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PTRS 852 - Neuro PT 1 Final > Stroke [Guest Lecture] > Flashcards

Stroke [Guest Lecture] Flashcards

1
Q

List the modifiable stroke risk factors

A

Diet

Sedentary life style

Obesity

Diabetes/Hypertension (can be well controlled)

Smoking

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2
Q

List the non-modifiable stroke risk factors

A

Family Hx

Age

Gender

Race/Ethnicity

Diabetes/Hypertension

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3
Q

List the 4 system of blood flow for brain circulation

A

Cerebral artery branches

Internal carotid bracnes

Vertebrobasilar system

Cerebell/spinal arteries

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4
Q

Describe a CVA to the MCA

A

Presents with:

Face droop

Dead arm

Walks with limp, may use a cane

Dysphasia

Dysarthria

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5
Q

Describe a CVA to the ACA

A

Presents with:

Leg weakness

Difficulty walking and standing, more likely to use a walker

Arm strength till intact

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6
Q

Describe a CVA to the PCA

A

Presents with visual deficits

Is less common in isolation, likely to present with other artery CVA

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7
Q

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
A

MCA

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8
Q

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
A

ACA

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9
Q

Artery:

  • Derived from the basilar artery
  • Supplies the occipital lobe
  • Occlusion affects vision
A

PCA

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10
Q

Side of Stroke:

  • Visual perceptual deficits
  • Poor judgement, cognitive/behavioral issues
  • Impulsive
  • Typically present with neglect
A

RIGHT sided stroke

Also presents with Left sided hemiparesis

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11
Q

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)
A

LEFT sided stroke

Also presents with right hemiparesis

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12
Q

Describe a Right Sided Stroke

A
  • Left hemiparesis
  • Visual perceptual deficits
  • Poor judgement, cognitive/behavioral issues
  • Impulsive
  • Typically present with neglect
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13
Q

Describe a Left Sided Stroke

A
  • 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)
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14
Q

List the 3 types of CVA

A

Ischemia (70%)

Hemorrhagic

TIA

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15
Q

Type of Stroke: Clot formed at site of effect

A

Ischemic: Thrombotic infarction

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16
Q

Type of Stroke: Clot formed elsewhere, moves to site and causes effect there

A

Ischemic: Embolic infarction

17
Q

Type of Stroke: abnormal bleeding in the brain

A

Hemorrhagic

18
Q

Describe the ischemic cascade

A

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

19
Q

Term: Atherosclerotic plaques in first major brachings of large cerebbral arteries, progressively narrows

20
Q

Describe the typical progression of a thrombotic CVA

A

Facial dropping > Aphasia > Loss of arm function > decreased brain capacity

21
Q

List the common risk factors for a thrombotic CVA

A

hypertension

daibetes

cardiac/vascular disease

22
Q

Term: thrombus from outside the brain, typically from a plaque in the carotide sinus, internal carotid, or heart

A

Embolic CVA

23
Q

List the risk factors for a embolic CVA

A

hypertension, diabetes, cardiac/vascular disease

PLUS A-fib, DVT, infection

24
Q

List the causes of hemorrhagic CVA

A

Aneurysm

Hypertension

AV malformation

25
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
26
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)
27
Describe the significant of a TIA or RIND
It's a RED FLAG for cerebrovascular health and may precede a larger/full blown CVA
28
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
29
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
30
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
31
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
32
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
33
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
34
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
35
Inpatient Rehab Setting: - SNF - Variable PT requirements - Pt. presents with more serious disablity and less endurance - Pt. cognitively intact
Sub-acute care
36
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
37
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
38
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

PTRS 852 - Neuro PT 1 Final (13 decks)

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