STROKE

Question 1

Objectives (lecture and lab)

Syllabus objectives 14, 15 & 16

Answer 1

FYI

Question 2

Stroke/CVA

2 TYPES

Answer 2

Ischemic

Hemorrhagic stroke

Question 3

Most common
80% of individuals
Due to clot or impairment of blood flow

What type of stroke?

Answer 3

Ischemic

Question 4

Blood vessel ruptures

what type of stroke?

Answer 4

Hemorrhagic stroke

Question 5

• Change in level of consciousness
• Impairment of sensory, motor , cognitive, perceptual and language functions
• By definition must persist > 24 hours (otherwise TIA)

Answer 5

Stroke

Question 6

Motor deficits that can happen due to a stoke

Answer 6

• Hemiplegia
• Hemiparesis

Question 7

paralysis -Motor deficit

Answer 7

Hemiplegia

Question 8

weakness - motor deficit

and what side of body

Answer 8

Hemiparesis

opposite

Question 9

• Frontal and parietal lobes
• BG, corpus callosum
• contralateral hemiparesis worse in LE
• dr c says to know these

what type of syndrome?

Answer 9

Anterior cerebral artery syndrome

Question 10

Left homonymous hemianopsia

what does their vision look like?

Answer 10

Only see 1/2 the picture in vision

Question 11

• Area is large; IC supplies ant carotid A and MCA
• Damage can be very extensive
• Can cause large amounts of edema and even death

What syndrome is this?

Answer 11

Internal carotid artery syndrome

Question 12

• Can cause vision issues (hemianopsia, visual agnosia, cortical blindness)
• Memory loss

What syndrome?

Answer 12

Posterior Cerebral Artery Syndrome

Question 13

• Very small vessels affected in white matter
• Can be either hypertensive issues or diabetic microvascular disease
• Can have several issues: : dysarthira, clumsy hand syndrome, atacia, dystonia, sensory/motor stroke
• Higher cortical levels are preserved

what type of syndrome?

Answer 13

• Lacunar syndromes


Question 14

Medical management of a stroke

Answer 14

• Oxygen
• Blood pressure
• Manage cardiac output
• Electrolyte balance
• Blood glucose levels
• Seizures
• Intracranial pressure
• Bladder function
• Integrity of skin and joints

Question 15

Primary Impairments

of a stroke

Answer 15

• sensation loss
• Pain
• vision changes
• motor functions
• weakness
• alterations in tone
• abnormal reflexes
• alterted coordination
• apraxia
• postural and control balance

Question 16

In a stroke what can happen to sensation?

Answer 16

• Can lose superficial or deep or can have issues with combined cortical sensation ( steriognosis, 2 pt discrim., barognosis, graphesthesia, dble simultaneous stim. Etc)
• Usually see face, UE,LE loss
• Can be face/UE or UE/LE
• Proprioceptive loss is common (motor control/posture/balance)

Question 17

describe pain associated with a stroke.

Answer 17

Can have severe head/neck /face pain

Post stroke (thalamic) pain (resulting typically from PCA stroke)

• Constant, severe, burning, intermittent sharp pain
• Trigger by stroking of skin, pinprick, temp change
• Loud noise, other mild irritants
• spontaneous recovery is rare

Question 18

what type of vision changes happen from a stroke?

Answer 18

• Hemianopsia
• Visual neglect-No attention to what happens on one side of them
  
  • Compensate with turning of head
• Forced gaze deviation
  
  • Eyes will deviate in the direction of the intact muscluture

Question 19

pg 719

stages of revovery

for motor functions from a stroke.

Answer 19

• UE and LE may be at different levels
• May have more complete recovery of LE and very little of UE
• Degree of recovery will vary
• Will see general patterns
• Variation will depend on location of insult, severity of lesion and capacity for adaptation

Question 20

what weakness impairments happen with a stroke?

Answer 20

• Found in large percentage of patients, major factor in disability
  
  • Relates to location of insult and size of area affected
• Many times UE more involved
  
  • Corticospinal system facilitates distal musculature
  • May see mild weakness on “good side”

Question 21

Motor Deficits

Anything > how many weeks may lead to permanent disability with a stoke pt?

Answer 21

3 weeks:

Question 22

Strokes are classified by what 3 etiologies?

Answer 22

• Thrombosis
• Embolus
• hemorrhage

Question 23

What can stokes be due to?

Answer 23

• Plaques
• Ischemic stroke
• Hemorrhagic stroke

Question 24

what can cause an Ischemic stroke?

Answer 24

• Thrombus
  
  • Cerebral thrombus: tissue death
• Embolism: comes from somewhere else, breaks off and lodges
• Conditions with low systemic perfusion pressures (lack cerebral blood flow)

Question 25

what causes a Hemorrhagic stroke?

Answer 25

• Intracerebral hemorrhage
  
  • Primary cerebral hemorrhage (small vessels)
  • Subarachnoid hemorrhage (large vessels)

Question 26


Risk factors for a stroke?

Answer 26

• Hypertension
• Coronary artery disease
• Congestive heart failure
• Peripheral arterial disease
• diabetes

Question 27

Early warning signs of a stroke?

Answer 27

• Sudden numbness or weakness of face, arm, or leg, especially on one side of body
• Sudden confusion, trouble speaking/understanding
• Sudden trouble seeing (this could be several things, most of which are dangerous!)
• Sudden trouble walking, dizziness, loss of balance, or coordination
• Sudden SEVERE headache (worst headache of my life)
• Sudden nausea/fever/vomiting
• Brief LOC or decreased consciousness

Question 28

what is the The Golden “hour”?

Answer 28

• Or, actually 3 hrs!
• If it is a thrombotic event, must use t-PA (clot dissolving enzyme) within 3 hours of symptom onset
• t-PA cannot be given for: _____________________
• More likely to fully recover or have limited disability if t-PA is given in time

Question 29

• Damage over 3-4 hours
• Cerebral edema: reaches maximal level at 3-4 days: should dissipate in 2-3 weeks

what Pathophysiology?

Answer 29

Ischemic cascade