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Canadian Exam > Stroke > Flashcards

Stroke Flashcards

1
Q

CVA definition

A

Disruption in cerebral circulation causing loss of neurons and neurological function

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2
Q

Types of stroke

A

Ischemic (roughly 80% of all strokes)
-thrombus (1st common) or embolus (2nd)
- low systemic perfusion
Hemorrhage
- aneurysm, artery or AVM
- increases mortality rate
- intracerebral (future or leak in brain) subarachnoid (due to an AVM)
- increase pressure causes compression and cellular death

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3
Q

TIA

A

Ischemia without tissue death. Symptom resolve in less than 24 hrs

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4
Q

Ischemia penumbra

A

Area surrounding ischemic event
- one of the main priorities is to save the penumbra area

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5
Q

Ateriovenvous malfomation

A

A congenital defect causing a tangle
Progresses dilation with age
50% of AVMs will burst

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6
Q

Major risk factors of stroke for woman

A

Early meno
Estrogen suppl
Preeclampsia
Pregnancy, birth, 6 weeks post birth

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7
Q

Warning sign

A

Face
Arms
Speech
Time to emergency services

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8
Q

Vascular syndromes

A

Anterior cerebral artery (ACA)
Middle MCA
Internal ICA
Posterior PCA
Vertebrobasilar artery syndrome
Lacunar

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9
Q

ACA

A

Frontal and parietal lobses, basal ganglia, anterior fronix, corpus callosum
Contra lateral patterns
LL affected
Urinary incontinence
Abulia (inability for will power)
A kinetic mutism
Apraxia
Broca’s aphasia

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10
Q

MCA

A

Most common
Lateral aspects (Frontal, temporal, parietal lobes) (internal capsule, corona radiata etc)
Extensive neurological damage
UL
Contralateral
Wernickes aphasia
Broca aphasia
Global aphasia
Perceptual deficits (neglect, agonsognosia, apraxia, depth perception/ disorganization)

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11
Q

Hemianopia

A

Loss of visual field on one side of midline

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12
Q

Homonymous

A

Loss on same side of both eyes

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13
Q

ICA

A

Supplies both MCA and ACA
Large obstruction of area supplied by MCA
uncal herniation

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14
Q

PCA

A

Occipital lobe, medial/inferior temporal lobe, upper brain stem, mid brain,
Peripheral territory: Homonymous hemianopia, visual agnosia, prosopagnosia, dyslexia
Central territory: central post stroke (thalamic) pain, hemianesthesia, sensory impairments, contra lateral hemiplegia, oculomotor nerve palsy

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15
Q

Vertebrobasilar artery syndrome

A

Cerebellum and medulla. Pons, internal ear, and cerebellum
Ipsilateral, contralateral S&S

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16
Q

Locked in syndrome

A

Aware and awake but has complete paralysis
Sudden onset
There is preserved consciousness and sensation
When the eyes are paralyzed as well, the syndrome is known as total locked in syndrome

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17
Q

Lacunar syndrome

A

Caused by occlusion of small penetrating arteries supplying the brains deep structures
20 of all strikes
Associated with hypertension and diabetes
Could be silent

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18
Q

Dysarthria

A

Motor speech disorder (lip tongue etc)
Speech may be slow

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19
Q

Aphasia

A

Impairment of language (written and spoken) affecting comprehension and/or production

Receptive/ Wernickes
- difficulty with comprehension of language
- can speak normal cadence but is random

Expressive/ Brocas
- difficulty with speech production
- flow is slow and hesitant, limited vocabulary, and impaired syntax

Global
- difficulty with language comprehension and production
- indicative of extensive brain damage
-limits patients ability to learn, therefore affects outcomes of rehab

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20
Q

DysphaGia

A

Difficulty swallowing
Aspiration occurs in 1/3 of patients
Can cause respiratory distress, aspirations pneumonia, and possibly even death
Nothing per oral (NPO) precautions are given

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21
Q

Cognitive Dysfunctions

A

Impairments in alterness, orientation, attention, memory or executive fxns
memory
Perseveration
- repeating a word or act over and over again

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22
Q

Altered emotional status

A

Pseudobulbar affect- random outbursts of emotions
Apathy- blunted emotional response
Euphoria- exaggerated feelings
Depression- feelings of sadness

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23
Q

Hemispheric behavioral differences- left

A

Slow, cautious, anxious
Hesitant for new tasks
Aware of deficits
Difficulty with communication and info processing

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24
Q

Hemispheric behavioral differences- right

A

They are almost reckless presenting
Unaware of their deficits
Increased safety risk

25
Q

Perceptual dysfunction

A

Dysfunction of Body scheme and body image
Agnosia (inability to processes any sensory information)

26
Q

Unilateral neglect

A

Lack of awareness of own body on one side
No reaction to sensory stimulation on one side
Almost always seen in right hemisphere lesion

27
Q

Spatial relations syndrome

A

Difficulty perceiving relationships b/w self and objects in space

28
Q

Agnosia

A

Interpreting sensory info
Visual, auditory, and tactile (asterognosis)

29
Q

What is the stages of motor recovery

A

Twitches and Brunnstrom
Stage 1-6
1- flaccid paralysis
6- disappearance of spacitiy

30
Q

Why are people initiallly flaccid immediately afte stroke

A

Cerebral shock

31
Q

What UMN responses may you expect in strokes

A

DTR: hyperreflexia, clonus, babinski, clasp knifed response

32
Q

Flexion synergy- stand outs

A

Elbow flexion

33
Q

Extensor synergy- standouts

A

Shoulder adduction an wrist pronation

34
Q

Choreoathetosis

A

Twisting or wringing type mvmts of the wrist

35
Q

Hemiballismus

A

Sudden uncontrolled mvmts

36
Q

Apraxia (Motor programming)

A

A problem of doing and planning the task.
No primary motor impairments

37
Q

Ideational apraxia (Motor programming)

A

Inability to produce purposeful mvmts on command or automatically
No idea how to do the mvmt

38
Q

Ideomotor apraxia

A

Inability to do purposeful mvmts on command, but can automatically.
Often perseverates

39
Q

Which side to the usually fall?

A

Towards the hemispheric side

40
Q

Pusher syndrome

A

A disorder of postural control- pushes weight to weaker hemiparetic side
Altered sense of verticality

41
Q

Scale for contraversive pushing

A

1- tilting toward paretic side often
2- abduction and extension of unaffected limbs
3- resistance to passive correction

42
Q

PT implications for push’s syndrome

A

Avoid transfers to pare tic side
Avoid gait aids
Be aware of where and how you position patients

43
Q

Interventions

A

Preventative
- minimize potential complaications and secondary impairments (essentially move them)
restorative
- aimed at improving impairments and limitations
Compensatory
- aimed at modifying the task, activity or environment to improve function and participation

44
Q

How to: improve sensory fxn

A

Sensory retraining/ stimulation approach
- mirror therapy
- sensory discrimination activities (different textures)
- compression techniques (ie weight bearing)
- electrical stimulations
- thermal stimulation

Saftey education (improve awareness of impairments and protection of anesthetic limb)

45
Q

How to: Improve hemianopia or unilateral neglect

A

Encourage awareness and use of environment and hemipaetic side
Active visual scannning mvmts
Cueing
UE exercises involving crossing midline toward hempareti side
Functional activities involving bilateral interactions
Prism glasses

46
Q

How to: improve flexibility and joint integrity

A

PROM and AROM (if possible) should be performed daily in all motions
Postioning to maintain soft tissue length and encourage proper joint alignment
Use protective devices (eg wrist splint)

47
Q

Side lying of affected shoulder

A

Benefits- allows patient to become more aware of affected side
Weight bearing on weaker side will regulate abnormal muscle tone
Inhibits abnormal postures

48
Q

How to: improve strength

A

Progressive resistive strength training
Combine resistance with functional activities
Exercise precautions
- specifically designed gloves with Velcro to help hand functions
- increase risk with postural or sensations impairments
- hypertension and cardiac disease is high in stroke patients

49
Q

How to: improve mvmt control and UE fxn

A

Focus on dissociation of segments and selective out of energy mvmt patterns
Aim for the mvmts to be normal- should be meaningful

50
Q

Contrain-induced movement therapies

A

Promotes increase use of affected UE. Used in 90% of waking hours

51
Q

shoulder pain (hemiplegic shoulder)

A

Flaccid stage (supraspinatus dis function)
- inferior subluxations
Spastic stage
- poor scapula positioning may lead to mvmt restrictions and subluxations
- frozen shoulder is common

52
Q

How to: manage shoulder pain (hemiplegic shoulder)

A

Arm supported at all times (positioning, handling, use of tray, arm sling when transferring, strapping / taping)
Gentle guided exercises
PROM an gentle mobs
Functional electrical stimulation FES/ NMES
Don’t pull on arm or let it hang unsupported

53
Q

How to: improve functional status

A

Bed mobility
STS transfers
Sitting
Standing
And other transfers

54
Q

Improve balance and postural control

A

Train active mvmts shift toward strong side
Encourage patient to problem solve
Visual cues or stimuli
Verbal cues or stimuli
Tactile cues or stimuli

55
Q

Improve gait an locomotion

A

BWS and motorized treadmills (gradually reduce to improve independence)
Functional electrical simulation
Orthsis and assistive devices
Wheelchairs (hemi-height, one arm driving, power wheelchair

56
Q

Different gait patterns

A

Circumduction
-Foot flap or drop foot
Hypertension of knee
- weak quads or poor motor control of quads
Decrease stance time on the affected limb
- pain or weakness

57
Q

Left Hemisphere lesions

A

slow, anxious, cautious, disorganized

58
Q

Right hemisphere lesions

A

quick, implusive, poor judgement

Canadian Exam (55 decks)

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