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Advanced Neuro Conditions > Stroke > Flashcards

Stroke Flashcards

1
Q

What is a stroke?

A

Sudden interruption of blood flow to the brain

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2
Q

What are the 2 types of stroke?

A

Ischaemic
Haemorrhagic

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3
Q

What is an ischaemic stroke?

A
  • 80% of stroke
  • Thrombosis or plaque block the artery
  • Embolism – travel form another location
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4
Q

What is a haemorrhagic stroke?

A
  • 20% of strokes
  • 2 types – intracerebral and subarachnoid
  • Intracerebral has 2 types – aneurism and hypertension
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5
Q

What are vascular territories?

A

The different zones of the brain based on blood supply

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6
Q

What does the MCA vascular territory supply?

A

Supplies parts of the frontal, temporal, and parietal lobes of the brain, as well as deeper structures including the caudate, internal capsule, and thalamus.

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7
Q

What does the ACA vascular territory supply?

A

Supplies the frontal, pre-frontal and supplementary motor cortex, as well as parts of the primary motor and primary sensory cortex

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8
Q

What does the PCA vascular territory supply?

A

Supplies the posteromedial surface of the temporal lobe and the occipital lobe

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9
Q

What does the impact of the stroke depend on?

A

Lateralisation and vascular territories

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10
Q

What does left side lateralisation stroke look like?

A

o Motor and sensory changes to the right side of the body
* Contralateral hemiplegia and hemianesthesia
o Aphasia - speech and language impairments

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11
Q

What does right side lateralisation stroke look like?

A

o Motor and sensory changes to the left side of the body
* Contralateral hemiplegia and hemianesthesia
o Spatial awareness and planning
* Eg. dressing apraxia, left sided neglect

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12
Q

How does an ACA affect the body?

A
  • Rare
  • Motor and sensory changes to the opposite side of the body
  • Particularly lower limb
  • Frontal lobe behavioural impact - JEM2
  • Bowel and bladder control
  • Paralysis of the lower extremity, usually more severe than the upper extremity – contralateral to the occluded vessel
  • Loss of sensation in the contralateral toes, foot, and leg
  • Loss if conscious control of bowel or bladder.
  • Balance problems in siting, standing, and walking.
  • Lack of spontaneity of emotion, whispered speech, or loss of all communication
  • Memory impairment
  • Hemiparesis/hemiplegia
  • Hemianesthesia (commonly loss/altered sensation of contralateral lower extremity)
  • Incontinence
  • Poor balance
  • Expressive aphasia
  • Memory impairment
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13
Q

How does an MCA affect the body?

A
  • Motor and sensory changes to the opposite sides of the body
  • Especially face and upper limb
  • Visual field loss/hemianopia - generally opposite side
  • Depression
  • Left - aphasia
  • Right - unilateral (left) neglect
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14
Q

How does a PCA affect the body?

A
  • Variety of visual and visual perception problems
    o Hemianopia/quadrantanopia
    o Visual agnosia
    o Cortical blindness (especially right PCA)
  • Left PCA - impaired ability around discrete literacy skills
    o Acalculia, agraphia, alexia, anomia
  • Disturbances to crude sensations eg. temperature, pain and vestibular (balance, vertigo)
  • Memory loss – hippocampus
  • Lots of visual issues
  • Homonymous hemianopia
  • Homonymous quadrantanopia (loss of 1 quadrant of visual field in both eyes)
  • Headaches
  • Some contralateral motor and sensory loss
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15
Q

How is a stroke diagnosed?

A

Neuroimaging (CT and MRI) show pathological changes in brain, zones of oedema and shifting of intracranial material

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16
Q

Course and prognosis of stroke

A

Depends on where blood supply was lost, neuroplasticity and if neuronal cell death occurred

17
Q

Risk factors of stroke

A
  • Hypertension
  • Smoking
  • Alcohol intake
  • Psychological stress
  • Cardiac problems
18
Q

Signs and symptoms of a stroke

A
  • Sudden numbness or weakness of the face, arm or leg – especially on one side
  • Sudden confusion, trouble speaking or understanding
  • Trouble seeing
  • Sudden trouble walking, dizziness and loss of balance or coordination
  • Sudden severe headache
19
Q

Left sided MCA impact

A
  • Deficits include
    o Hemiplegia (lack of movement on half of body), hemiparesis (weakness on half of body)
    o Hemianesthesia (loss of sensation on half of body)
    o Spatial and perceptual deficits
    o Homonymous (same in both eyes) hemianopia (loss of half of visual field) - Loss of half of visual field in BOTH eyes
    o Aphasia (if left hemisphere is affected)
  • Broca’s aphasia (expressive) - difficulty getting words out
  • Wernicke’s aphasia (receptive) - difficulty understanding words
20
Q

Right sided MCA impact

A
  • Weakness (hemiparesis) of paralysis (hemiplegia) on the left side of the body (face, arm, trunk, leg)
  • Impairment of sensation (touch, pain, temperature, proprioception) on the left side of the body
  • Spatial and perceptual deficits
  • Unilateral inattention (neglect) – patient neglects left side of body and/or left side of environment.
  • Dressing apraxia, unable to relate items of clothing to the body
  • Defective vision in the left halves of visual fields or left homonymous hemianopsia in which there is defective vision in each eye (the temporal half of the left eye and nasal half of the right eye)
  • Impulsive behaviour, quick, imprecise movements, and errors of judgment
21
Q

Vertebrobasilar stroke impact

A
  • Variety of visual disturbances including impaired coordination of the eyes
  • Impaired temperature sensation
  • Impaired ability to read and/or name objects.
  • Vertigo/dizziness
  • Disturbances in balance when standing or walking (ataxia)
  • Paralysis of the face, limbs or tongue
  • Clumsy movements of the hands
  • Difficulty judging distance when trying to coordinate limb movements (dysmetria)
  • Drooling and difficulty swallowing (dysphasia)
  • Localised numbness
  • Loss of memory
  • Drop attacks in which there is a sudden loss of motor and postural control resulting in collapse, but the individual remains conscious
22
Q

Medical treatment of stroke

A
  • Antiplatelet therapy
    o Prescribed when vascular lesion is not severely stenotic, and individual has not had CVA
    o Used for those at risk of CVA or have had previous CVA.
  • Anticoagulants
    o Inhibit clotting by interfering with activity of chemicals in liquid portion of blood that are essential for coagulation process.
  • Thrombolytics (tPA)
    o Used for dissolution of an occluding thrombus.
23
Q

stroke Impact on OP

A
  • Sensory – loss of protective tactile functions, forget body parts, difficulty maintaining balance
  • Motor – participation, hemiparesis/hemiplegia
  • Mental functions – cognition – info processing, comprehension, attention
  • Speech – expressing and receptive
  • Emotional – depression
  • Work
  • Social
  • ADLs
  • Depression/anxiety
  • Frustration/irritability
  • Visual impairments
  • Spatial awareness
  • Communication – aphasia, dysarthria
  • Memory

Advanced Neuro Conditions (3 decks)

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