Stroke

Question 1

What is the acronym for stroke?

Answer 1

F: facial drooping
A: arm weakness
S: speech difficulty
T: time

Question 2

Aside from the general FAST symptoms, what are other symptoms we should be aware of that might be indicative of stroke?

Answer 2

1. Sudden numbness/weakness of the leg
2. Sudden confusion or trouble understanding
3. Sudden trouble seeing in one or both eyes
4. Sudden trouble walking, dizziness, loss of balance/coordination
5. Sudden severe HA w/no known cause

Question 3

How long does a transient ischemic attack (TIA) last for?

Answer 3

few minutes but not longer than 24 hrs

Question 4

Why is a TIA such a big deal?

Answer 4

it is a precursor to susceptibility for both cerebral infarction & myocardial infarction

Question 5

What is a deteriorating stroke?

Answer 5

when their neurological status deteriorates after admission to the hospital

Question 6

Severity and symptoms are depednent on what 4 factors?

Answer 6

1. Location of the stroke area
2. Size of the stroke area
3. Nature & functions of structures involved
4. Availability of collateral blood flow

Question 7

What impact does PaCO2 and PaO2 have on vasodilation & vasoconstriction?

Answer 7

-Vasodilation & increased CBF are produced in response to increase in PaCO2 or decrease in PaO2 whereas vasoconstriction and decreased CBF are produced by the opposite stimuli

Question 8

What impact does pH have on vasodilation and vasoconstriction?

Answer 8

fall in pH produces vasodilation and increase in pH causes vasoconstriction

Question 9

What areas does the ACA supply? (2)

Answer 9

-frontal & parietal lobes
-basal ganglia

Question 10

What are the common S&S we would expect to see in a stroke involving the ACA? (4)

Answer 10

-Contralateral hemiparesis
-Sensory loss w/greater involvement of LE>UE
-Aphasia’s (Broca’s in frontal lobe & Wernicke’s in parietal)
-Urinary incontinence

Question 11

What areas does the MCA supply? (3)

Answer 11

-frontal, temporal, and parietal lobes

Question 12

What is the main concern with occlusion of a proximal MCA?

Answer 12

it produces extensive neurological damage with significant cerebral edema; increased ICP typically leads to LOC, brain herniation, and possibly death

Question 13

What are the common S&S we would expect to see in a stroke involving the MCA? (5)

Answer 13

-Contralateral spastic hemiparesis
-Sensory loss of the face
-UE>LE
-Broca’s & Wernicke’s aphasia
-Limb kinetic apraxia
-Ataxia of contralateral limbs

Question 14

Lesions of the parieto-occipital cortex of the dominant hemisphere (typically L) typically produce what?

Answer 14

aphasia

Question 15

Lesions of the R parietal lobe of the nondominant hemisphere (typically R) typically produce what?

Answer 15

perceptual deficits (unilateral neglect, anosognosia, apraxia, spatial disorganization)

Question 16

What is another common finding with MCA infarct?

Answer 16

homonymous hemianopsia

Question 17

Which area of the brain is the most common site of occlusion in stroke?

Answer 17

MCA

Question 18

Occlusion of the ICA typically produces what?

Answer 18

massive infarction in the region of the brain supplied by the MCA

Question 19

What is our main concern with an internal carotid artery infarct?

Answer 19

-significant edema with possible uncal herniation, coma, and eath

Question 20

What does the PCA supply? (2)

Answer 20

-occipital lobe & parts of the temporal lobe
-upper brainstem & midbrain

Question 21

What would be common S&S we would expect to see with a PCA stroke? (4)

Answer 21

-Contralateral homonymous hemianopsia
-Visual agnosia
-Prosopagnosia (difficulty naming ppl)
-Topographic disorientation

Question 22

What is a lacunar stroke?

Answer 22

caused by small vessel disease deep in the cerebral white matter (penetrating artery disease); strongly associated with hypertensive hemorrhage

Question 23

What do the vertebral arteries supply in the brain? (2)

How about the basilar artery? (1)

Answer 23

-cerebellum
-medulla

-pons

Question 24

What are some common S&S we might expect to see with a vertebrobasiliar artery stroke? (4)

Answer 24

-Ipsilateral to lesion (paralysis w/atrophy of 1/2 the tongue w/deviation to paralyzed side)
-Contralateral to lesion (paralysis of UE & LE)
-Impaired tactile & proprioceptive sense
-Horner’s syndrome (miosis, ptosis, decreased sweating)

Question 25

What is “Locked-in Syndrome”?

Answer 25

occurs with basilar artery thrombosis & bilateral infarction of the ventral pons

Preserved consciousness and sensation, but they cannot move or talk

Question 26

What will we see in a stroke that occurred in the R hemisphere? (5)

Answer 26

Question 27

What will we see in a stroke that occurred in the L hemisphere? (5)

Answer 27