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NEURO > Stroke > Flashcards

Stroke Flashcards

1
Q

Cerebrovascular Accident (CVA)

A

Distruption in cerebral circulation causing a sudden loss of neruons and neurological function

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2
Q

Ischemic Strokes (80%)
Name the etiology from most -> least

A
  1. Thrombotic
    - Blood clot fromed w/in the vessel wall in the brain interrupts cerebral blood flow
  2. Embolic
    - An embolus is formed elsewhere in the body, dislodges and travels through the circulatory system to lodge in the cerebral arteries’ vessels interrupting cerebral BF
    - SUDDEN ONSET as the lumen of the blood vessel becomes suddenly occulded
  3. Low Systemic Perfusion
    - May be due to cardiac failure or significant blood loss leading to systemic hypotension and thus decrease cerebral BF (ex. gunshot wound)
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3
Q

Transient Ischemic Accident (TIA)

A

Ischemia W/O tissue death which causes a transient episode of neurological dysfunction

  • Typically resolves in 24 hours or less
  • Considered a warnign sign for a CVA
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4
Q

Ischemic Penumbra

A

Area surrounding the ischemic event

  • Penumbra area may remain viable following an ischemic event for several hours d/t supply of collateral aterties to the area = window of opportunity to intervene
  • One of the main priorities immediately following an ischemic stroke is to attempt to save the ischemic penumbra

Thrombolytic agents are administered WITHIN 4.5 hours following onset of symptoms and attempts are made to DEC ICP from cerebral edema

Thrombolytics are NOT appropratie for HEMORRHAGIC strokes

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5
Q

Hemorrhagic Strokes (~20%)

Types

A
  1. Intracerebral
    - D/t a rupture or leak of a weak blood vessel in the brain
    = INE compressive forces = INC ICP & futher edema = INC compression
  2. Subarachnoid
    - D/t an anteriovenous malformation or a ruptured aneursym which causes bleeding in the subarachnoid space

Least common etiology
Typically SUDDEN onset
INC mortality rate

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6
Q

Arteriovenous Malformation

Definition & Issue

A

A congential defect resulting in a tangle of abnormal arteries and veins, which bypass the capillary system

  • progressive dilation with age
  • eventual bleeding in ~50% of AVM cases
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7
Q

Major RF specific to women?

A
  1. Early menopause
  2. Estrogen supplementation
  3. Pregnancy, birth, first 6 weeks post-partum
  4. Preclampsia

Preeclampsia is a serious condition that can happen after the 20th week of pregnancy or after giving birth (called postpartum preeclampsia). In addition to causing high blood pressure, it can cause organs, like the kidneys and liver, to not work normally

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8
Q

What does the ACA supply?

A
  • Medial aspect of cerebral hemisphere (frontal & parietal lobes)
  • Subcortical structures (basal ganglia, anterior fornix, corpus callosum)
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9
Q

Anterior Communicating Artery

How does it perfuse the proximal ACA & how may that have an impact?

A

Occulsion is PROXIMAL to the anterior communicating artery = minimal deficits

Occulsion is DISTAL to the anterior communicating artery = greater deficits
* Both ends feed into the ACA have been blocked = no potential for collatoral perfusion

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10
Q

Common characteristics of an ACA stroke…

(7)

A
  1. Contralateral hemiparesis & hemi-sensory loss
  2. LE affected > UE
  3. Urinary incontinence
  4. Abuila = absence in willpower OR inability to act decisively
  5. Akinetic Mutism = pt do not move much as well as speak often
  6. Apraxia = motor planning
  7. BROCA’s Aphasia (frontal lobe) = Production of speech
    * Difficulty with motor aspect - no issues w/ comprehension
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11
Q

What does the MCA supply?

A
  • Lateral aspect of the cerebral hemisphere (frontal, parietal, & temporal)
  • Subcortical structures (5)
    1. Internal capsule
    2. Corona radiata
    3. Globus pallidus -BG
    4. Caudate -BG
    5. Putament - BG
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12
Q

What is the most common site of occulusion in stroke?

A

MCA
* Occulusion of the proximal MCA results in extensive neurological damage

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13
Q

Common characteristics of a MCA stroke…

(7)

A
  1. Contralateral hemiparesis & hemi-sensory loss of face, UE, & LE
  2. UE affected > LE
  3. Contralateral homonymous hemianopia
  4. BROCA’s aphasia (frontal lobe)
  5. WERNICKE’s aphasia (temporal lobe)
  6. Global aphasia = nonfluent speech + poor comprehension - combination of both
  7. Perceptual deficits
    - unilateral neglect
    - anosognosia
    - apraxia
    - spatial disorganization/ depth perception - if lesion is in non-dominant hemisphere (right)
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14
Q

What is the more dominant hemisphere?

A

LEFT hemisphere is often the DOMINANT hemipshere

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15
Q

Homonymous Hemianopia

What does this mean?

A

Homonymous = loss on the same side of both eyes
Hemianopia = loss of visual field on one side of midline

Homonymous hemianopia is a loss of the right or left halves of the visual field of both eyes and usually occurs as a result of a middle cerebral or posterior cerebral artery stroke affecting either the optic radiation or visual cortex of the occipital lobe

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16
Q

Internal Carotid Artery (ICA) Syndrome

What does it supply? What is most affected?

A
  • Supplies both the MCA & ACA
  • Occulusion typically results in large obstruction of areas supplied by MCA
  • ACA has circulation from circle of Willis, but if absent, area supplied by ACA will also be affected
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17
Q

Uncal Herniation

A

Inner part of the TEMPORAL Lobe has so much pressure -> herniates down & puts pressure on the BRAINSTEM

ICA Syndrome causes significant edema (common) which may INC ICP possibly leading to uncal herniation, coma, and even death

18
Q

What does the PCA supply?

(4)

A
  1. Occipital lobe
  2. Medial & Inferior Temporal Lobe
  3. Upper brainstem (Midbrain)
  4. Posterior diencephalon (most of thalamus)
19
Q

Posterior Communicating Artery

How does it perfuse the proximal PCA & how may that have an impact?

A

Occulsion is PROXIMAL to the psoterior communicating artery = minimal deficits

Occulsion is DISTAL to the posterior communicating artery = greater deficits

  • Posterior Communicating artery allows for perfusion of the proximal PCA from either side
20
Q

Common Characteristics of PCA stoke…

Territory determines characteristics (6+

A

Peripheral Territory
1. Amnesia
2. Homonymous hemianopia (visual cortex affected)
3. Visal agnosia = difficulty w/ recognizing visual objects or ppl
4. Prosopagnosia = difficulty naming ppl on site (cannot recognize based on ppl’s facial features - NO problems with vision)
5. Dyslexia
6. Colouring naming & discrimination problems

Central Territory
1. Central post-stroke (thalamic) pain = burning & shooting - very severe & constant
2. Hemianesthesia = loss of sensation on one half of the body
3. Sensory impairment (all modalities - vision, smell, sight, touch)
4. Contralateral hemiplegia - paralysis
5. Oculomotor nerve palsy

21
Q

What does the Vertebral Artery supply?

A

Cerebellum & Medulla

22
Q

What does the Basilar Artery supply?

A

Pons, Internal Ear, & Cerebellum

23
Q

Common characteristics of a Vertebrobasilar Artery Syndrome?

A
  1. Ataxia (ipsilateral)
  2. Imparied sesnation over the face
  3. Impaired pain and thermal sensation (contralateral)
  4. Vertigo
  5. Diplopia
  6. Dysarthria
  7. Dysphagia

5D, 3Ns

Typically affected by FORCEFUL neck mvmts (whiplash)

24
Q

Locked-In Syndrome (LIS)

Definition & Details

A

A condition in which a patient is aware and awale, but has complete paralysis of nearly all VOLUNTARY muscles in the body except for the eyes and are otherwise cognitively intact

  • LIS is sudden onset
  • Perserved consciousness and sensation
  • Total locked-in syndrome: the eyes are paralyzed as well
25
Q

Lacunar Syndrome

Defintion, RF, Specifics

A

Caused by occulusions of small penetrating arteries supplying the brains deep structures.

  • 20% of all strokes
  • Strongly associated with HTN & DM
  • Higher corticol areas are perserved
  • Lacunar syndromes are consistent with specific anatomical sites
  • Pure motor lacunar stroke
  • Pure sensory lacunar stroke
  • Other lacunar syndromes: dyarthria/clumsy hand syndrome, ataxic hemiparesis, sensory/motor stroke, dystonia/involuntary mvmts
26
Q

Hemispheric Behavioral Differences:
LEFT Lesions

(4)

A
  1. Slow, cautious, anxious, and disorganized
  2. Hesitant to try new tasks - requires more feedback, support, and encouragement
  3. Aware of their deficits (may be why they are anxious)
  4. Difficulties w/ communication and processing information in sequential linear order

* More likely to experience frequent and severe depression also

27
Q

Hemispheric Behavioral Differences:
RIGHT Lesion

(4)

A
  1. Quick, impulsive, poor judgement (safety risk)
  2. Overestimates abilties. Unaware of their deficits (anosognosia)
  3. Increased safety risk - feedback focused on slowing down, and recognizing risks and consequences of actions
  4. Difficulties with spatial-perceptual taks and in grasping the whole idea of an activity or task
28
Q

RIGHT Parietal Cortex Lesions usually result in what dysfunction? May include disorders of (4)

Specific impairments also included

A

Perceptional Dysfunction
1. Body scheme: Internal awareness of the relationship of the body parts to each other and to the environment
2. Body Image: mental image and feeling of one’s own body
3. Spatial Relations
4. Agnosia

Specific impairments of body scheme/image
- Unilateral neglect
- Anosognosia - lack of insight into their condition
- Somatagnosia - disorder of body awareness
- Right-left discrimination
- Finger agnosia - loss of ability to distinguish/name/recognize fingers

29
Q

Unilateral Neglect

Definition and Complications

A

Lack of awareness of parts of one’s own body or of the external environment

  • Limited use of the more affected limbs
  • No reaction to sensory (visual, auditory, or somatosensory) stimuli presented on the more affected side

Almost always seen in RIGHT hemisphere lesions
- RT perceives both sides of the environment
- LT only perceives the RT

30
Q

Difference between Hemianopia & Neglect?

A

Hemianopia = loss in visual field. Sense that it is not working
- Fully aware of the deficit

Neglect = no problems with vision BUT they cannot perceive it. Does not exist to them

31
Q

Stages of Motor Recovery:
Stage 1

A

Flaccid paralysis

32
Q

Stages of Motor Recovery:
Stage 2

A

Recovery begins. Spasticity begins.
Development of minimal movement in synergies

33
Q

Stages of Motor Recovery:
Stage 3

A

Voluntary control of movement synergies.
Spasticity increased

34
Q

Stages of Motor Recovery:
Stage 4

A

Spasticity begins to decrease. Some movement out of synergies

35
Q

Stages of Motor Recovery:
Stage 5

A

Further decrease in spasticity.
Movement almost independent of syngeries

36
Q

Stages of Motor Recovery:
Stage 6

A

Disappearance of spasticity.
Patterns of movement are near normal

37
Q

UE Spasticity is strong in:

(8)

A
  1. Scapular retractors
  2. Shoulder adductors depressors, & IR
  3. Elbow flexors & forearm pronators
  4. Wrist and finger flexors
38
Q

LE Spasticity is strong in:

A
  1. Pelvic retractors
  2. Hip adductors, extensors, and IR
  3. Knee extensors
  4. Plantarflexors and supinators
  5. Toe flexors
39
Q

Pusher Syndrome

A

In the neck and trunk strong spasticity may cause increased lateral flexion to the hemiplegic side

  • Most likely to lean to unaffected side so they can WB
40
Q

Obligatory synergies w/ spasticity following a stroke

Definition - see chart on pg. 281

A

Patient is unable to perform an isolated movemetn of a single segmet without producing movement in the other segments of the same limb
- Cannot disassociate
- Synergisitic influence & voluntary control may vary from on limb to the other

Review Obligatory Synergy Patterns - pg. 281

NEURO (13 decks)

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