STROKE Flashcards
What does the ACA (anterior cerebral artery) supply?
And impairments
- frontal lobes
- parietal lobe
- Basal ganglia
- corpus collosum
Impairments:
- contralateral hemiplegia LE > UE
- sensory loss of contralateral LE> UE
- apraxia
What does the MCA (middle cerebral artery supply)?
And impairments
- portion of frontal lobe
- lateral surface of temporal/parietal lobe
- including: primary motor and sensory areas of the face, throat, hand and arm, areas for speech
Impairments:
- motor deficits in contra lateral face/ UE > LE
- sensory loss of contrateral face, UE, LE
- expressive, receptive and global aphasia
- neglect, apraxia, ability to judge distances (perceptual deficits)
- loss of conjugate gaze to contra lateral side, contra lateral homonymous hemianopsia
Posterior inferior cerebellar artery (PICA)
And impairments
- posterior, inferior portion of cerebellum and medulla
Impairments:
- Lateral Medullary syndrome (Wallenberg syndrome, PICA syndrome) - pushing ipsilateral to lesion
- nystagmus, nausea, vomiting, vertigo
- ipsilateral UE/LE limb ataxia, gait ataxia
- dysphagia/dysarthria
- contralateral loss of pain and temperature of body
- ipsilateral loss of pain and temperature to face
- ipsilateral Horner’s syndrome (smaller pupil, drooping of eyelid)
Basilar artery supplies
- midbrain
- cerebellum
- branches into PCA (posterior cerebral artery)
Superior cerebellar artery (SCA)
And impairments
- superior part of cerebellum and midbrain
Impairments:
- ataxia
- dizziness, nausea, vomiting, horizontal nystagmus
- decreased light touch, vibration, position sense of LE> UE (proprioception)
Anterior inferior cerebellar artery (AICA)
And impairments
Lateral pontine syndrome (2/3 of pons)
- anterior, inferior cerebellum
Impairments:
- sudden vertigo, vomiting, nystagmus
- ipsilateral ataxia, loss of balance to ipsilateral side, ipsilateral facial paralysis *
- ipsilateral loss of sensation of face
- ipsilateral hearing loss/ tinnitus
- contralateral loss of pain and temperature
Pontine arteries
- pons
Posterior cerebral artery (PCA)
And impairments
Temporal and occipital lobes
Impairments:
- contralateral hemiplegia
- involuntary movements, chorea, intention tremor
- oculomotor palsy
- sensory loss of contralateral UE/LE
- cortical blindness
- thalamic pain
- visual agnosia, prosopanogosia (facial recognition)
Repetitive transcranial magnetic stimulation post stroke
- translate into motor and sensory function impairments
- should be followed by motor task training
- optimal parameters are unknown
SAFE scores ( shoulder abduction and finger extension) (PREP algorithm) - predicted potential for upper limb recovery
Greater or equal to 8= excellent (by day 3)
< 8 - TMS- if MEP present= good
- if MEP absent- MRI
-if MRI shows: asymmetry index <0.15 = limited
- if MRI shows: asymmetry index > 0.15= none
MEP: motor evoked potentials in Paretic wrist extensor or first dorsal interosseous muscle
Modified Rankin Scale
- participation level measure
- ability and assistance measure
- degree of disability after a stroke
0-6
0: no disability
1: no significant disability
2: slightly disability
3: moderate disability (able to walk without assistance)
4: moderately severe disability (unable to walk without assistance)
5: severe disability (bedridden, incontinent)
6: dead
Barthel Index
0-100 - activities of daily living/mobility Cutoffs for acute stroke: - <63 = moderate disability - < 22 = severe disability
FIM
8-126 (highest score)
Burke lateralpulsion scale
Supine, sitting, standing, transfer and walking
- 17 is max score, higher is worse resistance to movement
Norms for blood glucose
Without diabetes
With diabetes
Without: 80-110 (fasting)
<140 (1-2 hrs after eating)
With: 80-130 (fasting)
<180 (1-2 hours after eating)
