Stroke #2 Flashcards
What’s the most common cause of long term disability?
Stroke
What is a stroke?
Acute onset of neurologic dysfunction secondary to abnormality in cerebral circulation. Resultant symptoms correspond to the involvement of certain brain areas
What is a CVA?
Refers to symptoms, Problems in the brain
Terms are used interchangeably with stroke
What are the types of CVA?
Ischemic-tissue died due to lack of blood flow
Hemorrhage-abnormal bleeding
Atherosclerosis
How long do symptoms of TIA last?
1-24 hours
no permanent damage
What side does a CVA effect?
Right CVA = Left hemiporesis
What’s in the Frontal Lobe?
Motor cortex and premotor cortex Broca's area (motor aspects of speech) Emotions & Behaviors Personality Inability to attend to a task
What happens when you have a problem in the frontal lobe?
Attention
Memory-(ability to store experiences and perceptions for later recall)
Confabulation (inappropriate words or fabricated stories)
Confusion
Perseveration (Repetition of words, thoughts or acts not related to a context)
Executive functions (planning, acting and performing a task)
What happens if there is damage in the pre-frontal cortex?
Impulsiveness
Impaired organization and sequencing
Impaired judgement
What is multi-infarct dementia?
Scattered areas of brain are damaged
What is delirium?
Acute confused state
What does the temporal lobe consist of?
Auditory cortex
Wernicke’s area (language reception & comprehension)
What are the types of Aphasia?
Receptive Aphasia (Wernicke's) = Difficulty understanding spoken or written words Expressive Aphasia (Brocca's) = Inability to speak or express language Global - impairments in both
What is Dysphagia?
Difficulty swallowing
What happens when there are problems in the parietal lobe?
Neglect (ignore the affected side of body)
Sensory cortex and somatosensory cortex
Perception and spatial relationships
Integrates sensory and visual information (Aphasia, Agnosia-ability to identify common objects by feeling it)
What is apraxia?
Deficits in motor planning
- Unable to complete sequence
- May take longer to learn task
- difficulty initiating and performing a task
What are the types of Apraxia?
Ideomotor - Can’t perform a task when asked, but can do it automatically
Ideational - Purposeful movements not possible (automatically or on command)
What is Dysarthria?
Lesion in a location that mediates speech production
Volitional and automatic actions impaired (chewing, swallowing, slurred speech)
What is neglect?
Patient does not register stimuli from one side of the body
(vision may be intact but cant process info)
Denial of deficits are often present
What is in the occipital lobe?
Primary visual cortex and visual association area
What are some problems if the stroke is in the occipital lobe?
Visual field cuts
Hallucinations & Illusions
What is a Homonymous hemianopsia?
Pt will have deficits on right or left of both sides of eye
What happens with a Cerebellum stroke?
Ipsilateral problems
Coordinates voluntary movement
Balance and equlibrium
Dysdiadochokinesis-(rapid alternating movement)
What happens with brain stem strokes?
Attention, arousal and consciousness go out
What is Ataxia?
Drunken sailor gait (need to call a taxi)
Where do most of the problems occur in the brain?
Circle of willis
Middle cerebral Artery
What does the middle cerebral artery (MCA) supply?
Frontal, parietal, temporal lobes
What will you see with a MCA stroke?
Contralateral hemiparesis Aphasia (Wernicke's and brocca's) Ataxia (drunken sailor gait) Neglect Loss of depth perception Agnosia (inability to process sensory info, can't tell what object is by feeling it) Contralateral homonymous hemianopsia The more proximal the infarct the more extensive the damage
What does the anterior cerebral artery (ACA) supply?
Frontal and Parietal
What will you see with a ACA stroke?
Contralateral hemiparesis and sensory loss
Urinary incontinence
Problems with imitation and bimanual tasks
Apraxia - deficits in motor planning
What does the posterior cerebral artery supply?
Occipital, cerebellum, brain stem
What are the deficits with PCA?
Contralteral hemiplegia Occipital infarct (homonymous hemianopsia bilateral or contralateral) Visual agnosia (can't recognize things) Memory defects Dyslexia
What happens with PCA stroke thats more in the central territory?
Contralateral Hemiparesis Occlusion of the thalamic branches (Hemianesthesia, thalamic pain - persistent and unpleasant sensation sensory impairments, involuntary movements, oculomotor palsies Paresis of eye movements
What’s a lacunar strokes?
Small vessels deep in white matter are affected
What happens c a lacunar stroke?
Ataxia
contralateral hemiparesis
pure sensory stroke or pure motor
Involuntary movements
What is Vertebrobasilar artery syndrome?
Wide variety of symptoms
Cerebellar deficits
Crania nerve deficits
What happens with a Right CVA?
Left hemiparesis left sensory loss neglect or denial impaired judgment and reasoning difficulty grasping a task rigidity and though memory impairments difficulty perceiving emotions
What happens with a Left CVA?
Right hemiparesis right sensory loss Aphasia (broca's or Wernicke's) Memory impairments related to language Perservation slow, cautions behaviors, disorganized Aware of impairments difficulty with problem solving highly distractible difficulty expressing positive emotions Apraxia (Motor planning)
What are some deficits regardless of place?
Visual field cuts (crazy double H thing can’t pronounce)
emotional abnormalities
Cognitive deficits
What are the most common motor deficits?
Muscle function, control activitation
coordination
changes in muscle tone (flaccid immediately then spastic)
Abnormal synergies
What are some synergies after a stroke?
Patient is unable to move an isolated limb segment without producing movement in rest of limb
-flexion and extension synergies
When does the acute phase of rehab start?
24-72 hours post stroke
want to get pt up and moving, early stimulation of affected side can make things recover fast
What happens in the subacute phase of rehab?
Intensive, inpatient rehab
3 hours a day
best outcomes within first 3 weeks of stroke
What happens in the chronic phase of rehab?
More than 6 months post stroke
Outpatient or home PT
Can continue to make gains
What are the Brunnstrom stages of recovery?
Stage 1- period of flaccidity, no movement of limbs
Stage 2- basic limb synergies, minimal voluntary movement, spasticity begins to develop
Stage 3- Voluntary control of synergies, spasticity increases
Stage 4- Movement combinations that don’t follow path of synergies, spasticity decrease
Stage 5- More difficult movement patters are learned
Stage 6- Full recovery
What’s the first thing you do with a stroke patient?
Take their blood pressure
