Stroke Flashcards
1
Q
Percentage of strokes that are ischemic
A
85%
2
Q
Types of ischemic stroke
A
embolism, thrombosis, lacunar
3
Q
Hunt and Hess scale
A
1-5 ranging from asymptomatic (1) to coma (5)
4
Q
Most common sited of ICH
A
Putamen
5
Q
SAH cause and presentation
A
rupture of berry aneurysm at AComm, sudden onset during exertion, “worst headache of my life”
6
Q
ICH cause and presentation
A
Htn causes vessel to burst, sudden onset at rest
7
Q
BP goal for ischemic stroke
A
keep SBP < 220
8
Q
BP goal for hemorrhagic stroke
A
keep SBP < 180
9
Q
ICP goal in acute stroke
A
keep ICP < 20 mmHg
10
Q
CPP =
A
MAP - ICP, goal > 60mmHg
11
Q
View of stroke on MRI
A
blood is dark on T2, infarction is bright white on T2
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)
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)
14
Q
medial lemniscus
A
c/l light touch and proprioception
15
Q
medial longitudinal fasciculus
A
ipsilateral INO (ipsilateral eye can’t adduct)
16
Q
Draw the brainstem blood supply
A
17
Q
Area affected in Wernicke aphasia
A
inferior division of MCA
18
Q
Area affecte in Broca aphasia
A
Superior division of MCA
19
Q
Fluency =
A
Motor aphasia
20
Q
Comprehension =
A
Sensory aphasia
21
Q
Repetition =
A
Conduction aphasia
22
Q
3 things to evaluate for classifying aphasia
A
Fluency, Comprehension, Repetition
23
Q
Three risk factors for not returing to work after stroke
A
- Aphasia
- Long Rehab stay
- Low Barthel Index
24
Q
Therapy type useful for Broca aphasia
A
melodic intonation
25
3 areas of brain affected in PCA stroke
visual cortex, cerebellum, and midbrain
26
Anton syndrome
bilateral visual cortex strokes causes cortical blindness where the patient is unaware of their deficit
27
area causing contralateral hemiballismus
subthalamic nucleus
28
area causing pure motor syndrome
posterior limb of internal capsule
29
area causing contralateral hemichorea
caudate nucleus
30
area causing dysarthria/clumsy hand syndrome
pons
31
Two symptoms absent in brainstem strokes
aphasia or cognitive deficits
32
Wallenberg Syndrome/Lateral Medullary Syndrome
* "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
33
Weber Syndrome
* "I'm paralyzed by 3 Webs"
* contralateral hemiparesis
* ipsilateral CN 3 palsy
* PCA (midbrain)
34
Medial medullary syndrome
* CN12 "lick your wounds"
* contralateral hemiparesis (motor pathway)
* contralateral numbness (medial lemniscus)
35
Locked-In syndrome
* basilary artery occlusion
* spares RAS
* patient can blink and move eyes vertically
36
Brunstrom Stages of Recovery
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
37
Bobath/Neurodevelopmental Technique
* "Take a cold bath"
* rehab by eliminating primitive reflexes and flexor synergy
38
Brunnstrom Technique
* opposite of NDT
* Utilize synergies for therapy
39
Rood Technique
use cutaneous stimuli to enhance motor activity and reduce spasticity
40
Proroceptive Neuromuscular Facilitation (PNF)
challenge proprioception by utilizing diagonal movement patterns
41
What must patient have to use CIMT therapy?
10 degrees active wrist extension
42
phase of swallow where aspiration occurs
pharyngeal
43
3 thicknesses of liquids
* Thickest: pudding (easiest to swallow)
* medium thickness: honey thick
* mild thickness: nectar thick
44
3 levels of dysphagia diet
1. puree (no chewing needed)
2. mechanically altered
3. soft (requires some chewing)
45
compensatroy strategies for dysphagia
1. chin tuck - constricts posterior pharynx to push bolus to esophagus
2. head rotation **towards weak side** - closes off weak side
46
best treatment for neurogenic bladder
timed voiding
47
Type of CRPS related to nerve injury
Type II
48
3 causes for post-stroke shoulder pain
* CRPS
* post-thalamic pain syndrome
* MSK pathology
49
3 muscles involved with torticollis
SCM (c/l), splenius, levator scapula
50
metabolic cause of restless leg syndrome
iron deficiency anemia
51
3 treatments for restless leg syndrome
* levodopa-carbidopa
* ropinirole
* pramipexole
52
Friedreich Ataxia
* Autosomal recessive
* muscle weakness affecting teenagers
* associated with hypertrophic obstructive cardiomyopathy
53
Huntington Disease
* degeneration of caudate nucles due to protein accumulation
* treatment seeks to decrease dopamine and increase Ach
* treat with antipsychotics
54
4 treatments for Parkinson's disease
1. levodopa-carbidopa
2. amantadine
3. benztropine
4. DBS
55
most important modifiable risk factor for ischemic and hemorrhagic strokes?
Htn
56
By how much does atrial fibrillation increase the risk of stroke?
five-fold
57
By what percentage have statins been shown to reduce the risk of stroke?
30%
58
What is the single most important risk factor for stroke worldwide?
age (risk more than doubles each decade after 55yo)
59
Where is CSF produced?
Mostly in the choroid plexus in the lateral, 3rd, and 4th ventricles
60
Describe the flow of CSF
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
Embolic stroke cause and presentation
cardiac source causes sudden onset of symptoms while awake
62
Thrombotic stroke cause and presentation
severe stenosis/occlusion causes gradual progressive onset of deficit while asleep
63
What is the most common type of stroke?
thrombotic (50%)
64
What is the least common type of stroke?
SAH (3%)
65
What percentage of cardiogenic emboli go to the brain?
75%
66
What risk factor are lacunar strokes strongly correlated with?
Htn
67
Transient mononocular blindness (amaurosis fugax) can be seen prior to stroke of what vessel?
Internal cartoid artery (nourishes the optic nerve)
68
What is the most common cause of superior MCA occlusion?
embolus
69
Deficit seen with involvement of right (non-dominant) superior MCA?
apraxia, hemineglect
70
Deficit seen with occlusion of right (nondominant) inferior MCA?
left visual neglect (homonymous hemianopsia)
71
Occlusion of what vessel presents with urinary incontinence and rigidity?
ACA
72
stroke causing paraplegia, incontinence, and frontal lobe dysfunctions hints to what anatomic varient?
both ACA's arising from one stem
73
What is prospagnosia?
Inability to read faces (seen with PCA occlusion)
74
What is palinopsia?
Abnormal recurring visual imagery
75
Lesion of what structure in Wallenberg Syndrome causes vertigo, nausea, and vomiting?
vestibular nuclei
76
Main artery of the midbrain?
PCA
77
What size aneurysms are more likely to ruputre and cause a SAH?
10mm or larger
78
What are the peak ages for rupture of a brain aneurysm causing a SAH?
50's and 60's
79
Compare the Hunt and Hess to the Glasgow Outcome Scale
Both are from 1-5. In GOS a 1 is death but in H&H a 1 is asymptomatic.
80
Describe the levels of the Hunt and Hess Scale for SAH patients
* 1 - Asymptomatic to mild headache
* 2- moderate to severe headache
* 3 - confusion, mild deficit
* 4- stupor, hemiparesis
* 5 - coma
81
What structure can be compressed with an aneurysm involving the posterior communicating artery?
CN 3 (presents with eye lateral deviation, ptosis, mydriasis)
82
What percentage of people with SAH die within the first 24hrs?
25%
83
What is the risk of SAH rebleeding in the first month?
30%
84
What will cause an AVM to rupture?
A distal occlusion raising pressure
85
What is the prefered medication to manage BP in stroke patients?
labetalol
86
What percentage can anticoagulation reduce the risk of stroke in patients with nonvalvular atrail fibrillation?
60%
87
What is the treatment to reduce the risk of vasospasms after SAH?
Nimodipine po 60mg q 4hrs x 21 days
88
What Brunnstrom stage of stroke recovery has peak spasticity?
Stage 3 of 7
89
What are the 3 stages of CRPS?
* Acute - pain/swelling
* Dystrophic - pain intensifies
* Atrophic - pain decreases
90
What is the gold standard for diagnosing dysphagia?
Videofluorographic swallowing evaluation (MBS)
91
What percentage of time is aspiration missed on bedside swallow evaluation?
50%
92
What are the four phases of swallowing?
oral prepatory, oral, pharyngeal, esophageal
93
What is the cause of nasal speech?
failure of the soft palate to elevate and close off nasal cavity from the oral cavity
94
What location of the brain is invoved with Wernicke's aphasia
superior temporal gyrus
95
What location of the brain is involved with Broca's aphasia?
inferior frontal lobe
96
What part of the brain is involved with anomic aphasia?
angular gyrus
97
What part of the brain is involved with conduction aphasia?
arcuate fasciculus
98
What part of the brain is involved with transcortical motor aphasia?
frontal lobe
99
What part of the brain is involved with transcortical sensory aphasia?
inferior temporal lobe
100
What is paraphasia?
Incorrect substitution of words
101
What is anomia?
word-finding difficulty
102
At what point in time does recovery from aphasia significantly drop off?
6 months
103
What are 4 negative risk factors for return to work after stroke?
aphasia, prolonged rehab stay, low Barthel index score, prior alcohol use
104
What is anosognosia?
Inability of a person to recognize his or her own deficit seen in right parietal lesions
