Stroke Neuro Conditions Flashcards
Causes of an intracerebral hemorrage…
most common is trauma, non-traumatic is hypertension or cerebral amyloid angiopathy
Causes of a subarachnoid hemorrage…
most common is trauma, non-traumatic are ruptured aneurysm
types of hemorrhagic stroke
(collection of blood) epidural (EDH), subdural (SDH), subarachnoid (SAH), intracerebral (ICH)
types of ischemic stroke
large vessel= thrombotic or emobolic small vessel (lacunar)
Causes of a Thrombotic ischemic stroke….
local obstruction, atheroscelrosis, dissection, hypercoaguable conditions
Causes of an embolic ischemic stroke …
traveling clot or debris = blood blot (a-fib, disseciotn, valvular vegetation), ruptured atheroscelrotic plaque
Causes of a small vessel ischemic stroke are…
HTN, DM, cholesterol, smoking, age
basal ganglia, internal capsule, pons
anterior circulation of the brain
supplied by the internal carotid artery – anterior cerebral artery and middle cerebral artery
What are effects of anterior cerebral artery syndrome?
contralateral hemiplegia and hemianesthesis, LE more involved than UE
profund abulia, delay in motor and verbal response
apathey
incontinence
apraxia –difficulty with desired movements
impaired judgment
What are the effects of middle cerebral artery syndrome?
within 10-12 hours
contralateral hemiplegia UE more involved
contralateral hemianesthesis
if R hemisphere more affected= L homonymous hemianopsia, decreased spatial awareness, neglect syndromes
if L hemisphere affected= R homonymous hemianopsia, Wernicke’s or Broca’s aphasia
Broca’s aphasia
motor, expressive, anterior, or non.-fluent aphasia
results from damage to the posterior part of the inferior frontal gyrus and
few words and difficulty with language production
comprehnesion intact
Wernicke’s Aphasia
sensor, receptive, posterior, or fluent aphasia
characteriized by deficit in language comprehension with relatively fluent but error filled production
Global Aphasia
includes broca’s and wernicke’s
characterized by impairments in language production and comprehension
hemianopia
visual deficit of one-half of the visual field
hemianesthesia
loss of tactile senses on one side of the body
What makes up the posterior circulation supply?
supplied by the vertebral arteries
basilar artery
posterior cererbral arteries (PCA)
What are the effects of posterior cerebral artery syndrome
contralateral homonymous hemianopia,
hemisensory loss (due to infarction)
cortical blindness
proximal occulsion affects: subthalamus, medial thalamus, ispislateral cerebral puducle and midbrain
signs include thalamix syndrome, abnormal sensation of pain, temp, proprioception, and touch
sensations may be exaggerated, light pressure may be interpreted as pain
what happens if the basilar artery is occluded?
brainstem symptoms are bilateral corticospinal tracts corticobulbar tracts - CN 3-12 medial and superior cerebellar peducles spinothalamic tracts
can have crossed symptoms– isps face and contralateral body
locked in syndrome– preserved blink and vertical eye movement
What happens with a lacunar stroke syndrome>
posterior limb of internal capsule= pure motor deficit
anterior limb= weakness of face and dysarthria
posterolateral thalamus= pure sensory stroke
pons= ataxia, clumsiness, weakness
dysarthria
weakness in the muscles used for speech= slurred or slow speech – motor speech disorder
symptoms of a cerebellar stroke?
gait unsteadiness, ataxia, vertigo, nausea/vomiting may be the first sign
How many stages are there in the Brunnstrom stages of recovery?
6
Describe stage 1 of Brunnstrom
no voluntray movement, areflexia, flaccidity
Describe stage 2 of Brunnstrom
minimal voluntary movement with primitive synergies
DTRS begin to appear, and spasticity begins
Describe stage 3 if Brunnstrom
movements in partial or full ROM, in primitive synergies
hyperreflexia
peak spasticity
describe stage 4 of Brunnstrom
some difficult fractionations from primitive synergies,
DTRs decrease
spasticity starts to decrease
Describe stage 5 of Brunstrom
primitive synergies lose dominance, and more fractionation is mastered, DTRs normalize
spasticity decreases
Describe stage 6 of Brunstrom
full fractionated movement is possible
decreased coordination and automaticity are still possible
What defines the hyperacute stage of the continuum of recovery
less than 7 days,
initial includes medical intervention, preservation of life, frequent neuro check, manage comorbid., consciousness/cognition, swallowing, activity restrictions
safety– early mobiliztion between 12-24 hours after receiving tPA
early mobiliyt= safe for pts after aneurysmal SAH
What is the PT managment of an acute ischemic stroke after tPA?
bedrest x 8 hours
fall precaution
BP parameters– elevated parameters if no bleed to increase perfusion
monitor– be alert for neuro changes that may indicate hemorrhagic conversion
What defines the acute state of the continuum of recovery
first month, initial team assessment includes assess for complication, risk factors for reoccurrence, medical co-morbitities, mobility and need for assistance, DVT,
assess physical and psychosocial impairments, decide on IRF or SNF
What amount of time shows the steepest and greatest recovery for a stroke
first 30 days
What defines the subacute stage of the continuum of recovery
1-6 months
significant rehab with constant reassessment of medical and functional status, as well as family support and resources
discontinuation of one level of service necessitates recommendation for the next level of service
What defines the chronic stage of the continuum of recovery
6+ months
assessment of discharge environment– functional needs, motivation and preferences, intensity of tolerable treatment, equipment, availability , transportation, home safety assessment
What types of imagain is commonly used for stroke?
CT scan, MRI, and angiograms
what types of meidcations are used for phsycial sequelae (anti-spasticity)
oral agents= baclofen, alpha 2 agaonists (Tizandine or Zanaflex),
dantrolene, gabapentis, bensodiazepines
botox
what types of medications are used to prevent future stroke (anti- coagulation)
anti-platelets= aspirin, clopidogrel
anti-coagulants– warfarin (coumadin) or DOAC
participation restrictions for stroke patients
difficulty with self-care, mobility in the home and community, engaging in socail settings and at risk for falling
activity restrictions for stroke patients
benchmark tasks, sitting, walking, transitional movements, stair negotiation, higher level gross mototr tasks
What is STREAM?
stroke rehabilitation assessment of movement– assesses motor control
What is PASS?
postural assessment for stroke patients – assesses balance
What is SIS
stroke impact scale
What is ARAT
action research arm test
What is ARAT
action research arm test
What does SERMAS stand for
sensation/pain endurance/fatigue ROM/joint mobility Motor control/coordination awareness/cognition strength/force production/power
How do you test sensation and pain of SERMAS>
light touch unilaterally, distal to proximal, not dermatome specific
test for extinction
proprioception
pain scales (Faces)
How do you test for endurance/fatigue of SERMAS?
6 MWT, 2MWT (measure distance wlaked in alotted time, count rest breask/rest time, not if AD is used
How do you test for ROM/joint mobility of SERMAS?
PROM, AROM, AAROM
How do you test for Motor control/coordination of SERMAS?
STREAM, observation
coordination if cerebellar stroke– finger to nose, heel to shin, rapid alternating movement
How do you test awareness/cognition of SERMAS?
pusher syndome (CPS)
neglect
communication
How to test strength/force produciton. power of SERMAS?
MMT with motor control assessment
What type of hemorrahgic stroke is twice as common as a SAH
intracerebral hemorraghic
What type of hemorrhagic stroke is common in elderly population?
subdural hemorrhagic
What are non-modifiable risk factors?
age, sex, race
What is Tension attained at any moment between the origin and the insertion of a muscle?
tone
What is increased resistance felt as one manupulates a joint through a range of motion, with the subject attempting to relax?
hypertonicity
What is velocity deendent increase in the tonic stretch reflex with exaggerated tendon jerks resuting rom hyperexcitability of stretch reflex as one component of the UMN syndrome?
spasticity
What is persistent increased tension and shortness in a muscle or group f muscles that cannot be releases voluntarily?
spasm
How do you confirm the presence of spaticity?
perform a quick passive movement and find resistance to this movement
What is the most current and accurate acronmym for early stroke detecition from a public health campaign?
BE FAST– ballance, eyes, face, arm, speech, time
What is the most common type of stroke?
arterial, ischemic
What early findings would you expect after an anterior cerbral artery stroke?
contralateral hemiplegia and hemianesthesis with the LE more involved
What vessels could be involved in a a Posterior circulation stroke?
basilar artery, vertebral artery , posterior cerebral artery
What are the modifiable risk factors for stroke>
HTN, DM, physical inactivity, obesity, high cholesterol, A-fib, alcohol, drug use, tobacco use
What are the non-modifiable risk factors for stroke?
previous stroke, over age 55, previous TIA, over age 55, family history, male, AA, Hispanic, genetic factors
What is the definition of the transient ischemic (TIA) ?
transient episode of neurological dysfunction caused by focal brain, spinal cord or retinal ischaemia, without acute infarction
temporary disruption of blood supply without evidence of cell death, stroke like symptoms <60 minutes
What does the NIH Stroke scale?
level of consciousness, best gaze, visual fields, facial paresis, lower score is better?
Glasgow Coma Scale is used when?
after initial 911 call, higher score is better
What is the neurosurgery for hemorrghic stroke?
evacutation of hematoma
What is the neurosurgery for ischemic stroke?
thrombectomy, remove blood clot from artery
What is an aneurysm?
bulge and weakening of the vessel wall
What is the arteriovenous malformation
tangle of abnormal arteries and veins with no capillaries in between
Treatment of hemorrhagic stroke?
supportive care, aneurysm: coil clip/diversion, aspiration to remove blood, craniectomy to relieve pressure
