Stroke epi Flashcards
is there increase in death rates associated with stroke
decrease mortality
there is better care following stroke
what does decrease mortality mean for us as PT
people are presenting with more sever deficits
shifting to improving peoples QOL
TPA is used for what kind of stroke
ischemic
what does TPA do
clot busting medication, used to dissolve the blood clot and restore regular blood flow to the brain
what is a ischemic stroke - simple
a blood clot stops the flow of any more blood to the brain
the tissue beyond this point needs o2 and the removal of Co2
what is a hemo stroke simple
when the blood vessel going to the brain bursts
the blood settle on the brain > this leads to compression of these structires
lead to disperse sysmtoms
risk factors that increase the liklehood stroke - everyone
HTN
smoking
CVD - heart disease
DM
previous stroke
age, sex, race
what is the greatest risk factor for a stroke
previous stroke
risks specific for women
birth control and preg
specific to black women
sickle cell disease
sex and risk factors
we have done lots of experiments on men and not women
that is why we know about men
age and stroke
risk doubles every 10 year after 55
75% of stroke occur in what population
65+
can stroke occur in a younger populations
yes
what is the relationship between race and stroke
social related factors
more then genetic differences
do strokes occur more in men or women
men
but more women die
what systoms to women report more with stroke
non focal:
headache
fatigue
cog changes
generalized malaise
weakness
APO
adverse preg outcomes
what is a endovascular thrombectomy
a minimally invasive surgical procedure used to treat acute ischemic stroke.
EVT involves the removal of a blood clot from a blocked artery in the brain, which can restore blood flow and prevent further brain damage.
why is HTN a risk factor for stroke
too much high pressure stretches the tissue
blood can add more tissue to protect from the damage (block)
or
the tissue cannot hold and breaks (rupture)
stroke and DM
there is more glucose in the blood then normal
increase in glucose leads to fatty deposists or clots in the blood vessels (block)
type 1 DM
not enough insulin produced by the pancreas
type 2 DM
the body is not receptive to insulin
what are the three factor the DM lead to the leads to atherlosis
systematic inflammation
arterial stiffness
endothelial dysfunction
CVD and stroke
CVD leads to atherosclerosis - thickening and hardening of the art (block)
plaque can break open and cause a clot - travels to the brain
what is CAD
plaque buildup in the arteries of your heart.
what is PAD
most often is plaque buildup in the arteries of the legs, but it can also build up in your arms or pelvis
what is Carotid artery disease
plaque buildup in the neck arteries.
what is the effect of carotid disease
It reduces blood flow to the brain.
Renal artery stenosis
plaque buildup in the arteries that supply blood to your kidneys
what is Vertebral artery disease
atherosclerosis in the arteries that supply blood to the back of the brain
what is the function of the back of the brain
controls body functions that are needed to keep you alive.
basic funtions
what is Mesenteric artery Ischemia
plaque buildup in the arteries that supply the intestines with blood.
what is the back defintion of a stroke
rapid onset of neuro symptoms
vascular territory
caused by underlying CVD
lasting longer 24 hours
signs of a stroke
numbness of the - face, arms, or leg, especially on onside of the body
confusion or trouble speaking
trouble seeing one or both eyes
trouble walking, dizziness, balance
server headache with no know cause
FAST
F - face droops while smiling
A - does on arm drift down when lifting arms up
S - speech is slurred or repeating the same phrase
T - time, if you see these call 911
what is hemiparesis
weakness or the inability to move on one side of the body
what is apraxia
pick up a comb and you want to brush your teeth with it
what is the most common type of stroke
MCA
what part of the brain does the mCA serve
lateral
what do we see with left hemisphere MCA
right hemiparesis
right sensory loss
right homo hemianopsia
dysarthria
aphasia
apriaxia
what is dysarthria
hard time speaking
what is reflective aphasia
wernickes
word salad
what is expressive aphasia
can understand language but cannot express speech
right hemiparesis what part of the brain
primary motor cortex and the internal capsule
right sensory loss brain
primary sensory cortex and the internal capsule
right homo hemianopsia brain
optic tract
optical radiation of the internal capsule
dysarthria brain
corna radiada
hypoglossal and facial nerve
apraxia brain
partial or premotor
right hemp MCA symptoms
left hemiparesis, sensory loss, homo hemianopsia, dysarthria
left side neglect
flat effect
anosognosia
asomatognosia
poor decision making
anosognosia
unaware of neuro defects
asomatognosia
he experience that one’s body has faded from awareness.
loss of ownership of ones own body part
neglect of the left environment brain
partial association cortex in right brain
flat effect brain
frontal lobe and amygdala
anosognosia brain
partial cortex
asomatognosia
right posterior partial cortex
what does the pCA supply
occiptal lobe
medial temporal lobe
thalamus
what is the function of the thalamus
the bodies information relay station
PCA effects
- Contralateral homonymous hemianopsia
- Visual agnosia
- Prosopagnosia (difficulty naming people on sight)
- Dyslexia (difficulty reading) without agraphia (difficulty writing), color naming (anomia), and color discrimination problems
- Memory defect
- Topographic disorientation
what is Visual agnosia
an impairment in recognizing visually presented objects, despite otherwise normal visual field, acuity, color vision, brightness discrimination, language, and memory
what is Topographic disorientation
an acquired inability to navigate the environment in daily life
ACA supplies what
medial part of the brain
frontal lobe
her ACA issues
personality
logical thought
contralateral voluntary movement
motor and sensory loss (
Mutism
in ACA do we lose more UE or LE motor and sensory loss
more LE than UE
what is mutism
the inablity to speak
becasue of brain
book ACA symptoms
Contralateral hemiparesis involving mainly the LE (UE is more spared
Contralateral hemisensory loss involving mainly the LE (UE is more spared)
Urinary incontinence
Problems with imitation and bimanual tasks (two hand task), apraxia
Abulia (akinetic mutism), slowness, delay, lack of spontaneity, motor inaction
Contralateral grasp reflex, sucking reflex. Can be asymptomatic if circle of Willis is competent
Contralateral hemiparesis involving mainly the LE (UE is more spared) brain
Primary motor area, medial aspect of cortex, internal capsule
Contralateral hemisensory loss involving mainly the LE (UE is more spared) brain
Primary sensory area, medial aspect of cortex
Urinary incontinence brain
Posteromedial aspect of superior frontal gyrus
Problems with imitation and bimanual tasks (two hand task), apraxia brain
Corpus callosum
right brain damage results in
left side neglect
spatial perceptual deficits
imparied judgement
left brain damage results in
speech-lang impairment
what is a lacunar stroke
occlusion of smaller vessels - penetrating branches of the circle of willis
cells distal to the occlusion dies - these are small areas
critically located infract for lacunar stroke
this leads to greater deficits
including paralysis and sensory loss
what happen a few months after a lacunar stroke
necrotic brain cells are absorbed by macrophage activity and a small cavity (lake)
lacunar stroke: what happens if there is a infract of the corona radiata
leads to ataxic hemiparesis
PICA CVA is also called a
wallenberg syndrome
what area of the brain does the pICA serve
the inferior cere and dorsalateral medulla
what is wallenburg
a neurological condition caused by a stroke in the brain stem, specifically in one of the arteries that provides blood to the cerebellum
symtoms of a PICA or wallenburg syndrome
balance problems (leaning)
facial numbness and eye droop
hoarseness and trouble swallowing
dizzness
isplateral the lesion
what do the vertobasilar arteries serve
lateral regions of the medulla and the cere
what does the basilar artery supply
pons and the cere
what does vestibularbasilar stroke present with
nausea and vertigo
isp face paralysis
contra limb paralysis
what can you do to differenciate between nausea and vertigo
postive HIT - peri issue not a central issue
what is the penumbra
the shadow around the dead cells
these cells ahve not decided whether they are going to die or live
how do we resolve the physiological damage from stroke
decrease local edema
resorption of local toxins
evascularization of pnumbra
what is neuroplascity
the sprouting of new synpatic connections
where does neuroplascity occur
occurs next to the lesion and in random part of the brain
what are the 10 tenents of neuroplascity
Use it or lose it
Use it and improve it
Specificity
Repetition matters
Intensity matters
Time matters
Salience matters
Age matters
Transference
Interference
what is the acute phase
less then a month post stroke
what is the subacute phase
1-6 months post stroke
what is the chronic stage
longer than 6 months
when does stroke recovery peak
1-3 months
can you still make progress past the 1-3 month window
yes
role of the PT in the iCU
mobilize the pt
discharge planning
role of the PT in Acute care
mobilze and DC planning
role of the IPR
get pt functional enough to get home, SNF, LTC
role of the home
max home independence
prepare for community integration
role of the OP
max community integration
role of the community based
reduce loss of gains
improve health and wellness
Role of PT SNF
functional enough to return home of LTC
Role of PT in the LTC
maintain/improve function
where do most stroke pt go after hospital stay
IPR next SNF
acute to intermediate concerns following stroke
UI, UTI
pressure ulcers
blood clots
pneumonia
chronic concerns following stroke
depression
sexual dysfunction
contractures -
where do we see most contracture for stroke pt’s
ankles and shoulders
what side do you gaurd on
the effected side
