Stroke Lecture Flashcards
What is the recurrence risk of stroke patients?
40%, higher for men
What ages, geographic locations, and races is stroke most prevalent in?
Ages 80 +
African American > Hispanic > Caucasian
Most prevalent death from stroke in South eastern US
Risk Factors for stroke
Hypertension High serum Cholesterol Obesity Heavy Alcohol use Cocaine use Smoking Diabetes Mellitus Heart Disease
Stroke Classifications
Thrombotic,
Embolic,
Cerebral Hemorrhage
Thrombotic Stroke (ischemic stroke)
- Caused by ASCHD (atherosclerosis) and HTN
- “Stroke-in-progress”
- Transient ischemic attack (indicative of thrombolytic disease, possible vasospasm, transient systemic arterial hypotension)
Thrombotic CVA and TIA medical management
- PREVENTION - most important
- Goal is to improve circulation ASAP
- Tissue Plasminogen Activator –> Use within 3 hours of symptoms
- Anticoagulants
- Antiplatelets
Figure 32-16 - Thromboendarterectomy (carotid, subclavian)
Embolic CVA Pathology
- Sign of cardiac disease
- Can originate from heart, internal carotid artery, or carotid sinus
- Branches of MCA most commonly affected (yields poorer outcomes)
What is an embolus?
A piece of plaque that has broken off from somewhere else
Medical Management of Embolic CVA
Prevention
Long term Anticoagulants
Surgery
Hemorrhagic CVA
Causes: HTN, Ruptured saccular aneurysm (berry), AV malformation (ages 10-35 most common)
- Bleeding displaces midline structures from pressure buildup
- Blood is reabsorbed over 6-8 months, so function comes back (best recovery)
Medical management of Hemorrhagic CVA
- Prevent and manage hypertension
- Surgery for ruptured aneurysm (with HOB restrictions, 4-6 wks limited activity, and anti-seizure meds)
S/S of CVA common to both sides
- sensory dysfunction (touch, proprioception)
- visual field defect
- cognitive impairment
S/S of Right Brain CVA
- Left sided paralysis
- Perceptual and memory deficits
- QUICK AND IMPULSIVE BEHAVIOR… dangerous
S/S of Left Brain CVA
- Right sided paralysis
- Speech and memory deficits
- Cautious and slow behavior… flaccid R leg = hard time to get WBing through LE because they don’t trust their R LE.
Review textbook
Figure 32-26, p 1474, 1455-8
CVA Impairments requiring Medical Management
Spasticity, seizures, respiratory dysfuction, trauma (may have fallen), DVT (due to low muscle tone), CRPS and pain
CVA Movement Dysfunction
- Decreased Force production
- Abnormal synergistic movement (not volitional)
- Altered ms contraction timing
- Decreased force regulation
- Delayed responses
- Abnormal Tone
CVA Sensory Dysfunction
- Awareness
- Interpretation
- Any modality can be affected
- Visual disturbances are common
CVA Secondary Impairments
- Alignment
- Mobility
- Ms and soft tissue length
- Pain
- Edema (no muscle pump)
Composite Impairments
- Movement deficits
- Atypical movements (compensatory mvmts)
- Undesirable compensation
Orpington Prognostic Scale (OPS)
- Specific to stroke
< 3.2 Minor (discharge in 3 wks, return to home)
3.2-5.2 Moderate (eventually home)
>5.2 Major (d/c to long term care)
Use during initial eval when neurologically stable!!! - Optimal predictive power at 2 weeks post-stroke
- Scores range from 1.6-6.8
Recovery
Initial functional gains due to - Reduced cerebral edema - absorption of damaged tissue - improved vascular flow Followed by Neuroplasticity (positive or negative)
Predictors of Motor Function Recovery (UE)
- Initial return of UE movement is predictive of possible full arm recovery
- Failure to recover some grip strength by 24 days is predictive of no UE recovery at 3 months
- 30% of patients have no arm recovery