Stroke Flashcards
Causes of stroke (Hemorrhagic stroke)
Hemorrhagic stroke ■Hypertension ■Cerebral aneurysm ■Heavy alcohol use ■Arteriovenous malformation (Rupturing of vessel blood spilling everywhere)
Causes of stroke (Ischemic stroke)
Ischemic stroke:
■Thrombosis 血栓
◆Blood clot formation in cerebral artery called thrombus, and then the artery in the
brain is narrows and becomes completely blocked preventing normal blood flow.
■Embolism 栓子
◆The blood clot that forms elsewhere in the body and then travel to the brain, the
embolus lodges in the narrowed artery and blocks blood flow
Sx of stroke in frontal lobe
Muscle weakness
Motor learning and planning;
Executive functioning (intelligence, reasoning,problem solving);
Mood /personality/behavior;
Attention
Sx of stroke in parietal lobe
Intelligence (math)
Sensation
Spatial awareness(e.g. right/left discrimination)
ability to multi-task
language (naming objects, writing)
Sx of stroke in temporal lobe
Hearing (understanding spoken word)
Language
Memory (especially long term)
emotions (Stroke here can result in aggressive behavior, persistent talking, and changes in sexual interest/behavior)
Sx of stroke in Cerebellum (Cerebellar Stroke)
Dizziness
Nausea
Vomiting
Balance problems or unsteady walking
Fine motor problem
Clumsiness or jerky movements in an arm or leg
Slurred speech
Rapid movement of the eyes (nystagmus)
Sx of stroke in Brain Stem
Decreased levels of alertness
Trouble breathing
Regulation of sleep/wake cycles
Blood pressure
Double or blurred vision
Dizziness
Swallowing problems
Slurred speech
Weakness or paralysis of arms and legs
Sx of stroke in Occipital Lobe
visual field cuts
difficulty identifying color
hallucinations
difficulties with reading and/or writing
RIGHT BRAIN damage results in
memory deficits
motor & sensation deficits of the LEFT side of the body
spatial and perceptual problem
limited insight & impulsivity
LEFT BRAIN damage results in:
memory deficits
motor & sensation deficits of the RIGHT side of the body;
speech/language deficits (expressive vs. receptive or global)
Expressive Aphasia
Broca’s: can’t speak clearly but can understand
Partial loss of the ability to produce language (spoken, manual, or written), although comprehension generally remains intact
Receptive Aphasia
Wernicke’s: can speak fluently but it is incomprehensible
Spasticity vs. Rigidity
Spasticity: issues with upper motor neurons and is velocity dependent
(ex: variation in the speed causes variable muscle tone)
Rigidity: is NOT velocity-dependent
Type of rigidity
Lead-pipe rigidity 鉛管式僵直
cogwheel rigidity 齒輪狀僵直
Decerebrate Posture
upper extremities (UEs) are extended and internally rotated
Legs are extended
feet are in plantar flexion
occurs in brainstem stroke patients. This posturing indicates problems in the pons or midbrain
Decorticate Posture
The UEs are rigidly flexed at the elbows and wrists (legs also may be flexed.)
Indicates problems with the cerebral hemisphere or cervical spinal tract
FTHUE Level 2 (Minimum Motion/Tasks/Key action)
Minimum Motion:
some voluntary motion of shoulder and elbow
Task:
a. Associated reaction 好手鬥力 （active motion）
b. Hand into lap 壞手自己放大腿 (combination of active motion in shoulder and elbow)
FTHUE Level 3 (Minimum Motion/Tasks/Key action)
Minimum Motion:
做到Mass flexion pattern：
Shoulder between 30-60 degree
Elbow between 60-100 degree
Task:
a. Arm clearance during shirt tuch 抬起壞手用好手弄衫尾 (shoulder abduction)
b. Hold a pouch 舉包包 (finger flexion for mass grasp)
FTHUE Level 4 (Minimum Motion/Tasks/Key action)
Minimum Motion:
做到Mass flexion pattern： Shoulder 大過 60 degree Elbow 大過 100 degree **有點 elbow extension **Lateral pinch 1.5 to 3 pounds
Task:
a. Stabilize a jar 拿穩水樽 (palmar grasp and wrist stability)
b. Ring a rag 扭毛巾 （shouder and elbow flexion）
FTHUE Level 5 (Minimum Motion/Tasks/Key action)
Minimum Motion:
做到combine flexion and extension pattern：
- *Lateral pinch 3 pounds 仲可以Release
- *Grasping 5 pounds
Task:
a. Block and Box 木仔 （shoulder adduction/abduction; elbow flex/extend; grasp/release）
b. Eat with spoon 匙羹波子 （shoulder inter.rotation; Pronation/supination; wrist extension; Ulnar/Radial deviation; lateral pinch/tripod grip）
FTHUE Level 6 (Minimum Motion/Tasks/Key action)
Minimum Motion:
表現isolated control in ULL against gravity UL full extension **Lateral pinch 超過 3 pounds **Grasping 超過 5 pounds ***Poor control and coordination
Task:
a. Box on shelf 放上架 (Grasp and release)
b. Drink from glass 飲水 （forearm supination and pronation; controlled grasp and release）
FTHUE Level 7 (Minimum Motion/Tasks/Key action)
Minimum Motion:
完美isolated control of all UL
***Good control and coordination
Task:
a. Key turning 開鎖 (supination/pronation)
b(1). Use chopsticks (慣用手)
b(2). Cip cloth peg(非慣用手)
Ischemic Stroke Syndromes - Total Anterior Circulation infarcts (TACI)
Unilateral weakness (and/or sensory deficit) of the face, arm and leg
Higher cerebral dysfunction (dysphasia, visuospatial disorder)
Homonymous hemianopia
Ischemic Stroke Syndromes - Partial Anterior Circulation infarcts (PACI)
Two of Sx of TACI
Ischemic Stroke Syndromes - Posterior circulation infarcts (POCI)
One of the following:
Cranial nerve palsy and a contralateral motor/sensory deficit
Bilateral motor/sensory deficit
Conjugate eye movement disorder (e.g. horizontal gaze palsy)
Cerebellar dysfunction (e.g. balance, coordination, vertigo, nystagmus, ataxia)
Isolated homonymous hemianopia
Ischemic Stroke Syndromes - Lacunar infarcts (LACI)
There is no loss of higher cerebral functions (e.g. dysphasia).
One of the following needs to be present for a diagnosis of a LACS:
Pure sensory stroke
Pure motor stroke
Sensorimotor stroke
Ataxic hemiparesis
Acute phrase medical Tx of stroke
Thrombolytic treatment: 溶血劑
recombinant tissue plasminogen activators (r-tPA)
Surgery 降低顱內壓: Craniotomy & clot evacuation +/- shunting (for relieving intracranial pressure), if clot size is very large
Operations targeting specific pathology for Hemorrhagic Stroke
Clipping of cerebral aneurysm
excision of arterio-venous malformation
Blood Thinners”薄血丸 or Anti-Clotting Drugs (for prevention of thrombosis and/or stroke)
Anticoagulants抗凝血藥 (Warfarin; Dabigatran etexilate)
Antiplatelet 抗血小板藥(Clopidogrel ; Aspirin)
Sometimes, using both “Clopidogrel + Aspirin” together would be termed DAPT – Dual Antiplatelet Therapy
Type of hemorrhagic stroke and Sx
Intracerebral hemorrhage
Subarachnoid hemorrhage
Hemorrhagic stroke may have,
headache/neck pain/vomiting/nausea
