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PT 742 Common Medical Conditions > Stroke #2 > Flashcards

Stroke #2 Flashcards

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USMLE® Step 1 flashcards
1
Q

What’s the most common cause of long term disability?

A

Stroke

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2
Q

What is a stroke?

A

Acute onset of neurologic dysfunction secondary to abnormality in cerebral circulation. Resultant symptoms correspond to the involvement of certain brain areas

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3
Q

What is a CVA?

A

Refers to symptoms, Problems in the brain

Terms are used interchangeably with stroke

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4
Q

What are the types of CVA?

A

Ischemic-tissue died due to lack of blood flow
Hemorrhage-abnormal bleeding
Atherosclerosis

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5
Q

How long do symptoms of TIA last?

A

1-24 hours

no permanent damage

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6
Q

What side does a CVA effect?

A

Right CVA = Left hemiporesis

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7
Q

What’s in the Frontal Lobe?

A 
Motor cortex and premotor cortex
Broca's area (motor aspects of speech)
Emotions & Behaviors
Personality
Inability to attend to a task
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8
Q

What happens when you have a problem in the frontal lobe?

A

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)

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9
Q

What happens if there is damage in the pre-frontal cortex?

A

Impulsiveness
Impaired organization and sequencing
Impaired judgement

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10
Q

What is multi-infarct dementia?

A

Scattered areas of brain are damaged

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11
Q

What is delirium?

A

Acute confused state

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12
Q

What does the temporal lobe consist of?

A

Auditory cortex

Wernicke’s area (language reception & comprehension)

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13
Q

What are the types of Aphasia?

A 
Receptive Aphasia (Wernicke's) = Difficulty understanding spoken or written words
Expressive Aphasia (Brocca's) = Inability to speak or express language
Global - impairments in both
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14
Q

What is Dysphagia?

A

Difficulty swallowing

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15
Q

What happens when there are problems in the parietal lobe?

A

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)

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16
Q

What is apraxia?

A

Deficits in motor planning

  • Unable to complete sequence
  • May take longer to learn task
  • difficulty initiating and performing a task
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17
Q

What are the types of Apraxia?

A

Ideomotor - Can’t perform a task when asked, but can do it automatically
Ideational - Purposeful movements not possible (automatically or on command)

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18
Q

What is Dysarthria?

A

Lesion in a location that mediates speech production

Volitional and automatic actions impaired (chewing, swallowing, slurred speech)

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19
Q

What is neglect?

A

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

20
Q

What is in the occipital lobe?

A

Primary visual cortex and visual association area

21
Q

What are some problems if the stroke is in the occipital lobe?

A

Visual field cuts

Hallucinations & Illusions

22
Q

What is a Homonymous hemianopsia?

A

Pt will have deficits on right or left of both sides of eye

23
Q

What happens with a Cerebellum stroke?

A

Ipsilateral problems
Coordinates voluntary movement
Balance and equlibrium
Dysdiadochokinesis-(rapid alternating movement)

24
Q

What happens with brain stem strokes?

A

Attention, arousal and consciousness go out

25
Q

What is Ataxia?

A

Drunken sailor gait (need to call a taxi)

26
Q

Where do most of the problems occur in the brain?

A

Circle of willis

Middle cerebral Artery

27
Q

What does the middle cerebral artery (MCA) supply?

A

Frontal, parietal, temporal lobes

28
Q

What will you see with a MCA stroke?

A 
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
29
Q

What does the anterior cerebral artery (ACA) supply?

A

Frontal and Parietal

30
Q

What will you see with a ACA stroke?

A

Contralateral hemiparesis and sensory loss
Urinary incontinence
Problems with imitation and bimanual tasks
Apraxia - deficits in motor planning

31
Q

What does the posterior cerebral artery supply?

A

Occipital, cerebellum, brain stem

32
Q

What are the deficits with PCA?

A 
Contralteral hemiplegia
Occipital infarct (homonymous hemianopsia bilateral or contralateral)
Visual agnosia (can't recognize things)
Memory defects
Dyslexia
33
Q

What happens with PCA stroke thats more in the central territory?

A 
Contralateral Hemiparesis
Occlusion of the thalamic branches (Hemianesthesia, thalamic pain - persistent and unpleasant sensation
sensory impairments, 
involuntary movements, 
oculomotor palsies
Paresis of eye movements
34
Q

What’s a lacunar strokes?

A

Small vessels deep in white matter are affected

35
Q

What happens c a lacunar stroke?

A

Ataxia
contralateral hemiparesis
pure sensory stroke or pure motor
Involuntary movements

36
Q

What is Vertebrobasilar artery syndrome?

A

Wide variety of symptoms
Cerebellar deficits
Crania nerve deficits

37
Q

What happens with a Right CVA?

A 
Left hemiparesis
left sensory loss
neglect or denial
impaired judgment and reasoning
difficulty grasping a task
rigidity and though
memory impairments
difficulty perceiving emotions
38
Q

What happens with a Left CVA?

A 
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)
39
Q

What are some deficits regardless of place?

A

Visual field cuts (crazy double H thing can’t pronounce)
emotional abnormalities
Cognitive deficits

40
Q

What are the most common motor deficits?

A

Muscle function, control activitation
coordination
changes in muscle tone (flaccid immediately then spastic)
Abnormal synergies

41
Q

What are some synergies after a stroke?

A

Patient is unable to move an isolated limb segment without producing movement in rest of limb
-flexion and extension synergies

42
Q

When does the acute phase of rehab start?

A

24-72 hours post stroke

want to get pt up and moving, early stimulation of affected side can make things recover fast

43
Q

What happens in the subacute phase of rehab?

A

Intensive, inpatient rehab
3 hours a day
best outcomes within first 3 weeks of stroke

44
Q

What happens in the chronic phase of rehab?

A

More than 6 months post stroke
Outpatient or home PT
Can continue to make gains

45
Q

What are the Brunnstrom stages of recovery?

A

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

46
Q

What’s the first thing you do with a stroke patient?

A

Take their blood pressure

PT 742 Common Medical Conditions (6 decks)

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