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Neuroanatomy > Module 8 - Stroke > Flashcards

Module 8 - Stroke Flashcards

1
Q

What is stroke?

A

Stroke, or CVA, is an acute onset of neurological dysfunction due to an abnormality in cerebral circulation with resultant signs and symptoms that correspond to involvement of focal areas of the brain.

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2
Q

Name 2 stroke associations.

A

1) National Stroke Association

2) American Stroke Association

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3
Q

What is the #1 stroke epidemiology?

A

disability

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4
Q

What is the #4 stroke epidemiology?

A

death

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5
Q

Are males or females at more risk for stroke?

A

slightly females

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6
Q

What is the number of stroke prevalence?

A

7,000,000

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7
Q

What is the number of stroke incidence?

A

750,000

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8
Q

What is the mortality rate of stroke?

A

140,000

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9
Q

What are some modifiable risk factors for stroke?

A 
TIA
HTN
obesity
alcohol
smoking
heart disease
diabetes mellitus
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10
Q

What are some UNmodifiable risk factors for stroke?

A 
age
race
gender
prior stroke
family history of stroke
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11
Q

What are some diagnostic procedures for stroke?

A 
blood panel
diagnostic imaging (ECG/EKG, echocardiogram, CT/MRI, US transcranial doppler)
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12
Q

What are the two classifications & percentages for stroke?

A

1) Ischemic - 87%

2) Hemorrhagic - 13%

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13
Q

What is ischemic?

A

cerebral thrombosis or embolis

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14
Q

What is hemorrhagic?

A 
intracerebral
subarchnoid
arteriovenous malformation (AVM)
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15
Q

Which artery is most common for a stroke to occur?

A

middle cerebral artery (MCA)

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16
Q

What happens when stroke occurs in the PCA?

A

this is the occipital lobe, blindness will occur

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17
Q

What happens what stroke occurs in the common carotid artery?

A

disrupts the major blood flow into the brain

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18
Q

What drug breaks up a clot?

A

TBA

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19
Q

When an intracerebral hemorrhage occurs what color is on the CT?

A

white

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20
Q

Right hemisphere stroke will have effects of…

A

left hemiparesis
left hemi-sensory loss
visual-perceptual deficits
impulsive/poor judgement

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21
Q

Left hemisphere stroke will have effects of…

A

right hemiparesis
right hemi-sensory loss
slow and cautious behavior
speech/language deficits

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22
Q

Which arteries is a branch of the internal carotid artery?

A

anterior (ACA)

middle (MCA)

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23
Q

The ACA supply what areas?

A

MCA (frontal and parietal lobes) and subcortical structure

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24
Q

What does the ACA effects?

A

contralateral hemiparesis

sensory loss LE > UE

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25
Q

Which area effect facial involvement?

A

MCA

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26
Q

The MCA supply what areas?

A

lateral cerebral hemispheres (frontal, temporal, and parietal) and subcortical structures

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27
Q

What does the MCA effects?

A

contralateral spastic hemiparesis
sensory loss
UE & face > LE

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28
Q

What makes the ICA area the most dangerous stroke (supplies area)?

A

it will block both the ACA & MCA

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29
Q

What happens when there is a complete occlusion in the ICA?

A

death

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30
Q

What happens when there is an incomplete occlusion in the ICA?

A

combo of ACA and MCA characteristics

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31
Q

Where does the PCA supply?

A

occipital, medial, inferior temporal lobes
upper brainstem
midbrain
posterior diencephalon

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32
Q

What does the PCA effects?

A

contralateral hemiplegia
sensory loss
visual impairments
thalamic pain syndrome

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33
Q

What is Lacunar Syndromes?

A

caused by deep small vessel disease and are consistent with specific anatomical sites

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34
Q

Where does the Vertebrobasilar Artery supply?

A

cerebrum
medulla
pons
internal ear

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35
Q

What happens when there is a complete occlusion of the Vertebrobasilar Artery?

A

death

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36
Q

What happens when there is an incomplete occlusion of the Vertebrobasilar Artery?

A 
ipsilaterally and contra-laterally
locked-in syndrome
bulbar palsy
Wallenberg's syndrome
vestibular deficits
cerebellar deficits
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37
Q

The Vertebrobasilar Artery effects what cranial nerves?

A

9-12

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38
Q

What drug is used for treating thrombus?

A

Coumadin

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39
Q

What drug is used for treating hypertension?

A

Procardia

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40
Q

What drug is used for treating seizures?

A

Dilantin

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41
Q

What drug is used for treating spasticity?

A

Baclofen

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42
Q

What drug is used for treating pain?

A

Vicodin

43
Q

What drug is used for treating insomnia?

A

Ambien

44
Q

What drug is used for treating depression?

A

Paxil

45
Q

What is the rehab process?

A

medically stable
functional recovery potential
guide to PT practice

46
Q

What is the guide to PT practice?

A

strength impairments
sensory and perceptual impairments
coordination impairments
balance impairments

47
Q

Who is involved in the rehab process?

A 
patient and family
physician
nurse
pt/ot/st/op
case manager
social worker
neuropsychologist
recreational therapists
48
Q

What is the subjective examination?

A

medical chart review
nursing consultation
patient and/or family member interview

49
Q

What is lethargy according to the standard descriptive terminology?

A

drowsy, able to respond briefly

50
Q

What is obtudination according to the standard descriptive terminology?

A

difficult to arouse, confused

51
Q

What is stupor according to the standard descriptive terminology?

A

unresponsive, awakened by intense stimuli

52
Q

What is coma according to the standard descriptive terminology?

A

unresponsive

53
Q

What does the Glascow Coma Scale measure?

A

eye opening
best motor response
verbal response

54
Q

What is a mild score on the Glascow Coma Scale?

A

13-15

55
Q

What is a moderate score on the Glascow Coma Scale?

A

9-12

56
Q

What is a severe score on the Glascow Coma Scale?

A

less or equal to 8

57
Q

Neuromotor disorders consists of:

A

dysarthria (impaired speech and non-speech oral muscles)
verbal apraxia (impaired speech muscles/Broca’s aphasia)
dysphagia (impaired swallowing)

58
Q

Aphasia consists of:

A

global aphasia (designation of severity versus type)
Broca’s aphasia (non-fluent or expressive aphasia)
Wernicke’s aphasia (fluent or receptive aphasia)

59
Q

Cognitive status:

A

Orientation (person, place, time, and circumstance)
Ability to follow 1-3 step commands
Mini-manual state examination
Preservation

60
Q

Emotional and behavioral status:

A

Emotional lability (psuedobulbar affect)
Depression
Apathy

61
Q

Vital signs:

A 
temperature: 96.8-99.5 F
blood pressure: 95-119/60-79 mmHg
heart rate: 60-90 bpm
respiratory rate: 12-20 breaths/min
oxygen saturation rate: 95-100%
62
Q

Bowel & bladder:

A

hyperreflexia
hyporeflexia
sphincter control
sensory loss

63
Q

Integumentary system:

A

Color
Integrity
Pressure sores

64
Q

Deep Vein Thrombosis:

A

Swelling and edema lower leg

Pain/tenderness/ache/tightness in calf

65
Q

Sensory integrity:

A

superficial, deep, and combined cortical

pain (thalamic pain, hyperalgesia)

66
Q

Vision:

A

visual neglect

homonymous hemianopsia

67
Q

CN I:

A

Olfactory

ask patient to identify items with very specific odors (spa, coffee) placed under nose; each nostril tested separately

68
Q

CN II:

A

Optic
ability to see is tested by asking patient to read an eye chart; peripheral vision is tested by asking patient to detect objects from corners of eyes

69
Q

CN III:

A

Occulomotor
ability to move each eye up, down, and inward is tested by asking patient to follow a target moved by examiner
pupils’ response to light is checked by shining a bright light into each pupil in a darkened room
upper eyelid is checked for drooping (ptosis)

70
Q

CN IV:

A

Trochlear

ability to move each eye down and inward is tested by asking patient to follow a target moved by examiner

71
Q

CN V:

A

Trigeminal
facial sensation is tested using a pin and a wisp of cotton; blink reflex is tested by touching cornea of eye with a cotton wisp
strength and movement of muscles that control jaw are tested by asking patient to clench teeth and open jaw against resistance

72
Q

CN VI:

A

Abducens

ability to move each eye outward beyond midline is tested by asking patient to look to side

73
Q

CN VII:

A

Facial
ability to move face is tested by asking patient to smile, open mouth, show teeth, and close eyes tightly
taste is tested using substances that are sweet, sour, and salty

74
Q

CN VIII:

A

Vestibulocochlear
hearing is tested with a tuning fork
balance is tested by asking patient to walk a straight line or by performing head thrust test

75
Q

CN IX:

A

Glossopharyngeal

76
Q

CN X:

A

Vagus

77
Q

Both CN IX and X are tested by:

A

ask patient to swallow, say “ah” to check movement of palate and uvula, back of throat is touched with a tongue blade to evoke gag reflex, patient asked to speak to determine whether voice sounds nasal

78
Q

CN XI:

A

Accessory

patient is aced to turn head and shrug shoulders against resistance

79
Q

CN XII:

A

Hypoglossal

patient asked to stick out tongue and is observed for deviations to one side or other

80
Q

Joint Integrity and Mobility is tested by:

A

AROM and PROM

81
Q

Perception:

A

Body scheme/image (unilateral neglect)
Spatial relations
Agnosia (telling what the objects are)

82
Q

Brunnstrum Stages of Motor Recovery at initial to overtime:

A

1: Flaccid
2: Minimal voluntary synergistic movement, spasticity emerges
3: More voluntary synergistic movement, spasticity maximal
4: Some movements out of synergy, spasticity declines
5: Synergy patterns lose dominance
6: no spasticity, individual joint movements possible

83
Q

Hemiplegia is:

A

complete

84
Q

Hemiparesis is:

A

incomplete

85
Q

Flaccidity is:

A

hypotonicity

86
Q

Spasticity if:

A

hypertonicity

87
Q

Modified Ashworth Scale (MAS) measures tone levels:

A

0: no increase in muscle tone
1: minimal increase in muscle tone at end of range
1+: minimal increase in muscle tone (less than half of PROM)
2: more marked increase in muscle tone (most PROM)
3: considerable increase in muscle tone (PROM difficult)
4: rigid

88
Q

Abnormal (Obligatory) Synergy Patterns:

A

UE Flexion
UE Extension
LE Flexion
LE Extension

89
Q

What are the 5 major UE internal rotators?

A 
anterior deltoid
teres major
lats
subscapularis
pectoralis major
90
Q

What is the UE Flexion pattern?

A 
scapular retraction, elevation
shoulder abduction, external rotation
elbow flexion
forearm supination
wrist and finger flexion
91
Q

What is the UE Extension pattern?

A 
scapular protraction
shoulder adduction, internal rotation
elbow extension
forearm pronation
wrist and finger flexion
92
Q

What is the LE Flexion pattern?

A

hip flexion, abduction, external rotation
knee flexion
ankle df and inversion
toe df

93
Q

What is the LE Extension pattern?

A

hip extension, adduction, internal rotation
knee extension
ankle pf and inversion
toe pf

94
Q

What are some abnormal reflexes?

A

hyporeflexia, flaccidity
hyperreflexia, clonus, clasp knife response, Babinski
associated reactions

95
Q

What are some altered coordinations?

A

ataxia
bradykinesisa
choreoathetosis and hemiballismus

96
Q

Ataxia have lesions in the:

A

cerebellar

97
Q

Bradykinesia, choreoathetosis, and hemiballismus lesions are in the:

A

basal ganglia

98
Q

Altered motor programming is either:

A

ideational or ideomotor apraxia

99
Q

Ideational apraxis is:

A

inability automatically or on command

100
Q

Ideomotor apraxia is:

A

automatically but not on command

101
Q

Postural control and balance:

A

Asymmetrical stance
Reactive postural control
Anticipatory postural control
Ipsilateral Pushing (Pusher Syndrome)

102
Q

Functional and mobility and ambulation:

A

Bed mobility
Transfers
Gait/Locomotion

103
Q

A specific instrument to measure disability:

A

Fugl-Meyer Assessment of Physical Performance (FMA)

Neuroanatomy (8 decks)

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