PTA Neuro - CVA and TBI Flashcards
What is CVA?
Cerebrovascular Accident
The sudden onset of neurological signs and symptoms resulting from a disturbance of blood supply to the brain that persists longer than 24 hours.
Name two causes of CVA
Ischemic - lack of blood flow
Hermorrhagic - abnormal bleeding due to blood vessel rupture or trauma
Name two types of Ischemic CVA
Cerebral Thrombosis
Cerebral Embolus
Explain cerebral thrombosis
Formation of thrombus (clot) within the cerebral, carotid, or vertebral arteries leads to infarction/tissue death.
Atherosclerosis is the cause (process of plaque buildup in an artery)
Explain cerebral embolus
A detached clot causes occlusion of cerebral arteries
Associated w cardiovascular disease (A-fib, valvular, MI)
Name three causes of hemorrhagic CVA
hyptertension
aneurysm
ateriovenous malformation
What is TIA?
Transient Ischemic Attack
temporary interruption of blood supply to the brain
How long does a TIA last?
Symptoms last from a few minutes to several hours, but < 24 hours
What causes a TIA?
May be due to embolus, arrhythmias, hypotension, cerebrovascular spasm
What damage is done during a TIA?
No evidence of residual brain damage or permanent neurological dysfunction afterwards
What is the risk of CVA after TIA?
33% of patients who have 1 or more TIAs will go on to have a CVA within 1 year
List risk factors for CVA
Hypertension Smoking Hypercholesterolemia Age (Risk doubles with each decade over the age of 55.) Heart disease Arrhythmias Diabetes Hyperlipidemia Physical inactivity Hx of CVA or TIA Male gender up to 80 yo Race – African American Family Hx ↑ alcohol consumption Drug abuse Hormonal treatment Abdominal obesity
What are the motor signs and symptoms of CVA?
- Flaccidity →hypertonicity—due to abnormal processing of afferent input after reaches spinal cord; decreased inhibition from higher cortical centers and spinal interneuron pathways
- Paralysis, paresis
- Posturing/moving in synergistic patterns
- Reflex changes – clonus, Babinski sign
- Associated reactions
- Incoordination secondary to cerebellar lesion, decreased proprioception, or motor weakness
What are the sensory signs and symptoms of CVA?
- Sensation often impaired on hemiplegic side but rarely totally absent
- Loss of superficial touch, pain, and temperature sensation are common
- Loss of proprioception may be a major problem and is common
What are language signs and symptoms of CVA?
Aphasia
- impaired language comprehension, oral express or formulation and use of symbols to communicate ideas
- usually from L CVA (R hemiplegia)
- three kinds
What are the three types of aphasia?
Expressive (Broca’s)
Receptive (Wernicke’s)
Global
What are the speech/language/swallowing signs and symptoms of CVA?
Agraphia Alexia Anomia Aphasia (three kinds) Apraxia Dysarthria Dysphagia Perseveration
What is the visual sign/symptom of CVA?
Homonymous Hemianopsia
- blindness of the nasal half of one and the temporal half of the other eye
- visual field deficit on the hemiplegic side
What are Cognitive-Perceptual deficits you would see in CVA?
Agnosia Anosognosia Apraxia Body Image Distortion Body Scheme Distortion Figure-Ground Discrimination Deficit Position in Space Deficit Problem Perceiving Verticality Topographical Disorientation Unilateral Neglect
Define two types of Apraxia
- Ideational Apraxia - inability to do purposeful movements on command or automatically
- Ideomotor Apraxia - inability to do purposeful movements on other’s command, but can do automatically
Cognitive Perceptual Deficits are more common in left or right CVA?
Right CVA (left hemiplegia)
List changes in mental function and behavior associated with Right Hemiplegia
Slow Cautious Uncertain Insecure Negative Anxious Depressed Problems w/processing information in sequential/linear fashion
List changes in mental function and behavior associated with Left Hemiplegia
Quick Impulsive Overestimates abilities Denial of diabilitiy Poor judgement (safety) Difficulty grasping a whole idea or overall organization of an activity Pusher syndrome
List changes in mental function and behavior associated with either side hemiplegia
memory probems emotional lability (pseudobulbar affect) confusion, irritability dementia (due to multiple infarcts) seizure (in small % of cases)
List Secondary Complications to CVA
- Contractures & deformities
- Deep vein thrombosis or pulmonary emboli
- Urinary incontinence; bowel impactions or incontinence
- Hemiplegic shoulder pain or subluxation
- Shoulder-hand syndrome = Complex regional pain syndrome = Reflex sympathetic dystrophy
- — Hand edema & shoulder pain → wrist & hand pain → ↓ed shoulder ROM, vasomotor changes, hypersensitivity
Distribution and Deficits of Anterior Cerebral Artery
- Supplies the medial aspect & superior border of the frontal and parietal lobes
- Contralateral weakness and sensory loss primarily in the lower extremity, incontinence, aphasia, memory and behavioral deficits
distribution and deficits of Middle Cerebral Artery
- Supplies the surface of the cerebral hemispheres and the deep frontal and parietal lobes
- Contralateral sensory loss and weakness in the face and upper extremity, less involvement in the LE, homonymous hemianopsia
distribution and deficits of Verterbrobasilar Artery
- Supplies the brain stem and the cerebellum
- Cranial nerve involvement, ataxia, vertigo, headaches, dizziness, diplopia, dysphagia, dysarthria
- Locked-in syndrome – basilar artery thrombosis
distribution and deficits of Posterior Cerebral Artery
- Supplies the occipital and temporal lobes, thalamus and upper brain stem
- Contralateral sensory loss, thalamic pain syndrome, homonymous hemianopsia, visual agnosia and cortical blindness
What is Lacunar Infarct?
- Small vessel arteriolar disease
- Associated with diabetes & HTN
- Affect deep brain structures, ie. internal capsule, thalamus, basal ganglia, pons
- Impairments:
- Contralateral weakness & sensory loss
- Ataxia – uncoordinated movement
- Dysarthria
- Pusher syndrome (R thalamic damage)
