a subarachnoid hemorrhage?
- arterial bleeding causes by aneurysm and AVM
What causes intracerebral stroke?
arterial bleeding in brain parenchyma
What is the most deadly stroke?
intracerebral strokes
Who are the most at risk for intracerebral hemorrhage?
older males and african Americans
How do subarachnoid hemorrhages begin?
onset of severe headache/thunderclap headache
What are the risk factors for subarachnoid hemorrhage?
- excessive alcohol
- smoking
- HTN
What are the symptoms of subarachnoid hemorrhages?
- thunderclap headache
- nausea and vomiting
- syncope(faint)
- neck pain
- coma
- confusion
- lethargy
- seizures
What do patients complain of with a subdural headache?
mild generalized headache and change in mental status
How fast are subdural hemorrhages?
slow onset due to venous bleeding
What does epidural hematoma lead to ?
bleeding between the periosteum and skull
What is the definition of stroke?
CNS infarction is brain, spinal cord, or retinal cell death attributable to ischemia based on imaging evidence or clinical evidence
What percentage of strokes are preventable?
80%
What type of stroke is the highest in infants and children <5 years an higher in boys?
ischemic strokes
What happens to neonates with strokes?
- experience cerebral palsy
- cognitive and speech impairments
- epilepsy
What are the modifiable factors for stroke?
- HTN
- A fib
- diabetes
- physical inactivity
- obesity
- high cholesterol
- cigarettes double risk
- alcohol consumption
- drug use
What are the non-modifiable risk factors for stroke?
- previous stroke or heart attack
- previous TIA
- increased age
- african American
- women have higher lifetime risk
- family history of stroke
- genetic component
How many mmHg decrease is associated with 40% reduction of stroke risk?
10 mmHg systolic or 5 mmHg diastolic
Which cardiac abnormalities increase the risks of HTN induced stroke?
- paten foramen ovale ad atrial septal aneurysm
How does physical activity decrease the risk of stroke?
decrease HTN, diabetes, and obesity
What is interesting about alcohol use relating to stroke?
light to moderate alcohol is protective, heavy drinking is associated with increased risk
What does BE FAST stand for?
- balance
- eyes
- face
- arm
- speech
- time
What is the Glasgow coma scale?
scale that is used as a way to communicate the level of consciousness of patients with an acute injury to the Brian?
what does the Glasgow coma scale measure?
eye opening, verbal response, motor response
lower score worse injury
What is the continuum of care?
intensive care unit > acute care > inpatient rehab > skilled nursing rehab > home health rehab > outpatient rehab
What is the hyper acute stage of care?
- 6 hours after onset
What is a acute stage of stroke care?
1 month after
What is sub-acute stage of stroke?
1-6 months after stroke
What is chronic stage of stroke care?
> 6 months after stroke
When is the steepest and greatest recovery after stroke?
30 days
What does the most natural recovery from a stroke occur?
3 months
When does recovery slow down but is still possible with correct intensity and neuroplasticity?
6 months
