STROKE Flashcards
Objectives (lecture and lab)
Syllabus objectives 14, 15 & 16
FYI
Stroke/CVA
2 TYPES
Ischemic
Hemorrhagic stroke
Most common
80% of individuals
Due to clot or impairment of blood flow
What type of stroke?
Ischemic
Blood vessel ruptures
what type of stroke?
Hemorrhagic stroke
- Change in level of consciousness
- Impairment of sensory, motor , cognitive, perceptual and language functions
- By definition must persist > 24 hours (otherwise TIA)
Stroke
Motor deficits that can happen due to a stoke
- Hemiplegia
- Hemiparesis
paralysis -Motor deficit
Hemiplegia
weakness - motor deficit
and what side of body
Hemiparesis
opposite
- Frontal and parietal lobes
- BG, corpus callosum
- contralateral hemiparesis worse in LE
- dr c says to know these
what type of syndrome?
Anterior cerebral artery syndrome
Left homonymous hemianopsia
what does their vision look like?
Only see 1/2 the picture in vision
- 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?
Internal carotid artery syndrome
- Can cause vision issues (hemianopsia, visual agnosia, cortical blindness)
- Memory loss
What syndrome?
Posterior Cerebral Artery Syndrome
- 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?
- Lacunar syndromes
Medical management of a stroke
- Oxygen
- Blood pressure
- Manage cardiac output
- Electrolyte balance
- Blood glucose levels
- Seizures
- Intracranial pressure
- Bladder function
- Integrity of skin and joints
Primary Impairments
of a stroke
- sensation loss
- Pain
- vision changes
- motor functions
- weakness
- alterations in tone
- abnormal reflexes
- alterted coordination
- apraxia
- postural and control balance
In a stroke what can happen to sensation?
- 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)
describe pain associated with a stroke.
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
what type of vision changes happen from a stroke?
- 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
pg 719
stages of revovery
for motor functions from a stroke.
- 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
what weakness impairments happen with a stroke?
- 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”
Motor Deficits
Anything > how many weeks may lead to permanent disability with a stoke pt?
3 weeks:
Strokes are classified by what 3 etiologies?
- Thrombosis
- Embolus
- hemorrhage
What can stokes be due to?
- Plaques
- Ischemic stroke
- Hemorrhagic stroke
what can cause an Ischemic stroke?
- Thrombus
- Cerebral thrombus: tissue death
- Embolism: comes from somewhere else, breaks off and lodges
- Conditions with low systemic perfusion pressures (lack cerebral blood flow)
what causes a Hemorrhagic stroke?
- Intracerebral hemorrhage
- Primary cerebral hemorrhage (small vessels)
- Subarachnoid hemorrhage (large vessels)
Risk factors for a stroke?
- Hypertension
- Coronary artery disease
- Congestive heart failure
- Peripheral arterial disease
- diabetes
Early warning signs of a stroke?
- 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
what is the The Golden “hour”?
- 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
- Damage over 3-4 hours
- Cerebral edema: reaches maximal level at 3-4 days: should dissipate in 2-3 weeks
what Pathophysiology?
Ischemic cascade
