Stroke

Question 1

List of non-modifiable risk factors for stroke? What’s the greatest?

Answer 1

1. Age
2. Sex (M more than F)
3. Race (AA’s more than Caucasians than Asians)
4. FH

Question 2

Greatest modifiable risk factor for stroke?

Answer 2

HTN

Question 3

CSF produced in brain largely by

Answer 3

modified ependymal cells in choroid plexus in lateral, third and fourth ventricles

Question 4

Pathway of CSF

Answer 4

Lateral ventricles to foramina of Munro, third ventricle, aqueduct of Sylvius, fourth ventricle, then foramen of Magendie and Luschka

Question 5

Which stroke type is more common, ischemic or hemorrhagic? Of the ischemic sub-type, which is most common?

Answer 5

Ischemic;

thrombotic

Question 6

____ % of cardiac emboli go to the brain

Answer 6

75%

Question 7

Superior division of MCA affects what area? Inferior division affects what area? What is most common cause of occlusion of superior division of MCA?

Answer 7

Broca’s;
Wernicke’s;
embolus

Question 8

ACA occlusion results in what deficits?

Answer 8

Contralateral weakness and sensory loss affecting distal contra leg;
Could see urinary incontinence with contralateral grasp reflex and paratonic rigidity;
Gait apraxia

Question 9

What CN’s are supplied by the interpeduncular branches of the PCA?

Answer 9

CN III and IV

Question 10

Where are nuclei for CN I and II located?

Answer 10

Forebrain

Question 11

Triad of medial medullary syndrome?

Answer 11

1. Ipsilateral CN 12 palsy
2. Contralateral hemiplegia
3. Contralateral lemniscal sensory loss

Question 12

Region of brain affected when one has dysarthria/clumsy hand?

Answer 12

Internal capsule (anterior limb), and basis pontis

Question 13

Most common location for hypertensive ICH?

Answer 13

Putamen; also thalamus, pons, cerebellum, cerebrum

Question 14

SAH: where are aneurysms most likely to occur? When most likely to rupture? Peak age for rupture?

Answer 14

Anterior part of circle of Willis;
10 mm or larger;
5th or 6th decade

Question 15

Risk of rebleeding within 1 month of SAH?

Answer 15

30%

Question 16

What is most common presentation of AVM rupture?

Answer 16

Hemorrhage, usually parenchymal;

could be seizures, HA’s

Question 17

Ischemic stroke BP management, what are IV agents used? What about hemorrhagic?

Answer 17

Labetalol, nicardipine, clevidipine;

labetalol

Question 18

Exclusion criteria for tPA?

Answer 18

1. Head CT positive for blood
2. BP over 185/100 despite medical treatment
3. Anticoagulation (INR over 1.7, on warfarin, etc)
4. Plt less than 100k
5. Glucose less than 50 or over 400
6. H/o stroke or severe head injury last 3 months
7. H/o ICH, AVM, aneurysm
8. H/o GI or GU bleed last 21 days
9. Major surg within past 14 days
10. Seizure at onset of stroke
11. Acute MI

Question 19

Best reason to anticoagulate after stroke?

Answer 19

Cardiac emboli

Question 20

CEA for symptomatic lesions and greater than ______ % stenosis

Answer 20

70

Question 21

What can help decrease cerebral vasospasm after SAH?

Answer 21

Nimodipine

Question 22

What is concept behind proprioceptive neuromuscular facilitation?

Answer 22

Uses spiral and diagonal components of movement rather than traditional movements in cardinal planes of motion with goal of promoting functional relevance

Question 23

Goal behind Bobath technique?

Answer 23

Normalize tone;
inhibit primitive patterns of movement;
facilitate automatic and voluntary reactions prior to normal movement patterns

Question 24

Goal behind Brunnstrom approach?

Answer 24

Uses primitive synergistic patterns in training in attempt to improve motor control through central facilitation

Question 25

Goal behind sensorimotor/Rood approach?

Answer 25

Modification of muscle tone and voluntary motor activity using cutaneous sensorimotor stimulation

Question 26

CIMT requisites?

Answer 26

At least 10 degrees active wrist extension, 10 degrees thumb abduction/extension, at least 10 degrees extension in at least 2 additional digits

Question 27

What phase of recovery after stroke is shoulder pain most likely to develop?

Answer 27

Spastic

Question 28

When is stellate ganglion block considered successful?

Answer 28

Ipsilateral Horner’s

Question 29

Sling for shoulder subluxation indicated?

Answer 29

Routine use is not indicated

Question 30

Gold standard for evaluating dysphagia? What other studies can be used?

Answer 30

VFSS (modified barium swallow);

FEES (visualize vocal cords)

Question 31

Predictors of aspiration on bedside swallow

Answer 31

Abnormal cough, cough after swallow, dysphonia, dysarthria, abnormal gag, voice change after swallow

Question 32

Four phases of swallowing?

Answer 32

1. Oral prep phase
2. Oral phase
3. Pharyangeal phase
4. Esophageal phase

OOPE

Question 33

What’s required in oral phase of swallow?

Answer 33

1. Tension in labial and buccal musculature to close anterior and lateral sulci
2. Anterior-posterior tongue movement to transport bolus to pharynx
3. Soft palate elevation and velopharyngeal port closure to close off nasal cavity

Question 34

When is aspiration most likely to occur? What does this phase require?

Answer 34

Pharyngeal phase;

1. laryngeal elevation with forward movement of hyoid bone and folding of epiglottis
2. Adduction of ventricular and true vocal cords to protect the airway
3. Coordinated pharyngeal constriction and cricopharyngeal relaxation to transport bolus into esophagus

Question 35

Strategies to prevent aspiration

Answer 35

Chin tuck;

head rotation to PARETIC side; tilt to strong side

Question 36

What intervention can be used for aphasia recovery?

Answer 36

Melodic intonation therapy: recruit right hemisphere for communication by incorporating melodies or rhythms with simple statements; particularly good for non-fluent Broca’s

Question 37

When does greatest amount of recovery occur with aphasia?

Answer 37

First 2-3 months

Question 38

Negative factors for return to work post-stroke

Answer 38

1. Low score on Barthel index at time of rehab discharge
2. Prolonged rehab length of stay
3. Aphasia
4. Prior EtOH abuse