Stroke (Big Red Ch. 15)

Question 1

TIA

Answer 1

• Temporary interruption of blood flow to the brain.
• Symptoms last a few minutes to hours, no longer than 24 hours
• No permanent neurological damage
• Precursor for stroke or MI

Question 2

CVA

Answer 2

Sudden loss of neurological function caused by interruption of blood flow to the brain.

Question 3

tPA

Answer 3

• Used to immediately treat ischemic strokes
• Breaks up clot to restore blood flow and minimize brain damage
• Cannot be used for hemorrhagic strokes

Question 4

Anterior cerebral artery syndrome

Answer 4

• Supplies medial frontal and parietal lobes
• Contralateral hemiparesis and sensory loss
• LE>UE

Question 5

Middle cerebral artery syndrome

Answer 5

• Most common site of infarct
• Supplies lateral aspect for frontal, temporal, and parietal lobes
• Contralateral spastic hemiparesis and sensory loss of face and UE>LE
• Left hemisphere results in Broca’s or Wernicke’s aphasia
• Right hemisphere results in perceptual deficits, neglect, apraxia, spatial disorganization
• Visual deficits are common (homonymous hemianopsia)

Question 6

Posterior cerebral artery syndrome

Answer 6

• Supplies occipital lobes, inferomedial temporal lobes, upper brainstem, and midbrain
• Central post-stroke thalamic pain
• Visual agnosia
• Prosopagnosia
• Blindness

Question 7

Lacunar stroke

Answer 7

• Small, deep vessels in cerebral white matter
• Presentation and sensory/motor involvement varies depending on area of involvement
• Associated with HTN and diabetic microvascular disease

Question 8

Vertebrobasilar artery syndrome

Answer 8

• High mortality rate (59%)
• Supplies cerebellum, pons, medulla, and inner ear
• Wide variety of symptoms depending on area of involvement
• Numerous cranial nerve and cerebellar abnormalities are possible
• Can also be caused by damage to vertebral artery d/t whiplash

Question 9

Left hemisphere lesion presentation

Answer 9

• Right hemiplegia
• Communication deficits
• Deficits with processing info in linear and sequential manner
• Highly distractable
• Cautious, anxious, disorganized
• Realistic in appraisal of their existing problems

Question 10

Right hemisphere lesion presentation

Answer 10

• Left hemiplegia
• Deficits with spatial-perceptual tasks
• Deficits with grasping the whole idea
• Left side neglect
• Agnosia
• Quick, impulsive, poor judgement
• Poor understanding of existing problems
• Safety risk

Question 11

Stage 1 Motor Recovery

Answer 11

• Flaccidity
• No voluntary movement

Question 12

Stage 2 Motor Recovery

Answer 12

• Synergies and spasticity develop
• Minimal voluntary movement

Question 13

Stage 3 Motor Recovery

Answer 13

• Spasticity increases
• Pt gains voluntary control of movement synergies

Question 14

Stage 4 Motor Recovery

Answer 14

• Spasiticity declines
• Movment combinations follow either synergy pattern**

Question 15

Stage 5 Motor Recovery

Answer 15

• Basic movement synergies lose their dominance

Question 16

Stage 6 Motor Recovery

Answer 16

• Spasticity resolves
• Normal function may return or recovery plateaus

Question 17

Pusher Syndrome

Answer 17

• Stroke in posterior thalamus
• Altered perception of vertical position
• Ipsilateral pushing/leaning toward hemiparetic side
• 10% stroke patients

Question 18

Obligatory synergies

Answer 18

• Muscle groups linked in a highly stereotyped, abnormal pattern
• Isolated joint movements outside the pattern are not possible

Question 19

UE flexion synergy

Answer 19

• Scap retraction/elevation or hyperextension
• Shoulder abd, ER
• Elbow flexion
• Forearm supination
• Wrist and finger flexion

Question 20

LE flexion synergy

Answer 20

• Hip flex, abd, ER
• Knee flex
• Ankle DF, inv
• Toe DF

Question 21

UE extension synergy

Answer 21

• Scap protraction
• Shoulder add, IR
• Elbow ext
• Forearm pronation
• Wrist and finger flexion

Question 22

LE extension synergy

Answer 22

• Hip ext, add, IR
• Knee ext
• Ankle PF, inv
• Toe PF