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PM&R > Stroke > Flashcards

Stroke Flashcards

1
Q

Percentage of strokes that are ischemic

A

85%

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2
Q

Types of ischemic stroke

A

embolism, thrombosis, lacunar

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3
Q

Hunt and Hess scale

A

1-5 ranging from asymptomatic (1) to coma (5)

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4
Q

Most common sited of ICH

A

Putamen

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5
Q

SAH cause and presentation

A

rupture of berry aneurysm at AComm, sudden onset during exertion, “worst headache of my life”

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6
Q

ICH cause and presentation

A

Htn causes vessel to burst, sudden onset at rest

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7
Q

BP goal for ischemic stroke

A

keep SBP < 220

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8
Q

BP goal for hemorrhagic stroke

A

keep SBP < 180

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9
Q

ICP goal in acute stroke

A

keep ICP < 20 mmHg

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10
Q

CPP =

A

MAP - ICP, goal > 60mmHg

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11
Q

View of stroke on MRI

A

blood is dark on T2, infarction is bright white on T2

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12
Q

Rule of 4’s “S” sideline structures

A
  • spinothalamic (c/l pain and temperature)
  • spinocerebellar (ipsilateral ataxia)
  • sympathetic (ipsilateral Horner’s syndrome)
  • sensory nucleus of CN5 (ipsilateral pain and temp to the face)
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13
Q

Rule of 4’s “M” midline structures

A
  • motor pathway (c/l hemiplegia)
  • motor nuclei (3, 4, 6, 12) (ipsilateral loss of CN)
  • MLF (ipsilateral eye cannot adduct)
  • medial lemniscus (c/l light touch and proprioception)
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14
Q

medial lemniscus

A

c/l light touch and proprioception

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15
Q

medial longitudinal fasciculus

A

ipsilateral INO (ipsilateral eye can’t adduct)

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16
Q

Draw the brainstem blood supply

A
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17
Q

Area affected in Wernicke aphasia

A

inferior division of MCA

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18
Q

Area affecte in Broca aphasia

A

Superior division of MCA

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19
Q

Fluency =

A

Motor aphasia

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20
Q

Comprehension =

A

Sensory aphasia

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21
Q

Repetition =

A

Conduction aphasia

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22
Q

3 things to evaluate for classifying aphasia

A

Fluency, Comprehension, Repetition

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23
Q

Three risk factors for not returing to work after stroke

A
  • Aphasia
  • Long Rehab stay
  • Low Barthel Index
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24
Q

Therapy type useful for Broca aphasia

A

melodic intonation

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25
Q

3 areas of brain affected in PCA stroke

A

visual cortex, cerebellum, and midbrain

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26
Q

Anton syndrome

A

bilateral visual cortex strokes causes cortical blindness where the patient is unaware of their deficit

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27
Q

area causing contralateral hemiballismus

A

subthalamic nucleus

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28
Q

area causing pure motor syndrome

A

posterior limb of internal capsule

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29
Q

area causing contralateral hemichorea

A

caudate nucleus

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30
Q

area causing dysarthria/clumsy hand syndrome

A

pons

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31
Q

Two symptoms absent in brainstem strokes

A

aphasia or cognitive deficits

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32
Q

Wallenberg Syndrome/Lateral Medullary Syndrome

A
  • “Dr. Horner Wallenberg at the VA says don’t PICA horse that can’t eat”
  • VA/PICA stroke
  • Hoarsness (CN 9)
  • Dysphagia (CN 10)
  • Patients may fall towards side of the lesion
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33
Q

Weber Syndrome

A
  • “I’m paralyzed by 3 Webs”
  • contralateral hemiparesis
  • ipsilateral CN 3 palsy
  • PCA (midbrain)
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34
Q

Medial medullary syndrome

A
  • CN12 “lick your wounds”
  • contralateral hemiparesis (motor pathway)
  • contralateral numbness (medial lemniscus)
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35
Q

Locked-In syndrome

A
  • basilary artery occlusion
  • spares RAS
  • patient can blink and move eyes vertically
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36
Q

Brunstrom Stages of Recovery

A
  1. Flacid
  2. Spastic with UE flexor synergy and LE extensor synergy
  3. spasticity peaks
  4. spasticity decreases
  5. complex voluntary movements
  6. spasticity gone
  7. normal
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37
Q

Bobath/Neurodevelopmental Technique

A
  • “Take a cold bath”
  • rehab by eliminating primitive reflexes and flexor synergy
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38
Q

Brunnstrom Technique

A
  • opposite of NDT
  • Utilize synergies for therapy
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39
Q

Rood Technique

A

use cutaneous stimuli to enhance motor activity and reduce spasticity

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40
Q

Proroceptive Neuromuscular Facilitation (PNF)

A

challenge proprioception by utilizing diagonal movement patterns

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41
Q

What must patient have to use CIMT therapy?

A

10 degrees active wrist extension

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42
Q

phase of swallow where aspiration occurs

A

pharyngeal

43
Q

3 thicknesses of liquids

A
  • Thickest: pudding (easiest to swallow)
  • medium thickness: honey thick
  • mild thickness: nectar thick
44
Q

3 levels of dysphagia diet

A
  1. puree (no chewing needed)
  2. mechanically altered
  3. soft (requires some chewing)
45
Q

compensatroy strategies for dysphagia

A
  1. chin tuck - constricts posterior pharynx to push bolus to esophagus
  2. head rotation towards weak side - closes off weak side
46
Q

best treatment for neurogenic bladder

A

timed voiding

47
Q

Type of CRPS related to nerve injury

A

Type II

48
Q

3 causes for post-stroke shoulder pain

A
  • CRPS
  • post-thalamic pain syndrome
  • MSK pathology
49
Q

3 muscles involved with torticollis

A

SCM (c/l), splenius, levator scapula

50
Q

metabolic cause of restless leg syndrome

A

iron deficiency anemia

51
Q

3 treatments for restless leg syndrome

A
  • levodopa-carbidopa
  • ropinirole
  • pramipexole
52
Q

Friedreich Ataxia

A
  • Autosomal recessive
  • muscle weakness affecting teenagers
  • associated with hypertrophic obstructive cardiomyopathy
53
Q

Huntington Disease

A
  • degeneration of caudate nucles due to protein accumulation
  • treatment seeks to decrease dopamine and increase Ach
  • treat with antipsychotics
54
Q

4 treatments for Parkinson’s disease

A
  1. levodopa-carbidopa
  2. amantadine
  3. benztropine
  4. DBS
55
Q

most important modifiable risk factor for ischemic and hemorrhagic strokes?

A

Htn

56
Q

By how much does atrial fibrillation increase the risk of stroke?

A

five-fold

57
Q

By what percentage have statins been shown to reduce the risk of stroke?

A

30%

58
Q

What is the single most important risk factor for stroke worldwide?

A

age (risk more than doubles each decade after 55yo)

59
Q

Where is CSF produced?

A

Mostly in the choroid plexus in the lateral, 3rd, and 4th ventricles

60
Q

Describe the flow of CSF

A

CSF flows from the lateral ventricles through the foramina of Monro (interventricular foramina) to the third ventricle then through the aqueduct of Sylvus (cerebral aquaduct) to the fourth ventricle. Flow continues through the foramen of Magendie (median aperature) and foramina of Luschka (lateral apertures) to the subarachnoid space for uptake in the arachnoid granulations.

61
Q

Embolic stroke cause and presentation

A

cardiac source causes sudden onset of symptoms while awake

62
Q

Thrombotic stroke cause and presentation

A

severe stenosis/occlusion causes gradual progressive onset of deficit while asleep

63
Q

What is the most common type of stroke?

A

thrombotic (50%)

64
Q

What is the least common type of stroke?

A

SAH (3%)

65
Q

What percentage of cardiogenic emboli go to the brain?

A

75%

66
Q

What risk factor are lacunar strokes strongly correlated with?

A

Htn

67
Q

Transient mononocular blindness (amaurosis fugax) can be seen prior to stroke of what vessel?

A

Internal cartoid artery (nourishes the optic nerve)

68
Q

What is the most common cause of superior MCA occlusion?

A

embolus

69
Q

Deficit seen with involvement of right (non-dominant) superior MCA?

A

apraxia, hemineglect

70
Q

Deficit seen with occlusion of right (nondominant) inferior MCA?

A

left visual neglect (homonymous hemianopsia)

71
Q

Occlusion of what vessel presents with urinary incontinence and rigidity?

A

ACA

72
Q

stroke causing paraplegia, incontinence, and frontal lobe dysfunctions hints to what anatomic varient?

A

both ACA’s arising from one stem

73
Q

What is prospagnosia?

A

Inability to read faces (seen with PCA occlusion)

74
Q

What is palinopsia?

A

Abnormal recurring visual imagery

75
Q

Lesion of what structure in Wallenberg Syndrome causes vertigo, nausea, and vomiting?

A

vestibular nuclei

76
Q

Main artery of the midbrain?

A

PCA

77
Q

What size aneurysms are more likely to ruputre and cause a SAH?

A

10mm or larger

78
Q

What are the peak ages for rupture of a brain aneurysm causing a SAH?

A

50’s and 60’s

79
Q

Compare the Hunt and Hess to the Glasgow Outcome Scale

A

Both are from 1-5. In GOS a 1 is death but in H&H a 1 is asymptomatic.

80
Q

Describe the levels of the Hunt and Hess Scale for SAH patients

A
  • 1 - Asymptomatic to mild headache
  • 2- moderate to severe headache
  • 3 - confusion, mild deficit
  • 4- stupor, hemiparesis
  • 5 - coma
81
Q

What structure can be compressed with an aneurysm involving the posterior communicating artery?

A

CN 3 (presents with eye lateral deviation, ptosis, mydriasis)

82
Q

What percentage of people with SAH die within the first 24hrs?

A

25%

83
Q

What is the risk of SAH rebleeding in the first month?

A

30%

84
Q

What will cause an AVM to rupture?

A

A distal occlusion raising pressure

85
Q

What is the prefered medication to manage BP in stroke patients?

A

labetalol

86
Q

What percentage can anticoagulation reduce the risk of stroke in patients with nonvalvular atrail fibrillation?

A

60%

87
Q

What is the treatment to reduce the risk of vasospasms after SAH?

A

Nimodipine po 60mg q 4hrs x 21 days

88
Q

What Brunnstrom stage of stroke recovery has peak spasticity?

A

Stage 3 of 7

89
Q

What are the 3 stages of CRPS?

A
  • Acute - pain/swelling
  • Dystrophic - pain intensifies
  • Atrophic - pain decreases
90
Q

What is the gold standard for diagnosing dysphagia?

A

Videofluorographic swallowing evaluation (MBS)

91
Q

What percentage of time is aspiration missed on bedside swallow evaluation?

A

50%

92
Q

What are the four phases of swallowing?

A

oral prepatory, oral, pharyngeal, esophageal

93
Q

What is the cause of nasal speech?

A

failure of the soft palate to elevate and close off nasal cavity from the oral cavity

94
Q

What location of the brain is invoved with Wernicke’s aphasia

A

superior temporal gyrus

95
Q

What location of the brain is involved with Broca’s aphasia?

A

inferior frontal lobe

96
Q

What part of the brain is involved with anomic aphasia?

A

angular gyrus

97
Q

What part of the brain is involved with conduction aphasia?

A

arcuate fasciculus

98
Q

What part of the brain is involved with transcortical motor aphasia?

A

frontal lobe

99
Q

What part of the brain is involved with transcortical sensory aphasia?

A

inferior temporal lobe

100
Q

What is paraphasia?

A

Incorrect substitution of words

101
Q

What is anomia?

A

word-finding difficulty

102
Q

At what point in time does recovery from aphasia significantly drop off?

A

6 months

103
Q

What are 4 negative risk factors for return to work after stroke?

A

aphasia, prolonged rehab stay, low Barthel index score, prior alcohol use

104
Q

What is anosognosia?

A

Inability of a person to recognize his or her own deficit seen in right parietal lesions

PM&R (21 decks)

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