Stroke Flashcards
speech/language deficits =
left brain damage
spatial/ perceptual deficits =
right brain damage
quick/impulsive =
right brain damage
slow/cautious =
left brain damage
performance memory deficits =
right brain damage
language memory deficits =
left brain damage
describe the double whammy of hemorrhagic stroke
- tissue starved of oxygen/nutrients
- bleeding damages surrounding tissue
prevalence of ischemic stroke
70-80%
prevalence of hemorrhage stroke
20-30%
thrombus/embolus are associated with
ischemic stroke
3rd leading cause of death
stroke
hemorrhagic stroke mortality
38%
ischemic stroke mortality
12%
1 cause of disability
Stroke
what percentage of stroke survivors require LTC
26%
atherosclerosis
plaque formation with accumulated lipids, carbs, calcium, etc on arterial walls
arterial narrowing occurs commonly at
- origin of the common carotid artery
- transition from ICA> MCA
- main bifurcation of MCA
- junction of vertebral a w/ basilar a.
hemorrhagic stroke
abnormal bleeding into extravascular areas of the brain from a ruptured cerebral vessel
hemorrhagic stroke leads to
- increased ICP
- restricted distal blood flow
which form of imaging better detects a stroke
MRI
which form of imaging is more commonly used on suspected stroke pt. and why
CT b/c it is inexpensive
ischemic stroke
partial or total blockage of vessels
how long is the recovery of surrounded area damaged by the ischemic stroke
3-4 weeks
thrombosis
thrombus (blood clot) from platelet adhesion and aggregation of plaques
cerebral embolism
traveling blood clot formed elsewhere that lodged in a cerebral artery
strokes can also be caused by
low systemic profusion pressure (hypotension)
most common location of ischemic strokes
MCA
MCA stroke occurs when
embolic blood clots from the heart or ICA > MCA
Right cortical damage =
spatial recognition problems
Left cortical damage =
language problems (expressive and receptive)
Left CVA (dominant)
- R. Hemiparesis
- R. sensory loss
- aphasia
- dysarthria
- difficulty read, write, calculate
Right CVA (non-dominant)
- L. Hemiparesis
- L. sensory loss
- spatial disorientation
- L visual field deficit
R. CVA behavioral deficit
- spatial perceptual
- quick/impulsive
- overestimate ability, underestimate disability
- emotion labile
- disturbed body image, depth perception
- difficulty in loud, cluttered environment
R. CVA perceptual deficit
- unilateral neglect
- anosognosia
- apraxia
anosognosia
lack of self awareness, unaware of disability
L. CVA behavior deficit
- processing info (language/reading comprehension)
- easily discouraged
- slow, cautious, anxious
- depression is common
Left brain
- logic
- language
- numbers
- analysis
- reasoning
Right brain
- color
- image
- symbol
- imagination
- special visualization
ACA impairments
- contralateral sensory loss
- hemiparesis of contralateral let/foot
- cognitive impairment
- imitation and bimanual task problem
- slow, delay, lack of spontaneity
- urinary incontinence
- abulia
- distractibility
abulia
inability to make decisions
damage to posteromedial aspect of superior frontal gyrus
urinary incontinence
damage to corpus callosum
problems with imitation and bimanual tasks
what are some ACA cognitive impairments
- preservation
- confusion
damage to primary motor cortex/ internal capsule
hemiparesis of contralateral leg/foot
damage to medial cortex, primary sensory
contralateral sensory loss
cerebellar ataxia
motor disorder when planning amplitude is to large
sensory ataxia
cant feel the limb
- if they can see the limb they can better mange the movement
MCA impairments
- 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
damage to the optic radiation in internal capsule =
homonymous hemianopsia
homonymous hemianopsia
visual field loss on the same side of both eyes from damage of contralateral brain
damage to the parietal lobe =
sensory ataxia of contra limb
damage to broca’s area
difficulty with motor (expressive) speech
damage to Wernicke’s area
receptive aphasia
receptive aphasia
difficulty understanding written and spoken language
damage to the parietal sensory association cortex
perceptual dysfunctions
where do the ICA branch
at the base of the brain in the Circle of Willis
ICA stroke involves
lesions of both MCA & ACA
ICA impairments
- widespread deficits
- massive edema
- possible brain herniation, coma and death
- incomplete lesions can produce mixed ACA and MCA signs
PCA impairments
- 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)
thalamic syndrome
pain (any sensory info can be perceived as pain)
prosopagnosia
inability to recognize familiar faces
thalamic sensory syndrome occurs from a lesion in the
PCA: VPL thalamus
thalamic sensory syndrome impairments
- 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
vertebrobasilar a. impairments
- 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
cerebellar symptoms
- gait ataxia
- dysarthria
- nystagmus
- head ache
- amnesia
- bilateral field deficits
- motor/sensory loss in all 4 limbs
basal ganglia signs
- hypotonia
- flaccid paralysis
- impaired ambulation/gait
- movement disorders
movement disorders associated with basal ganglia
- dyskinesia
- hemiballism (subthalamic lesion) - flinging motion
- bradykinesia
- dystonia
- chorea
- tremors
brain stem symptoms
- vertigo
- CN sx
- ipsi motor and sensory CN signs w/ contra hemiplegia/hemianesthesia
- bilateral hemiparesis
- gait ataxia
- dysarthria-clumsy hand syndrome
dysarthria- clumsy hand syndrome
slurring of speech plus clumsiness of hands
pontine lesion
- double vision, sensation of ear canal blockage
- severe dysarthria/hx of vertigo or gait instability
- horizontal nystagmus (Sustained)
midbrain lesion
cerebral peduncle = ipsi oculomotor paralysis w/ contra hemiplegia
Weber Syndrome
ipsi oculomotor paralysis w/ contra hemiplegia
lacunar stroke
- occlusion of small perforating a.
- sx can be sudden and progressive
- cortical symptoms
most common brainstem lesion
dysarthria clumsy hand syndrome
PONS
80% of this stroke are “clinically silent”
lacunar stroke
lacunar stroke signs
- pure motor/ hemiparesis
- ataxic hemiparesis
- dysarthria/clumsy hand
- pure sensory
- mixed sensorimotor
what percentage of lacunar stroke have hyper- reflexia and Babinski
33-50%
ataxia hemiparesis
combo of cerebellar/motor sx
- weakness
- clumsy ipsi side of body (leg)
- nystagmus
dysarthria/clumsy hand
pons lesion
- unilateral lower face weakness
- ipsi hemiparesis
- arm ataxia
- ipsi hyper-reflexia & positive babinski
CVA clinical impairments
- motor
- somatosensory
- visual
- multi sensory integration
- perceptual
- cognitive/affect
- language/ comprehension
- speech/swallow
- behavior change
- balance/posture/ positioning
UE flexion synergy
- scap retract/elevate
- shoulder flex/ABD/ER
- elbow flex
- forearm supinate
- wrist/finger flex
LE flexion synergy
- hip flex/ABD/ER
- knee flex
- ankle DF/invert
- toe DF
LE extension synergy
- hip ext/ADD/IR
- knee ext
- ankle PF/invert
- toe PF
UE extension synergy
- scap protract/depress
- shoulder ext/ADD/IR
- elbow ext
- forearm pronate
- wrist/finger extension
Brunnstorm Stages 1
flaccidity
Brunnstorm Stage 2
synergies/ hypertonicity begin, some voluntary movement
Brunnstorm Stage 3
more voluntary control, more hypertonicity
Brunnstorm Stage 4
movement out of synergy as hypertonicity declines
Brunnstorm Stage 5
synergies lose dominance, more complicated isolated patterns are learned
Brunnstorm Stage 6
hypertonicity disappears & movement/ coordination is near normal
what is used as indicator of arm function following stroke
return of grip strength w/n 24 days
typical appearance of arm early post stroke
- arm hangs by side, IR, elbow extended, forearm pronated
- inf shoulder sublux
typical appearance of rib early post stroke
convex lateral curve on affected side
typical standing appearance early post stroke
- pelvis tilted down
- hip and knee flex
- weight shifted to strong side
- PF
typical appearance early post stroke
WEAK, HYPOTONIC
arm appearance over time
- body in flexion
- one shoulder lower
standing appearance over time
leans on AD for balance
hypertonicity and mm imbalance over time can cause
- 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
