Neuro Stroke Flashcards
Right hemisphere stroke presentation
“baby”
Tone/sensation: left hemiparesis/hemisensory loss
Impairments: visual-perceptual impairments, neglect, difficulty with visual cues
Behavior: quick, impulsive, safety risk
Intellectual: rigidity of thought
Emotional: difficulty with negative emotions
Common: homonymous hemianopsia
Left hemisphere stroke presentation
“old person”
L = Language
Tone/sensation: Right hemiparesis/hemisensory loss
Impairments: language, aphasias, difficulty with verbal cues
Behavior: slow, cautious
Intellectual: highly distractible
Emotional: difficulty with positive emotions
Common: homonymous hemianopsia
What part of the brain is supplied by the middle cerebral artery (MCA)?
lateral brain
*most common stroke
What part of the brain is supplied by the anterior cerebral artery (ACA)?
medial brain
What part of the brain is supplied by the posterior cerebral artery (PCA)?
posterior brain
ACA signs and symptoms
Contralateral hemiparesis/hemisensory loss in LE
Urinary incontinence
Problems with imitation, bimanual tasks, apraxia
Slowness, delay, motor inaction
Contralateral grasp reflex, sucking reflex (ped reflexes come back with ACA stroke)
“baby”
MCA signs and symptoms
M.P.H.
Contralateral hemiparesis/hemisensory loss in UE and face
MOUTH: Language and speech impairments (L brain - brocas, wernickes, global)
PERCEPTION: perceptual disorders, unilateral neglect (R brain)
HH: contralateral homonymous hemianopsia (L or R brain)
What parts of the MCA are affected in Broca’s, Wernicke’s, and global aphasia, respectively?
L brain = language deficits
Broca’s = superior division MCA, frontal lobe
Wernicke’s = inferior division MCA, temporal lobe
Global = stem of MCA (before sup/inf div split); both Broca’s and Wernicke’s
Unilateral neglect description
Right MCA - left side neglect typical
Lack of awareness of weak side
Intervention:
- encourage awareness and use of the environment of hemiparetic side and use of hemiparetic extremities
- active visual scanning > turning of the head and axial trunk rotation to the more involved side
Homonymous hemianopsia description
R or L MCA (and PCA)
“same half no vision”
ex: R MCA = L HH, left half of each eye blindness aka R nasal half, L temporal half
PCA peripheral territory signs and symptoms
Feeds occipital lobe > vision
CL homonymous hemianopsia
Visual agnosia - prosopagnosia (inability to recognize familiar faces)
Dyslexia without agraphia
Color discrimination
Memory deficits
Topographical disorientation aka wayfinding
PCA central territory signs and symptoms
Thalamus: central post stroke thalamic pain syndrome
All sensation relay through thalamus
Immense sensitivity and pain to non-painful stimuli
Spasticity vs synergy
Spasticity: increased tone, velocity dependent, PROM
Synergy: patterned movement, AROM
Brunnstrom Stage 1
Flaccidity, no active limb movement
Brunnstrom Stage 2
beginning of voluntary movement
synergies, some spasticity
Brunnstrom Stage 3
voluntary control of mvmt synergy
spasticity and synergy at peak
think top of bell curve
Brunnstrom Stage 4
movement outside of synergy
less spasticity
Brunnstrom Stage 5
Increased complex mvmt, greater independence from limb synergies
selective control of mvmt
Brunnstrom Stage 6
isolated, coordinated mvmt
Brunnstrom Stage 7
normal function
Spasticity pattern in UE
“T-Rex arms”
Scapula: retraction, downward rotation
Shoulder: adduction, IR, depression
Elbow: flexion
Forearm: pronation
Wrist: flexion, adduction
Hand: finger flexion, clenched fist thumb, adducted in palm
Spasticity pattern in LE
“ballerina”
Pelvis: retraction (hip hiking)
Hip: adduction (scissoring), IR, extension
Knee: extension
Foot and ankle: PF, inversion, equinovarus, toes claw, toes curl
Spasticity treatment
position out of spasticity
Flexion synergy pattern UE
make a bicep
Scapula retraction/elevation or hyperextension
Shoulder abduction, ER
Elbow flexion
Wrist and finger flexion
