Stroke Flashcards
stroke
The sudden loss of neurological function as the result of a disruption to blood flow resulting in tissue death
two types of stroke
- Ischemic
2. Hemorrhagic
Risk factors for stroke (can be control)
o Hypertension o Smoking o Hyperlipidemia o Cardiac disease o DM o Obesity (abdominal) o Sedentary lifestyle o Excessive alcohol consumption
risk factors for stroke that you cannot control?
o Age o Sex o Heredity o Race o Geography
females or males more likely to have a stroke
males
what race is higher for stroke
african americans
geography that is more likely to have a stroke
southeast US
warning signs of stroke include sudden effects of?
- numbness (face, arm, leg)
- dif speaking, understanding
- trouble seeing (1 or 2 eyes)
- walking, dizziness, LOB
- severe headache
when should you go to hospital if you think you had a stroke?
less then 3 hours: less disability
What does FAST mean
- Facial droop
- Arm weakness
- Speech difficulties
- Time
how is stroke usually diagnosed?
Non-contrast CAT scan
What is given with the “Golden” 3 hours
tPA
What is tPA
tissue plasminogen activator that results in lysis of fibrin (break up clot)
What type of stroke uses tPA
ischemic
MERCI procedure
Go through femoral artery to take clot out.
8 hour window
University of Oxford ABCD Scale
- performed in MD office
- predictor of stroke after TIA
What is the standardized tool to assess impairment ?
NIH stroke scale
score of 42 on NIH
Max score –> severe stroke
what is a good outcome score on the NIH
12-20
What score on the NIH will you see significant deficits ?
over 20
80% of strokes are?
ischemic strokes
Thrombotic onset is?
gradual
Thrombotic symptoms
awaken
embolic
A thrombus that originates elsewhere breaks away and is carried through bloodstream to a narrowing region
onset of embolic
abrupt & often with activity
embolic common area of origin
cardiac, post surgery
ischemic attacks include
- lacunar infarct
- TIA
lacunar infarct
occlusion of small vessels
onset of lacunar infarct
gradual
lacunar infarct associated with
HTN & DM
TIA symptoms recover within
24 hours
Ischemic Penumbra
Rim of mild to moderately ischemic tissue around the area of infarction Is evolving
Brain requires ….. of regular blood flow to survive
20-25%
Hemorrhagic Stroke onset?
sudden
Hemorrhagic Stroke closely linked to
HTN
Hemorrhagic Stroke causes a decrease in
level of consciousness, heachache, nausea and vomiting
Hemorrhagic stroke includes (4)
oIntracerebral hemorrhage
oSubarachnoid hemorrhage
oSubdural hematoma
oEpidural hematoma
Intracerebral hemorrhage
Arterial bleeding into the brain parenchyma
ICH results in
- Distortion of structures
- Rise in intracranial pressure
- Development of severe edema causing midline shift
Subarachnoid Hemorrhage
Blood in subarachnoid space
Subarachnoid Hemorrhage onset
sudden with a headache
most common cause of Subarachnoid Hemorrhage
AVM/ Berry aneurysm
Epidural Hematoma
Traumatic tearing of the meningeal arteries that supply the periosteal layer of the dura
what drugs need to be screen for with a epidural hematoma
cocaine
Where can a skull cap be kept during a craniotomy
frozen, abdomen
aphasia
difficulties in speaking, listening, reading, and writing, but does not affect intelligence
alexia
impairement in reading – knowing they are letters but unable to decode
agraphia
impairment in writing
apraxia
inability to execute a voluntary motor movement despite being able to demonstrate muscle function- understands requirement- present with and without paresis
Anosognosia
lack of awareness of illness
Dysarthia
motor speech disorder affecting respiration, articulation and phonation
Dysphagia
inability/ difficulty in swallowing due to CN involvement (CN V & VII, CN IX-XII)
Perseveration
unable to refrain from certain behaviors—NO brakes (might not be able to get off a specific topic)
Visual Perception
the ability to process incoming sensory information, to relate it to what you already known & to use it to generate functional outcomes, e.g. I recognize the comb & know to use it on my hair
Spatial Perception
ability to sense the size, shape, movement, distance, and orientation of objects & awareness of oneself in space and its relation to other objects
flexor synergy UE
- Scap retraction/ elevation
- Shoulder abduction
- Elbow flexion
- Forearm supination
- Wrist/ finger flexion
flexor synergy LE
- Hip flex/ abd/ er
- Knee flex
- Ankle df/ inv
- Toe df
extensor UE
- Scap retraction
- Shoulder add/ir
- Elbow ext
- Forearm pron
- Wrist/ finger flex
extensor LE
- Hip ext/ add/ir
- Knee ext
- Ankle PF/INV
- Toe PF
Anterior circulation responsible for how many CVA
less than 3%
most common region of CVA
Middle cerebral artery
common cause of middle cerebral artery CVA
internal carotid thrombus
most frustrating CVA population to work with
contraversive pushing/ pusher
pushers midlines are
18 to ipsilesional side
characteristics of pushers
oSpontaneous body posture – towards involvement
oIncrease pushing force
oResistance to passive correction posture
Seated and standing posture
treatment for pusher includes
combination of visual, somatosensory, motor learning
what is complete basilar artery syndrome
locked in syndrome
