Stroke [Guest Lecture] Flashcards
List the modifiable stroke risk factors
Diet
Sedentary life style
Obesity
Diabetes/Hypertension (can be well controlled)
Smoking
List the non-modifiable stroke risk factors
Family Hx
Age
Gender
Race/Ethnicity
Diabetes/Hypertension
List the 4 system of blood flow for brain circulation
Cerebral artery branches
Internal carotid bracnes
Vertebrobasilar system
Cerebell/spinal arteries
Describe a CVA to the MCA
Presents with:
Face droop
Dead arm
Walks with limp, may use a cane
Dysphasia
Dysarthria
Describe a CVA to the ACA
Presents with:
Leg weakness
Difficulty walking and standing, more likely to use a walker
Arm strength till intact
Describe a CVA to the PCA
Presents with visual deficits
Is less common in isolation, likely to present with other artery CVA
Artery:
- Derived from the internal cartoid artery
- Supplies a large area of teh frontal, parietal, and temoral lobes
- Occulsion causes dysfunction of face, UE, language, and speech
MCA
Artery:
- Derived from the internal carotid artery
- Supplies the medial portion of the frontal and parietal lobes
- Occlusion causes dysfunction of the cortical area supplying primarily the LE
ACA
Artery:
- Derived from the basilar artery
- Supplies the occipital lobe
- Occlusion affects vision
PCA
Side of Stroke:
- Visual perceptual deficits
- Poor judgement, cognitive/behavioral issues
- Impulsive
- Typically present with neglect
RIGHT sided stroke
Also presents with Left sided hemiparesis
Side of Stroke:
- Language deficits
- Aphasia (Broca’s or Werniecke’s)
- Apraxia (automatic motion intact, step by step commands difficult)
- Processing delays
- Perseveration (getting stuck on a step)
LEFT sided stroke
Also presents with right hemiparesis
Describe a Right Sided Stroke
- Left hemiparesis
- Visual perceptual deficits
- Poor judgement, cognitive/behavioral issues
- Impulsive
- Typically present with neglect
Describe a Left Sided Stroke
- Right hemiparesis
- Language deficits
- Aphasia (Broca’s or Werniecke’s)
- Apraxia (automatic motion intact, step by step commands difficult)
- Processing delays
- Perseveration (getting stuck on a step)
List the 3 types of CVA
Ischemia (70%)
Hemorrhagic
TIA
Type of Stroke: Clot formed at site of effect
Ischemic: Thrombotic infarction
Type of Stroke: Clot formed elsewhere, moves to site and causes effect there
Ischemic: Embolic infarction
Type of Stroke: abnormal bleeding in the brain
Hemorrhagic
Describe the ischemic cascade
The tissue immediately surrounding the lesion is the ischemic core, it won’t regain function
The tissue surrounding the core is called the ischemic penumbra, it’s tissue is still viable and may survive
Secondary injury can then occur
The tissue remains viable for 2-4 hours
Term: Atherosclerotic plaques in first major brachings of large cerebbral arteries, progressively narrows
Thrombus
Describe the typical progression of a thrombotic CVA
Facial dropping > Aphasia > Loss of arm function > decreased brain capacity
List the common risk factors for a thrombotic CVA
hypertension
daibetes
cardiac/vascular disease
Term: thrombus from outside the brain, typically from a plaque in the carotide sinus, internal carotid, or heart
Embolic CVA
List the risk factors for a embolic CVA
hypertension, diabetes, cardiac/vascular disease
PLUS A-fib, DVT, infection
List the causes of hemorrhagic CVA
Aneurysm
Hypertension
AV malformation
Describe the effects on the brian of an hemorrhagic CVA
There is ischemic injury to the area supplied by the vessel PLUS there is mechanical injury from blood and edema to distant neurons
more GLOBAL problems than an ischemic CVA
Term: Temporary interruption of brain blood flow with neuro sx lasting < 24 hours due to a evolving thrombus or small emboli
Transient Ischemic Attact (TIA) or Reversible Ischemic Neurological Disorder (RIND)
Describe the significant of a TIA or RIND
It’s a RED FLAG for cerebrovascular health and may precede a larger/full blown CVA
Describe what occurs in the ER when a pt. presents with a suspected CVA
Neuro exam on admission
Rule out CVA or determine etiology/pathology of CVA
Assess comorbidities i.e. COPD, BP, etc
List the information that is helpful in establishing an initial diagnosis of CVA
Hx of event/Timing (immediate up to 12 hrs = potential CVA)
PMH/Risk factors
Dx tests: confirm, location, evalution, risk of recurrent
Describe the use of a CT and an MRI to assess CVA
CT is used 90% of the time, its cheap with fewer precautions. It can ID blood on the brain and thus ddx b/t hemorrhagic stroke vs. other types or no stroke
MRI is more expensive with more precautions but can show the location of the CVA lesion
List the priorities of CVA acute care
- Control life threatening problems and prevent recurrent stroke
- Prevent complications
- Manage general health conditions
- MOBILIZE and resume SELF CARE when medically stable
List extra issues to address with acute care of a hemorrhagic CVA
Monitor and/or decrease intracranial pressure, > 25 mmHg = dangerous
Seizure prophylaxis
Surgery for large/progressing bleeds
Describe why it is important to rule out a hemorrhagic CVA before tx an ischemic CVA
The tx for an ischemic CVA promotes blood thinning via antiocoagulant and antiplatelet drug therapy. If a pt. has a hemorrhagic stroke and is placed on these medications they are likely to die
Inpatient Rehab Setting:
- Rehab unit of hospital or rehab center
- 3-6 hr/day of PT
- Medically stable pt. w/functional disability and adequate endurance
- Pt. cognitively intact
Rehab hospital
Inpatient Rehab Setting:
- SNF
- Variable PT requirements
- Pt. presents with more serious disablity and less endurance
- Pt. cognitively intact
Sub-acute care
Inpatient Rehab Setting:
- Nursing home
- 2-3x/wk of PT
- Need for 24 hr care b/c of cognition, comorbidities, lack of home support
Long-term care
Type of Care:
- Pt. who live at home but are functionally homebound
- Check out for safety/function
- 2-3x/wk of PT
- Limited equipment, focus on functional traning in relevant setting
Home Care Rehabilitation
List the requirements for community ambulation
Can walk 1000 ft
Speed: can make it across street during traffic light
Can adapt to ambient conditions i.e. rain, temp, light
Can operate doors, carry packages
Can adapt to terrain i.e. stairs, curbs, slopes, obstacles
Can accomodate to attentional demands
