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Systems T3 > Stroke > Flashcards

Stroke Flashcards

1
Q

What are the classic symptoms of a stroke?

A

Sudden onset of:

• Numbness or weakness of face, arm, or leg (especially one side)
• Confusion, trouble speaking or understanding speech
• Trouble seeing in one or both eyes
• Trouble walking, dizziness, loss of balance or coordination
• Severe headache with no known cause (hemorrhagic stroke)
• May include: stiff neck, facial pain, pain between the eyes, vomiting, altered consciousness

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2
Q

What does FAST stand for in stroke recognition?

A

• Face – Is it drooping when smiling?
• Arms – Can they raise both?
• Speech – Is it slurred or jumbled?
• Time – Call 911 if these symptoms appear

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3
Q

What additional stroke symptoms may females experience?

A

Females may have:

• Fainting
• Seizures
• Sudden hiccups
• Sudden nausea
• Chest, jaw, or neck pain
• Fatigue
• Shortness of breath
• Racing heartbeat
• Anxiety or “feeling something isn’t right”
• General weakness (not just one-sided)
• Fever

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4
Q

What are the signs and symptoms of an anterior cerebral artery stroke?

A

• Spastic paralysis of contralateral foot/leg
• Spastic paresis of contralateral arm
• Sensory loss in toes, foot, leg
• Cognitive issues: decision-making problems, lack of spontaneity, distractibility, slow thinking
• Aphasia (depends on hemisphere affected)
• Urinary incontinence
• Mood & cognitive disorders

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5
Q

What are the signs and symptoms of a middle cerebral artery stroke?

A

• Contralateral spastic hemiplegia (face & arm)
• Contralateral sensory impairment
• Aphasia
• Homonymous hemianopia
• Altered consciousness (confusion → coma)
• Inability to turn eyes toward paralyzed side
• Denial of paralysis (hemi-inattention)
• Potential cognitive deficits:
- Acalculia (math difficulties)
- Agraphia (writing impairment)
- Alexia (reading impairment)
- Finger agnosia
- Left-right confusion
• Vasomotor paresis & instability

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6
Q

What are the signs and symptoms of a posterior cerebral artery stroke?

A

• Homonymous hemianopia (loss of vision on one side)
• Other visual defects:
- Color blindness
- Loss of central vision
- Visual hallucinations
• Memory deficits
• Perseveration (repetitive verbal/motor responses)

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7
Q

What are the signs of a stroke with thalamus involvement?

A

• Loss of all sensory modalities
• Spontaneous pain
• Intentional tremor
• Mild hemiparesis
• Aphasia

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8
Q

What are the signs of a stroke with cerebral peduncle involvement?

A

• Oculomotor nerve palsy
• Contralateral hemiplegia

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9
Q

What are the signs of a stroke in the basilar & vertebral arteries?

A

• Visual disturbances: diplopia
• Dystaxia (coordination problems)
• Vertigo
• Dysphagia (trouble swallowing)
• Dysphonia (voice changes)

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10
Q

How does age affect stroke risk?

A

Stroke risk increases with age, especially >55

• Males have higher stroke risk at younger ages
• Females have more strokes than males at older ages

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11
Q

How does sex affect stroke risk?

A

• Females have more strokes & higher mortality than males
• Risk factors for females:
- Pregnancy
- History of preeclampsia/eclampsia or gestational diabetes
- Oral contraceptives (esp. with smoking)
- Menopause & post-menopausal hormone therapy

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12
Q

How does race affect stroke risk?

A

African-Americans & Hispanics have a higher risk of stroke-related death than Caucasians

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13
Q

How does a previous TIA, stroke, or MI affect future stroke risk?

A

Having a TIA = 10x higher stroke risk compared to someone who hasn’t had one

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14
Q

How does sickle cell disease (SCD) increase stroke risk?

A

• Mainly affects African-American & Hispanic children
• Sickled RBCs reduce oxygen delivery, increasing stroke risk
• Cells stick to blood vessel walls, causing blockages leading to stroke

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15
Q

What is the most significant controllable risk factor for stroke?

A

Hypertension

• A leading cause of stroke
• Most significant modifiable risk factor

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16
Q

Why is diabetes mellitus a stroke risk factor?

A

• Independent risk factor
• Many with diabetes also have:
- High blood pressure
- High cholesterol
- Overweight/obesity
- These factors further increase stroke risk

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17
Q

How does hypercholesteremia contribute to stroke risk?

A

• Excess LDL (“bad” cholesterol) increases stroke risk
• May be due to diet or genetics
• Leads to atherosclerosis and blood vessel blockages

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18
Q

How does carotid artery disease increase stroke risk?

A

• Narrowing of carotid arteries due to atherosclerosis
• May become blocked by a blood clot, leading to stroke

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19
Q

How does peripheral artery disease (PAD) increase stroke risk?

A

• Atherosclerosis in peripheral arteries raises risk
• Increases likelihood of carotid artery disease

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20
Q

How does atrial fibrillation (AFib) increase stroke risk?

A

• Causes irregular heartbeats
• Can lead to blood clots traveling to the brain

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21
Q

What heart diseases increase stroke risk?

A

• Congestive heart failure
• Valve diseases
• Dilated cardiomyopathy

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22
Q

How does smoking increase stroke risk?

A

• Nicotine & carbon monoxide damage blood vessels
• Risk greatly increases when combined with birth control
• African Americans who smoke have double the stroke risk compared to non-smokers

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23
Q

How does physical inactivity increase stroke risk?

A

Leads to higher risk of:
• Stroke
• Heart disease
• Overweight/obesity
• High blood pressure
• High cholesterol
• Diabetes

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24
Q

How does obesity increase stroke risk?

A

• Linked to high blood pressure, diabetes, heart disease, and stroke

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25
Q

What other factors increase stroke risk?

A

• Alcohol abuse
• Drug abuse
• COVID-19
• Sleep issues:
- Insufficient sleep
- Sleep apnea

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26
Q

What are the main goals of post-stroke treatment?

A
  1. Prevent recurrent stroke
  2. Prevent medical complications
  3. Promote fullest possible recovery of function
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27
Q

When is the risk of stroke recurrence the highest?

A

• First week after stroke or TIA
• Early implementation of antiplatelet drugs or anticoagulants (e.g., warfarin) is critical in cardioembolic stroke

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28
Q

What percentage of stroke survivors will have another stroke within the first year?

A

Almost 25% (a quarter)

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29
Q

What is the most effective way to prevent long-term stroke recurrence?

A

Aggressive reduction of modifiable risk and behavioral factors, especially:

• Smoking
• Hypertension
• Diabetes
• Hyperlipidemia (e.g., hypercholesteremia)

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30
Q

How does medication adherence affect stroke risk?

A

Patients taking 75% or less of their prescribed medications had a 4x higher risk of stroke compared to those taking medications exactly as directed

31
Q

What dietary pattern is associated with a reduced stroke rate?

A

Mediterranean diet, which includes:

• Abundant fruits & vegetables
• Whole grains
• Low in processed foods
• Substantial polyunsaturated fat source (e.g., olive oil)

32
Q

What are the most common post-stroke impairments?

A

Motor deficits (most common), followed by:

• Language deficits (e.g., dysarthria, aphasia)
• Sensation deficits
• Cognition deficits

33
Q

How do motor deficits progress after a stroke?

A

• Initially: Weakness & flaccidity
• Within 6-8 weeks: Hyperlexia & spasticity
• If no voluntary movement appears within months, significant function in that extremity will likely not return

34
Q

What is hemi-inattention (aka hemineglect or hemispatial neglect)?

A

• Inability to attend to/react to stimuli from the contralateral (usually left) side
• May not track, orient, or reach to neglected side
• May neglect to use limbs on that side despite normal motor function
• May not shave, wash, or comb that side
• Unaware of their own neglect (Anosognosia)

35
Q

What is homonymous hemianopia (hemianopsia)?

A

Loss of vision on one side (right or left) in both eyes, due to a brain lesion on the opposite side

36
Q

What are symptoms of homonymous hemianopia?

A

• Bumping into or failing to notice objects on the affected side
• Missing parts of words or lines of text when reading
• Not noticing objects on a table or food on a plate on the affected side
• Frustration while reading (difficulty finding the start of the next line)
• Turning head/body away from the affected side
• Drifting toward the unaffected side when walking
• Visual hallucinations (lights, shapes, objects, or duplicated movements)

37
Q

What is alexia?

A

Partial or complete inability to read

38
Q

What is acalculia?

A

Inability to process numbers and perform calculations

39
Q

What is agnosia?

A

Inability to interpret sensations and recognize objects

40
Q

What is finger agnosia?

A

• Inability to name, move, or touch specific fingers when identified by the examiner
• Affects both hands, typically worse with three central fingers
• Can also affect toes (digit agnosia)
• Visual loss worsens the disability
• May extend to recognizing examiner’s fingers or finger images

41
Q

What is agraphia?

A

Inability to write what one wants or is told to write

• Can still copy text and spell correctly
• Likely due to motor planning issues (a form of apraxia)

42
Q

What is left-right disorientation?

A

Inability to distinguish left from right on one’s own body or the examiner’s body

• No difficulty distinguishing front/back or up/down

43
Q

What is Gerstmann Syndrome?

A

Rare neuropsychological disorder caused by stroke, characterized by:

  1. Acalculia
  2. Finger agnosia
  3. Agraphia
  4. Left-right disorientation
44
Q

What is the primary goal of post-stroke treatment?

A

Prevent recurrent stroke, reduce medical complications, and promote functional recovery.

45
Q

When is the highest risk period for stroke recurrence?

A

The first week after stroke or transient ischemic attack (TIA).

46
Q

What is a critical early intervention for preventing cardioembolic stroke?

A

Early administration of antiplatelet drugs or anticoagulants (e.g., warfarin).

47
Q

What percentage of stroke survivors will have another stroke within the first year?

A

Almost 25%.

48
Q

What are the most effective long-term prevention strategies for stroke recurrence?

A

Aggressive reduction of modifiable risk factors such as:

• Smoking
• Hypertension
• Diabetes
• Hyperlipidemia (e.g., hypercholesterolemia)

49
Q

How does medication adherence impact stroke risk in patients with coronary artery disease?

A

Patients who take 75% or less of their medications as prescribed have 4 times the risk of stroke compared to those who follow their prescriptions exactly.

50
Q

What dietary pattern is associated with a reduced stroke risk?

A

Mediterranean diet—rich in fruits, vegetables, whole grains, and polyunsaturated fats (e.g., olive oil), while low in processed foods.

51
Q

What are the most common post-stroke impairments?

A

Motor deficits (most common), followed by language, sensation, and cognition deficits.

52
Q

Describe the progression of post-stroke motor deficits.

A

Starts with weakness and flaccidity, then progresses to hyperreflexia and spasticity within 6-8 weeks.

53
Q

What happens if voluntary movement does not return within a few months?

A

Significant function is unlikely to return to the affected extremity.

54
Q

What is hemineglect (hemispatial neglect/ hemi-inattention)?

A

Inability to attend to stimuli from the contralateral side (typically left) due to brain injury.

55
Q

What are key signs of hemineglect?

A

• No visual tracking or reaching toward neglected side.
• Neglect of self-care on that side (not shaving, washing, or dressing that side).
• Unawareness of the neglect itself (anosognosia).

56
Q

What is homonymous hemianopia?

A

Vision loss in the same side of the visual field of both eyes, opposite the brain lesion.

57
Q

What are signs of homonymous hemianopia?

A

• Bumping into or missing objects on the affected side.
• Skipping parts of words/lines when reading.
• Difficulty detecting food/objects on a plate or desk.
• Frustration with reading due to difficulty finding the next line.
• Turning head/body away from the affected side.
• Drifting when walking.
• Visual hallucinations (lights, shapes, objects).

58
Q

Define alexia.

A

Partial or complete inability to read.

59
Q

Define acalculia.

A

Inability to process numbers and perform calculations.

60
Q

Define agnosia.

A

Inability to interpret sensations and recognize objects.

61
Q

Define finger agnosia.

A

Inability to identify, move, or touch fingers when requested.

62
Q

Define agraphia.

A

Inability to write despite preserved copying and spelling ability (motor planning issue, a form of apraxia).

63
Q

Define left-right disorientation.

A

Inability to distinguish left from right on oneself or others.

64
Q

What is Gerstmann Syndrome?

A

A rare neuropsychological disorder characterized by:

  1. Acalculia
  2. Finger agnosia
  3. Agraphia
  4. Left-right disorientation
65
Q

What questions should the RMT ask regarding the patient’s stroke history?

A

• Type of stroke and medical treatment received.
• Progress in rehab and current therapy (physio, prescribed exercises, lifestyle changes).
• Seizure history and anti-ictal medication use.
• Any recent TIAs and MD evaluation.
• Support system (support groups, family, caregivers).

66
Q

What medications should an RMT specifically ask about?

A

• Anticoagulants
• Analgesics
• Antispasmodics
• Blood pressure meds
• Anti-ictal meds
• Mood stabilizers

67
Q

What CV concerns should the RMT assess?

A

• Hypertension (stable or erratic? influenced by stress/pain?)
• Recent BP increases
•Orthostatic intolerance
• Dyspnea (shortness of breath)
• Congestive heart failure (CHF) status
• Vasomotor paresis
• Deep vein thrombosis (DVT) risk

68
Q

What is an important consideration for RMTs regarding BP?

A

• Monitor BP pre- and post-massage
• Seek MD consultation if BP trends upward
• Be cautious if hypertension and TIAs are present

69
Q

What should the RMT assess regarding motor impairments?

A

• Type and location of impairment.
• Dysphagia/aphagia (swallowing issues).
• Mobility issues (gait, balance, wheelchair use, fall risk).
• Activities of daily living (ADL) challenges.
• Use of hydrotherapy.
• Bladder control issues/catheter use.

70
Q

What sensory/cognitive deficits should the RMT assess?

A

• Hemineglect/hemispatial neglect.
• Agnosia (e.g., finger agnosia).
• Left-right confusion.
• Dysarthria/aphasia.
• Cognitive impairment (memory, consent challenges).
• Communication difficulties.
• Mood/personality changes, depression, anxiety.
• Vision and hearing impairments.
• Pain levels and locations.

71
Q

How should an RMT accommodate sensory impairments?

A

• Ensure comfortable positioning for breathing, pain, and spasticity relief.
• Consider cognitive and communication challenges when obtaining consent.

72
Q

What are key considerations for an RMT treating a recent stroke patient?

A

• Assess for neurogenic shock and apply appropriate considerations.
• Determine past and current medical treatment (surgery, infections, healing status).
• Check MD’s opinion on lesion site stability.
• Evaluate current medications and their impact on massage treatment.
• Assess seizure history and risk.
• Monitor BP stability and other cardiovascular concerns.
• Confirm consciousness, communication, and consent status.
• Consider emotional state and support system.
• Determine current ADLs and level of functionality.
• Ensure the patient is making necessary lifestyle changes.
• Verify MD approval for massage therapy.

73
Q

What should the RMT consider in treatment planning for a recent stroke patient?

A

• Decide if massage is appropriate on a case-by-case basis.
• Determine when to begin rehab-focused treatments.
• Modify treatment to align with other practitioners in the circle of care.

Systems T3 (26 decks)

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