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Bringman Neuro > Stroke > Flashcards

Stroke Flashcards

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1
Q

Mini stroke resolves in 24 hours

A

TIA - Transient Ischemic attack. Also called pin stroke or mini-stroke

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2
Q

Types of stroke

A

Hemorrhagic stroke Occlusive

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3
Q

Common feature of Hemorrhagic stroke

A

Headache very common, accounts for 20% of strokes

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4
Q

Which is more common occlusive or hemorrhagic stroke

A

Occlusive 80%

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5
Q

Types of Hemorrhagic aneurism BA

A
  • AVM- arterial venous malformation (Fusiform) - artery and vein mingled together –(congenital defect). Very common b/c intracranial pressures rise rapidly,- silent killer- increased BP, or valsalva later in life could cause hemorrhagic stroke.
  • intracerebral hemorrhage- rupture of cerebral vessel w/ bleeding into brain
  • cerebral hemorrhage- typically in smaller vessels weakened by atherosclerosis
  • subarachnoid hemorrhage- occurs from saccular or berry aneurysm (rupture associated with Valsalva ie. bathroom use) and causes bleeding into subarachnoid space- Berry aneurism- looks like berry- out pouching of the vessel
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6
Q

Treatment of Hemorrhagic stroke

A

Coil or clip

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7
Q

Used for aneurism that has or has not ruptured

A

Clip

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8
Q

Used when aneurism has not yet ruptured

A

Coiling –bird’s nest of wire that the aneurism is filled with. Coil would NOT fix a rupture.

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9
Q

Effects of Hemorrhagic aneurism on the brain O2UCH2IS

A
  • Occlusion of the artery- eventually Pressure away from the actual site
  • Occlusion of other arteries
  • Uncle herniation
  • Cells distal to bleed become starved of blood
  • Headaches - prolonged
  • High blood pressure
  • Increased ICP
  • Scattered wide spread symptoms- difficulty to decide where issue is stemming from
  • Hemorrhagic midline shifts
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10
Q

What type of people does Hemorrhagic stroke affect?

A

younger people

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11
Q

2 types of occlusive stroke- TE

A

Thrombolytic- buildup of plaque, lipid hypothesis. caused by poor eating- systemic inflammation, cholesterol medications does not decrease rate of stroke

Embolytic- Placque breaks off,

80% of occlusive stroke are MCA- FACE

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12
Q

Embolytic

A

Blood clot (easiest to get rid of) using tPA- tissue plasminogen activator- breaks off and flows to the brain, can occur from air embuli, fat embuli and cancer. tPA should be administered within 3h of the manifestation

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13
Q

Thins blood & breaks up blood clots Needs to be administered within 3 hrs after the pt. goes to ER. Made from bats.

A

tPA

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14
Q

Risk factor if tPA is mistakenly administered with a hemorrhagic stroke. 

A

if Dr. don’t know when stroke started and its origin they will not administer tPA but will give cumadin instead.

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15
Q

Minor stroke symptoms

A

Lasting symptoms with minor deficits- Limb paresis / paralysis, foot drop, eg, distal part of limb etc.

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16
Q

Major stroke symptoms

A

Complete (entire side) paralysis Speech problems, cognative issues including memory and planning, harder for them to get back to some level of functioning.

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17
Q

Occlusive but lots of tiny clots breaks off from bigger clot causing tiny strokes in brain -could be caused from doing an endartdectomy in carotid vertebrae.

A

Shower stroke

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18
Q

Tests done after an occlusive stroke:

A
  • Echocardiogram
  • Carotid ultrasound
  • CT
  • MRI
  • BP
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19
Q

Risk Factors for Stroke BAD2 SHA2P

A
  • Birth control – don’t smoke
  • Sedentary lifestyle
  • Hereditary / family history
  • Diet
  • A-fib
  • Aging
  • Post-menopausal
  • Drinking
  • African American
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20
Q

Symptoms of ACA Syndrome- AIL 710-711 table

A
  • LE affected more than UE
  • Apraxia- difficulty / inability to perform task /move
  • Incontinence – high risk of skin breakdown (moisture)
  • Hemiperesis LE
  • Apatethic Akenetic Mutism
  • Slowness
  • Lack of spontaneity
  • Motor inaction
  • Contralateral grasp & sucking reflex impaired.
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21
Q

Symptoms of MCA Syndrome U SHAPe- FAST

A
  • UE affected more than LE
  • 80% strokes are MCA
  • Homonymous Hemianopsia- Know how to draw pic- left occlusion causes losses in right visual field
  • Aphasia
  • Perceptual deficits
  • If right sides MCA. then pt. becomes a pusher, left sided neglect.
  • Hemeperesis face and arm
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22
Q

Symptoms of PCA Syndrome CV

Check in red book to get details 652

A

Cerebellum – balance & coordination Visual Issues, spacial & memory

Hemianopsia

Contralateral hemiplegia

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23
Q

Symptoms of Vertebral Basilar Artery Syndrome

A

Locked in Syndrome

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24
Q

Rood’s Technique- facilitatory

A

Way to increase or decrease threshold- normal resting threshold is +3 so nervous system is inhibited or excited in order to maintain the threshold but when contraction is desired we need to create an imbalance in order to increase the treshold to +5 so this is facilitated by the Rood’s technique.

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25
Bronstrum stroke recovery scale- Stages Synergistic patterns
1 = Lowest no associated reactions / flaccid 2 = Small synergistic movements when pt. asked to flex or extend the limb / might be able to illicit an associated reaction 3 = voluntary control of movement synergy- little that they could illicit 4 = Movement combination that does not follow the synergy pattern 5 = able to move even more out of the synergy pattern 6 = no synergy anymore could do technical tasks
26
When should finger flexion & wrist function be addressed in therapy? pt. fingernail may grow into skin. Also skin breakdown
First day
27
If patient is trying to do too many tasks they may look regressed but actually they may be able to do more with their arm
T
28
Which synergy should be tested first in stroke patients for UE?
Extensor- because they are the weakest UE synergies last longer then LE
29
Unilateral neglect cause from
Right sided injury- pt. will be a pusher Pt. will be impulsive, quick with movement, unaware of impairment. poor judgement, don't realize they have had a stroke, issues with negative emotions, frustration with constructive feedback, memory problem and spatial issues.
30
Left CVA pathology
Broca's & Werneke's aphasia, Global Aphasia- pt. usually overly aware of their impairment. Will have fear issues, afraid of their impairment so may need to do a lot of coaxing and be patient with them. Memory impairments related to language.
31
Personality trait that affects both L & R sided stroke patient
Labile - unstable personality,problems with neurological processing, crying but not sad So pull a Schaefer, cry for 2 minutes then off to therapy. Laugh at inappropriate things, Apathetic, get depressed so will be on antidepressants. Can get irritable, confused, short attention span, issues with executive higher function.
32
Recovery of stroke
Will see angeogenesis but wouldn't happen fast, some plasticity depending on size of damage. In order for plasticity to occur you need a stimulus We can create neuroplasticity by therapy, environment to make new connections Collateral blood flow, During the recovery process the pt. will sleep a lot so don't wake them cause sleep is good but once out of this phase we need to get them up and moving since this creates neuroplasticity. This causes loading of the muscle, which sends signals to brain which send signal back to the muscle for cocontraction. be mindful of limb alignment when you get them up , pinching alignment etc. Neuroplasticity is easer to occur if body is not flaccid.
33
Positional Changes - **ATNR- AKA**
Fencing position turning head to one side- by positioning a patient in bed we could change the flexor or extensor threshold of the patient. Nose facing the sound side to encourage the opposite arm to flex. With someone with a 3, turn their head to the involved side to reduce the flexor tone
34
STNR
Patient neck is always more in the flexed position- remove pillows from head and keep them completely supine. Will encourage arm extension
35
TLR
If head is in supine position increase the extensor time. Side lying- WB side increases extensor and opposite side increases flexion
36
PSR
Can be best friend or worst enemy- pressure on ball of involved foot
37
Positioning stroke patient
One side cannot feel or move the other side can Educate hemiplegic patients to not change position Hemiplegic shoulder at risk for subluxations (test sulcus sign at 90 bilaterally) do in upright position If patient has subluxations already Passive ROM still has to be done on the spastic and flaccid side / arm- Make sure to touch with hand to ensure humeral head tracts in glenoid fossa follow 2 hr rule for positioning.
38
Obligatory synergistic patters following a CVA
After a sroke pt. reverts back to synergistic patterns in UE & LE Extent depends on the stroke severity What happening in UE & LE? Contraction Synergies flexor extensor UE & LE & a combined synergy
39
Flexor synergy UE
Scapular retraction, elevation, shoulder abduction elbow flexion forearm supination, wrist finger flexion
40
Extensor synergy UE
Scapular protraction shoulder ext & abd, pronation, writ & finger flexion
41
LE synergy is the most
Typically patients will have a combination of the two Synergy helps with transfers its better than for them to be flaccid Use synergy to classify patients
42
Hemiplegia
Paralysis
43
Hemiparesis
minor????
44
Right vs. left side stroke -Right Hemisphere
Left hemiplegia/paresis left side sensory loss Visual - Perceptual Impairment left side unilateral neglect agnosis visuospatial disorders disturbances of body image and scheme difficulty processing visual cues Behavioral Deficits quick, impulsive poor judgement, unrealistic inability to self-correct poor insight & awareness of impairments, denial of disability Intellectual Deficits difficulty with abstract reasoning or problem solving difficulty synthesizing info & grasping whole idea of task rigidity of thought memory impairments, typically related to spatial perceptual info Emotional Deficits difficulty w/ ability to perceive emotions difficulty with expression of negative emotions Task Performance fluctuations of performance
45
Labile
Pathological emotional expression, generally due to neurological degeneration or other complications; may or may not be mood-congruent. In other words, the patient might sob uncontrollably in an only moderately sad situation (an excessive but mood-congruent reaction), or he or she might also cry when upset or angry (a mood-incongruent reaction). Labile affect is also known as pseudobulbar affect, emotional incontinence, or involuntary emotional expression disorder (IEED).
46
Symptoms of R sided CVA
Right CVA usually becomes pushers to the left side Typically impulsive Quick with movement Unaware of their environment- does not know they have CVA- watch what you say and how you verbalize it Problems with negative emotions & expressing them Sometimes could get a bit chippy with constructive criticisms Memory / spatial relationships – difficulty dealing with time
47
Symptoms of L sided CVA
Wernicke, Broca’s & Global aphasia Lability / labile – e.g. crying but not sad Apathy Irritable Confusion, short attention span Overall inability to perform executive functions
48
Recovery
Angiogenesis Eventual plasticity- need stimulus to work, stimulation creates connections Collateral blood flow When these are all happening patient will sleep a lot Patient education / family education Be mindful of limb alignment- hyperextension
49
Rood's technique- Stretch
Quick stretch facilitatory– jars the muscle to influence it to contract Repetitive \> 100 HZ excites - place on \< 100 HZ or repetitive stretch inhibits (relax) 10HZ is CPM Prolonged stretch – inhibitory (serial casting) Joint Minipulation
50
Cutaneous touch
Quick stroke over a muscle belly excites someone, maintained touch causes relaxation. Pediatrics – tight clothing & cuddling / hug- warmth relaxes them
51
ICE
Facilitatory – excites, however prolonged icing relaxes & becomes inhibitory
52
Heat
Never use heat for excitation its for relaxation
53
Vestibular
Bouncing and spinning patients to stimulate them rocking to relax them
54
Auditory
Loud voice/ clapping, bright colors facilitatory, soft voice soothes,
55
Visual
Bright colors stimulates, light colors relaxes
56
Gustatory
Excite pt. with early stage TBI - stimulate with lemon/lime sour stuff Inhibit chocolates, wine
57
Olfactory
When u smell bleach it's excitatory in bad way subjective
58
Rood's technique
Stretch Cutaneous touch ICE- Heat Vestibular Auditory Visual Gustatory Olfactory
59
Advantages for Bronstrum
Put pt. in a synergy in order to illicit a movement and get them out of flaccidity
60
Right vs. left side stroke -Left Hemisphere
Right hemiplegia/paresis right side sensory loss Visual - Perceptual Impairment Broca's aphasia Wernicke's aphasia global aphasia difficulty processing verbal cues, verbal commands **Behavioral Deficits** slow cautious behavioral style disorganized often very aware of impairments & extent of disability **Intellectual Deficits** disorganized problem solving difficulty initiating tasks, processing delays highly distractible memory impairments, typically related to language preservation Emotional Deficits difficulty with expression of positive emotions Task Performance Apraxia common: difficulty planning and sequencing movements * ideational * ideomotor
61

Bringman Neuro (7 decks)

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