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7209 Movement Disorder > Stroke > Flashcards

Stroke Flashcards

1
Q

speech/language deficits =

A

left brain damage

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2
Q

spatial/ perceptual deficits =

A

right brain damage

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3
Q

quick/impulsive =

A

right brain damage

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4
Q

slow/cautious =

A

left brain damage

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5
Q

performance memory deficits =

A

right brain damage

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6
Q

language memory deficits =

A

left brain damage

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7
Q

describe the double whammy of hemorrhagic stroke

A
  • tissue starved of oxygen/nutrients

- bleeding damages surrounding tissue

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8
Q

prevalence of ischemic stroke

A

70-80%

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9
Q

prevalence of hemorrhage stroke

A

20-30%

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10
Q

thrombus/embolus are associated with

A

ischemic stroke

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11
Q

3rd leading cause of death

A

stroke

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12
Q

hemorrhagic stroke mortality

A

38%

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13
Q

ischemic stroke mortality

A

12%

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14
Q

1 cause of disability

A

Stroke

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15
Q

what percentage of stroke survivors require LTC

A

26%

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16
Q

atherosclerosis

A

plaque formation with accumulated lipids, carbs, calcium, etc on arterial walls

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17
Q

arterial narrowing occurs commonly at

A
  • origin of the common carotid artery
  • transition from ICA> MCA
  • main bifurcation of MCA
  • junction of vertebral a w/ basilar a.
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18
Q

hemorrhagic stroke

A

abnormal bleeding into extravascular areas of the brain from a ruptured cerebral vessel

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19
Q

hemorrhagic stroke leads to

A
  • increased ICP

- restricted distal blood flow

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20
Q

which form of imaging better detects a stroke

A

MRI

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21
Q

which form of imaging is more commonly used on suspected stroke pt. and why

A

CT b/c it is inexpensive

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22
Q

ischemic stroke

A

partial or total blockage of vessels

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23
Q

how long is the recovery of surrounded area damaged by the ischemic stroke

A

3-4 weeks

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24
Q

thrombosis

A

thrombus (blood clot) from platelet adhesion and aggregation of plaques

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25
Q

cerebral embolism

A

traveling blood clot formed elsewhere that lodged in a cerebral artery

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26
Q

strokes can also be caused by

A

low systemic profusion pressure (hypotension)

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27
Q

most common location of ischemic strokes

A

MCA

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28
Q

MCA stroke occurs when

A

embolic blood clots from the heart or ICA > MCA

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29
Q

Right cortical damage =

A

spatial recognition problems

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30
Q

Left cortical damage =

A

language problems (expressive and receptive)

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31
Q

Left CVA (dominant)

A
  • R. Hemiparesis
  • R. sensory loss
  • aphasia
  • dysarthria
  • difficulty read, write, calculate
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32
Q

Right CVA (non-dominant)

A
  • L. Hemiparesis
  • L. sensory loss
  • spatial disorientation
  • L visual field deficit
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33
Q

R. CVA behavioral deficit

A
  • spatial perceptual
  • quick/impulsive
  • overestimate ability, underestimate disability
  • emotion labile
  • disturbed body image, depth perception
  • difficulty in loud, cluttered environment
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34
Q

R. CVA perceptual deficit

A
  • unilateral neglect
  • anosognosia
  • apraxia
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35
Q

anosognosia

A

lack of self awareness, unaware of disability

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36
Q

L. CVA behavior deficit

A
  • processing info (language/reading comprehension)
  • easily discouraged
  • slow, cautious, anxious
  • depression is common
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37
Q

Left brain

A
  • logic
  • language
  • numbers
  • analysis
  • reasoning
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38
Q

Right brain

A
  • color
  • image
  • symbol
  • imagination
  • special visualization
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39
Q

ACA impairments

A
  • contralateral sensory loss
  • hemiparesis of contralateral let/foot
  • cognitive impairment
  • imitation and bimanual task problem
  • slow, delay, lack of spontaneity
  • urinary incontinence
  • abulia
  • distractibility
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40
Q

abulia

A

inability to make decisions

41
Q

damage to posteromedial aspect of superior frontal gyrus

A

urinary incontinence

42
Q

damage to corpus callosum

A

problems with imitation and bimanual tasks

43
Q

what are some ACA cognitive impairments

A
  • preservation

- confusion

44
Q

damage to primary motor cortex/ internal capsule

A

hemiparesis of contralateral leg/foot

45
Q

damage to medial cortex, primary sensory

A

contralateral sensory loss

46
Q

cerebellar ataxia

A

motor disorder when planning amplitude is to large

47
Q

sensory ataxia

A

cant feel the limb

  • if they can see the limb they can better mange the movement
48
Q

MCA impairments

A
  • contra sensory loss
  • contra hemiparesis of face, arm, leg
  • homonymous hemianopsia
  • deviation of head/eyes to side of lesion
  • contra limb sensory ataxia
  • motor speech (expressive)
  • receptive aphasia
  • perceptual dysfunctions
  • loss of conjugate gaze to opposite side
49
Q

damage to the optic radiation in internal capsule =

A

homonymous hemianopsia

50
Q

homonymous hemianopsia

A

visual field loss on the same side of both eyes from damage of contralateral brain

51
Q

damage to the parietal lobe =

A

sensory ataxia of contra limb

52
Q

damage to broca’s area

A

difficulty with motor (expressive) speech

53
Q

damage to Wernicke’s area

A

receptive aphasia

54
Q

receptive aphasia

A

difficulty understanding written and spoken language

55
Q

damage to the parietal sensory association cortex

A

perceptual dysfunctions

56
Q

where do the ICA branch

A

at the base of the brain in the Circle of Willis

57
Q

ICA stroke involves

A

lesions of both MCA & ACA

58
Q

ICA impairments

A
  • widespread deficits
  • massive edema
  • possible brain herniation, coma and death
  • incomplete lesions can produce mixed ACA and MCA signs
59
Q

PCA impairments

A
  • contra homonymous hemianopsia
  • contra sensory loss
  • thalamic syndrome
  • dominant hemi lesion (left) affect language/memory
  • non dominant hemi lesion (Right) = prosopagnosia
  • involuntary movements
  • visual symptoms (blur, focusing, graying)
  • hypothalamus (smell and emotion)
60
Q

thalamic syndrome

A

pain (any sensory info can be perceived as pain)

61
Q

prosopagnosia

A

inability to recognize familiar faces

62
Q

thalamic sensory syndrome occurs from a lesion in the

A

PCA: VPL thalamus

63
Q

thalamic sensory syndrome impairments

A
  • sensation (touch, pain, temp)
  • transient/persistent sx (Numb early, hyperesthesia and pain later)
  • involves face arm, leg on one side
  • over dramatic pain from a touch stimulus
  • delayed onset
  • postural changes/depression
64
Q

vertebrobasilar a. impairments

A
  • vertigo
  • visual change
  • ataxia, diplopia
  • dysphagia, dysarthria
  • medial medullary syndrome
  • lateral medullary syndrome
  • basilar artery syndrome (locked in syndrome)
  • medial inferior pontine syndrome
  • lateral inferior pontine syndrome
65
Q

cerebellar symptoms

A
  • gait ataxia
  • dysarthria
  • nystagmus
  • head ache
  • amnesia
  • bilateral field deficits
  • motor/sensory loss in all 4 limbs
66
Q

basal ganglia signs

A
  • hypotonia
  • flaccid paralysis
  • impaired ambulation/gait
  • movement disorders
67
Q

movement disorders associated with basal ganglia

A
  • dyskinesia
  • hemiballism (subthalamic lesion) - flinging motion
  • bradykinesia
  • dystonia
  • chorea
  • tremors
68
Q

brain stem symptoms

A
  • vertigo
  • CN sx
  • ipsi motor and sensory CN signs w/ contra hemiplegia/hemianesthesia
  • bilateral hemiparesis
  • gait ataxia
  • dysarthria-clumsy hand syndrome
69
Q

dysarthria- clumsy hand syndrome

A

slurring of speech plus clumsiness of hands

70
Q

pontine lesion

A
  • double vision, sensation of ear canal blockage
  • severe dysarthria/hx of vertigo or gait instability
  • horizontal nystagmus (Sustained)
71
Q

midbrain lesion

A

cerebral peduncle = ipsi oculomotor paralysis w/ contra hemiplegia

72
Q

Weber Syndrome

A

ipsi oculomotor paralysis w/ contra hemiplegia

73
Q

lacunar stroke

A
  • occlusion of small perforating a.
  • sx can be sudden and progressive
  • cortical symptoms
74
Q

most common brainstem lesion

A

dysarthria clumsy hand syndrome

PONS

75
Q

80% of this stroke are “clinically silent”

A

lacunar stroke

76
Q

lacunar stroke signs

A
  • pure motor/ hemiparesis
  • ataxic hemiparesis
  • dysarthria/clumsy hand
  • pure sensory
  • mixed sensorimotor
77
Q

what percentage of lacunar stroke have hyper- reflexia and Babinski

A

33-50%

78
Q

ataxia hemiparesis

A

combo of cerebellar/motor sx

  • weakness
  • clumsy ipsi side of body (leg)
  • nystagmus
79
Q

dysarthria/clumsy hand

A

pons lesion

  • unilateral lower face weakness
  • ipsi hemiparesis
  • arm ataxia
  • ipsi hyper-reflexia & positive babinski
80
Q

CVA clinical impairments

A
  • motor
  • somatosensory
  • visual
  • multi sensory integration
  • perceptual
  • cognitive/affect
  • language/ comprehension
  • speech/swallow
  • behavior change
  • balance/posture/ positioning
81
Q

UE flexion synergy

A
  • scap retract/elevate
  • shoulder flex/ABD/ER
  • elbow flex
  • forearm supinate
  • wrist/finger flex
82
Q

LE flexion synergy

A
  • hip flex/ABD/ER
  • knee flex
  • ankle DF/invert
  • toe DF
83
Q

LE extension synergy

A
  • hip ext/ADD/IR
  • knee ext
  • ankle PF/invert
  • toe PF
84
Q

UE extension synergy

A
  • scap protract/depress
  • shoulder ext/ADD/IR
  • elbow ext
  • forearm pronate
  • wrist/finger extension
85
Q

Brunnstorm Stages 1

A

flaccidity

86
Q

Brunnstorm Stage 2

A

synergies/ hypertonicity begin, some voluntary movement

87
Q

Brunnstorm Stage 3

A

more voluntary control, more hypertonicity

88
Q

Brunnstorm Stage 4

A

movement out of synergy as hypertonicity declines

89
Q

Brunnstorm Stage 5

A

synergies lose dominance, more complicated isolated patterns are learned

90
Q

Brunnstorm Stage 6

A

hypertonicity disappears & movement/ coordination is near normal

91
Q

what is used as indicator of arm function following stroke

A

return of grip strength w/n 24 days

92
Q

typical appearance of arm early post stroke

A
  • arm hangs by side, IR, elbow extended, forearm pronated

- inf shoulder sublux

93
Q

typical appearance of rib early post stroke

A

convex lateral curve on affected side

94
Q

typical standing appearance early post stroke

A
  • pelvis tilted down
  • hip and knee flex
  • weight shifted to strong side
  • PF
95
Q

typical appearance early post stroke

A

WEAK, HYPOTONIC

96
Q

arm appearance over time

A
  • body in flexion

- one shoulder lower

97
Q

standing appearance over time

A

leans on AD for balance

98
Q

hypertonicity and mm imbalance over time can cause

A
  • hip hiking, rotation toward affected side, hip flex/IR
  • knee extension, post pelvic tilt with hip ABD and knee flex
  • no heel strike, loss of hip extension (difficulty advancing limb)
  • fisting fingers and toes

7209 Movement Disorder (3 decks)

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