neuro (class 9) stroke

Question 1

stroke

Answer 1

sudden decrease of blood flow ( oxygen & nutriens) to an area of the brain.

Question 2

stroke causes

Answer 2

a leak-hemorrhagic stroke
most fatal, blood vessel ruptures & leaks into brain tissues surrounding the vessel. 2 types intracerebral hemorrhage and subarachnoid hemorrhage aneurysm, arteriovenous malformation.
congenital vessel problems: aneurysm, AVM.

a plug-ischemic stroke: most common, blood supply to an area of the brain is interrupted = ischemia & death of tissue.

thrombotic: grows there, stenosis, plaque rupture & clot formation.
embolic: flows there (often cardiogenic due to afib) lodges in a vessel too small to pass thru, bifurcations

Question 3

transient ischemic attack (TIA)

Answer 3

mini stroke

brief period of localized cerebral ischemia that causes neurologic deficits lasting less than 24 hours.

warning signs for ischemic stroke.

effects vary according to location and size of vessel involved

deficits include: contralateral numbness or weakness of the leg, hand, forearm, and corner of the mouth; aphasia; and visual disturbances such as blurring or amaurosis fugax

Question 4

risk factors

Answer 4

previous TIA or stroke.
hypertension.
atherosclerosis/hyperlipidemia. smoking, substances use, ETOH abuse. low physical activity.

other disease processes: DM, sickel cell, sleep apnea,obesity, afib, autoimmune diseases, clotting disorders.
stress
women: oral contraceptives, pregnancy, childbirth, menopause, migraines, LT HRT.

unmodifiable: age, gender, race, heredity.

Question 5

clinical manifestations

Answer 5

depend on area of brain involved
sudden onset
transient or permanent

can impact any brain function.

usually one-sided;focal.

Question 6

contralateral deficits

Answer 6

motor pathways cross at the junction of the medulla & spinal cord so the loss/impaired sensorimotor function appears on the side opposite the injury

ex: CVA in the right side of the brain will result in paralysis on left side of the body.

Question 7

ACT FAST

Answer 7

F-face ask the person to smile; look for drooping.

A-ask the person to lift both arms; look for unilateral drift down.

S- ask the person to repeat a simple sentence; listen for slurred or strange speech.

T- time; get the patient to the hospital ASAP.

Question 8

sensory-perceptual deficits

Answer 8

impaired ability to integrate, interpret, attend to sensory data.
can impact any sense & increase risk of injury. pain, numbness, strange sensations.

ex) hemianopia-loss of half the visual field.
agnosia- loss of recognition ( can be visual, tactile, or auditory)

apraxia-loss of ability to carry out motor pattern- impact on ADLs.

hemineglect syndrome- ignores input form the affected side.

Question 9

cognitive & behavior changes

Answer 9

altered LOC
behavior: emotional lability, loss of self-control, stress tolerance.

intellectual changes: memory, judgement, attention, & reasoning problems.

Question 10

aphasia

Answer 10

inability to use or understand language
expressive
recptive
mixed

Question 11

motor deficits

Answer 11

body movement is complex function

weakness, paralysis, spasticity with damage in some areas of the brain.

Question 12

hemiplegia

Answer 12

paralysis on one half of the body

Question 13

hemiparesis

Answer 13

weakness on one half the body

Question 14

flaccidity

Answer 14

loss of muscle tone

Question 15

spasticity

Answer 15

excessive muscle tone= weakness, rotation, contractures.

Question 16

elimination problems

Answer 16

sensory loss- frequency, urgency, incontinence.

secondary problems due to cognitive dysfunction, altered intake, or immobility.

Question 17

right brain

Answer 17

affects left side of body.
difficulty with perception
vision loss
impulsiveness & lower attention span
problems with decision making.
difficulty with time concepts.
neglect syndrome more common.
short term memory problems.

Question 18

left brain

Answer 18

affects right side of body.
difficulty with speech/language.
slow careful movement.
depression
math ability impaired
dysphagia.

Question 19

surgery

Answer 19

prevention: carotid endarterectomy.
repair & revascularization.
clot exacuation.
hemorrhagic stroke: repair of aneurysms or AVM to prevent/treat bleeding.

Question 20

medications for CVA

Answer 20

prevention: antiplatelet agents. control HTN, DM, lipids.

acute ischemic stroke:
fibrinolytics tPA to lyse the clot, must be given within few hours of onset.
anticoagulants to prevent extension of the clot.
blood pressure management.