Stroke Flashcards
What are the classic symptoms of a stroke?
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
What does FAST stand for in stroke recognition?
• Face – Is it drooping when smiling?
• Arms – Can they raise both?
• Speech – Is it slurred or jumbled?
• Time – Call 911 if these symptoms appear
What additional stroke symptoms may females experience?
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
What are the signs and symptoms of an anterior cerebral artery stroke?
• 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
What are the signs and symptoms of a middle cerebral artery stroke?
• 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
What are the signs and symptoms of a posterior cerebral artery stroke?
• 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)
What are the signs of a stroke with thalamus involvement?
• Loss of all sensory modalities
• Spontaneous pain
• Intentional tremor
• Mild hemiparesis
• Aphasia
What are the signs of a stroke with cerebral peduncle involvement?
• Oculomotor nerve palsy
• Contralateral hemiplegia
What are the signs of a stroke in the basilar & vertebral arteries?
• Visual disturbances: diplopia
• Dystaxia (coordination problems)
• Vertigo
• Dysphagia (trouble swallowing)
• Dysphonia (voice changes)
How does age affect stroke risk?
Stroke risk increases with age, especially >55
• Males have higher stroke risk at younger ages
• Females have more strokes than males at older ages
How does sex affect stroke risk?
• 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
How does race affect stroke risk?
African-Americans & Hispanics have a higher risk of stroke-related death than Caucasians
How does a previous TIA, stroke, or MI affect future stroke risk?
Having a TIA = 10x higher stroke risk compared to someone who hasn’t had one
How does sickle cell disease (SCD) increase stroke risk?
• 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
What is the most significant controllable risk factor for stroke?
Hypertension
• A leading cause of stroke
• Most significant modifiable risk factor
Why is diabetes mellitus a stroke risk factor?
• Independent risk factor
• Many with diabetes also have:
- High blood pressure
- High cholesterol
- Overweight/obesity
- These factors further increase stroke risk
How does hypercholesteremia contribute to stroke risk?
• Excess LDL (“bad” cholesterol) increases stroke risk
• May be due to diet or genetics
• Leads to atherosclerosis and blood vessel blockages
How does carotid artery disease increase stroke risk?
• Narrowing of carotid arteries due to atherosclerosis
• May become blocked by a blood clot, leading to stroke
How does peripheral artery disease (PAD) increase stroke risk?
• Atherosclerosis in peripheral arteries raises risk
• Increases likelihood of carotid artery disease
How does atrial fibrillation (AFib) increase stroke risk?
• Causes irregular heartbeats
• Can lead to blood clots traveling to the brain
What heart diseases increase stroke risk?
• Congestive heart failure
• Valve diseases
• Dilated cardiomyopathy
How does smoking increase stroke risk?
• 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
How does physical inactivity increase stroke risk?
Leads to higher risk of:
• Stroke
• Heart disease
• Overweight/obesity
• High blood pressure
• High cholesterol
• Diabetes
How does obesity increase stroke risk?
• Linked to high blood pressure, diabetes, heart disease, and stroke
What other factors increase stroke risk?
• Alcohol abuse
• Drug abuse
• COVID-19
• Sleep issues:
- Insufficient sleep
- Sleep apnea
What are the main goals of post-stroke treatment?
- Prevent recurrent stroke
- Prevent medical complications
- Promote fullest possible recovery of function
When is the risk of stroke recurrence the highest?
• First week after stroke or TIA
• Early implementation of antiplatelet drugs or anticoagulants (e.g., warfarin) is critical in cardioembolic stroke
What percentage of stroke survivors will have another stroke within the first year?
Almost 25% (a quarter)
What is the most effective way to prevent long-term stroke recurrence?
Aggressive reduction of modifiable risk and behavioral factors, especially:
• Smoking
• Hypertension
• Diabetes
• Hyperlipidemia (e.g., hypercholesteremia)
How does medication adherence affect stroke risk?
Patients taking 75% or less of their prescribed medications had a 4x higher risk of stroke compared to those taking medications exactly as directed
What dietary pattern is associated with a reduced stroke rate?
Mediterranean diet, which includes:
• Abundant fruits & vegetables
• Whole grains
• Low in processed foods
• Substantial polyunsaturated fat source (e.g., olive oil)
What are the most common post-stroke impairments?
Motor deficits (most common), followed by:
• Language deficits (e.g., dysarthria, aphasia)
• Sensation deficits
• Cognition deficits
How do motor deficits progress after a stroke?
• 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
What is hemi-inattention (aka hemineglect or hemispatial neglect)?
• 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)
What is homonymous hemianopia (hemianopsia)?
Loss of vision on one side (right or left) in both eyes, due to a brain lesion on the opposite side
What are symptoms of homonymous hemianopia?
• 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)
What is alexia?
Partial or complete inability to read
What is acalculia?
Inability to process numbers and perform calculations
What is agnosia?
Inability to interpret sensations and recognize objects
What is finger agnosia?
• 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
What is agraphia?
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)
What is left-right disorientation?
Inability to distinguish left from right on one’s own body or the examiner’s body
• No difficulty distinguishing front/back or up/down
What is Gerstmann Syndrome?
Rare neuropsychological disorder caused by stroke, characterized by:
- Acalculia
- Finger agnosia
- Agraphia
- Left-right disorientation
What is the primary goal of post-stroke treatment?
Prevent recurrent stroke, reduce medical complications, and promote functional recovery.
When is the highest risk period for stroke recurrence?
The first week after stroke or transient ischemic attack (TIA).
What is a critical early intervention for preventing cardioembolic stroke?
Early administration of antiplatelet drugs or anticoagulants (e.g., warfarin).
What percentage of stroke survivors will have another stroke within the first year?
Almost 25%.
What are the most effective long-term prevention strategies for stroke recurrence?
Aggressive reduction of modifiable risk factors such as:
• Smoking
• Hypertension
• Diabetes
• Hyperlipidemia (e.g., hypercholesterolemia)
How does medication adherence impact stroke risk in patients with coronary artery disease?
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.
What dietary pattern is associated with a reduced stroke risk?
Mediterranean diet—rich in fruits, vegetables, whole grains, and polyunsaturated fats (e.g., olive oil), while low in processed foods.
What are the most common post-stroke impairments?
Motor deficits (most common), followed by language, sensation, and cognition deficits.
Describe the progression of post-stroke motor deficits.
Starts with weakness and flaccidity, then progresses to hyperreflexia and spasticity within 6-8 weeks.
What happens if voluntary movement does not return within a few months?
Significant function is unlikely to return to the affected extremity.
What is hemineglect (hemispatial neglect/ hemi-inattention)?
Inability to attend to stimuli from the contralateral side (typically left) due to brain injury.
What are key signs of hemineglect?
• 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).
What is homonymous hemianopia?
Vision loss in the same side of the visual field of both eyes, opposite the brain lesion.
What are signs of homonymous hemianopia?
• 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).
Define alexia.
Partial or complete inability to read.
Define acalculia.
Inability to process numbers and perform calculations.
Define agnosia.
Inability to interpret sensations and recognize objects.
Define finger agnosia.
Inability to identify, move, or touch fingers when requested.
Define agraphia.
Inability to write despite preserved copying and spelling ability (motor planning issue, a form of apraxia).
Define left-right disorientation.
Inability to distinguish left from right on oneself or others.
What is Gerstmann Syndrome?
A rare neuropsychological disorder characterized by:
- Acalculia
- Finger agnosia
- Agraphia
- Left-right disorientation
What questions should the RMT ask regarding the patient’s stroke history?
• 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).
What medications should an RMT specifically ask about?
• Anticoagulants
• Analgesics
• Antispasmodics
• Blood pressure meds
• Anti-ictal meds
• Mood stabilizers
What CV concerns should the RMT assess?
• 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
What is an important consideration for RMTs regarding BP?
• Monitor BP pre- and post-massage
• Seek MD consultation if BP trends upward
• Be cautious if hypertension and TIAs are present
What should the RMT assess regarding motor impairments?
• 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.
What sensory/cognitive deficits should the RMT assess?
• 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.
How should an RMT accommodate sensory impairments?
• Ensure comfortable positioning for breathing, pain, and spasticity relief.
• Consider cognitive and communication challenges when obtaining consent.
What are key considerations for an RMT treating a recent stroke patient?
• 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.
What should the RMT consider in treatment planning for a recent stroke patient?
• 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.
