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Neuroconditions 2022 > Stroke Neuro Conditions > Flashcards

Stroke Neuro Conditions Flashcards

1
Q

Causes of an intracerebral hemorrage…

A

most common is trauma, non-traumatic is hypertension or cerebral amyloid angiopathy

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2
Q

Causes of a subarachnoid hemorrage…

A

most common is trauma, non-traumatic are ruptured aneurysm

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3
Q

types of hemorrhagic stroke

A

(collection of blood) epidural (EDH), subdural (SDH), subarachnoid (SAH), intracerebral (ICH)

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4
Q

types of ischemic stroke

A 
large vessel= thrombotic or emobolic
small vessel (lacunar)
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5
Q

Causes of a Thrombotic ischemic stroke….

A

local obstruction, atheroscelrosis, dissection, hypercoaguable conditions

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6
Q

Causes of an embolic ischemic stroke …

A

traveling clot or debris = blood blot (a-fib, disseciotn, valvular vegetation), ruptured atheroscelrotic plaque

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7
Q

Causes of a small vessel ischemic stroke are…

A

HTN, DM, cholesterol, smoking, age

basal ganglia, internal capsule, pons

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8
Q

anterior circulation of the brain

A

supplied by the internal carotid artery – anterior cerebral artery and middle cerebral artery

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9
Q

What are effects of anterior cerebral artery syndrome?

A

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

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10
Q

What are the effects of middle cerebral artery syndrome?

A

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

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11
Q

Broca’s aphasia

A

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

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12
Q

Wernicke’s Aphasia

A

sensor, receptive, posterior, or fluent aphasia

characteriized by deficit in language comprehension with relatively fluent but error filled production

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13
Q

Global Aphasia

A

includes broca’s and wernicke’s

characterized by impairments in language production and comprehension

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14
Q

hemianopia

A

visual deficit of one-half of the visual field

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15
Q

hemianesthesia

A

loss of tactile senses on one side of the body

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16
Q

What makes up the posterior circulation supply?

A

supplied by the vertebral arteries
basilar artery
posterior cererbral arteries (PCA)

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17
Q

What are the effects of posterior cerebral artery syndrome

A

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

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18
Q

what happens if the basilar artery is occluded?

A 
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

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19
Q

What happens with a lacunar stroke syndrome>

A

posterior limb of internal capsule= pure motor deficit
anterior limb= weakness of face and dysarthria
posterolateral thalamus= pure sensory stroke
pons= ataxia, clumsiness, weakness

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20
Q

dysarthria

A

weakness in the muscles used for speech= slurred or slow speech – motor speech disorder

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21
Q

symptoms of a cerebellar stroke?

A

gait unsteadiness, ataxia, vertigo, nausea/vomiting may be the first sign

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22
Q

How many stages are there in the Brunnstrom stages of recovery?

A

6

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23
Q

Describe stage 1 of Brunnstrom

A

no voluntray movement, areflexia, flaccidity

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24
Q

Describe stage 2 of Brunnstrom

A

minimal voluntary movement with primitive synergies

DTRS begin to appear, and spasticity begins

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25
Q

Describe stage 3 if Brunnstrom

A

movements in partial or full ROM, in primitive synergies
hyperreflexia
peak spasticity

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26
Q

describe stage 4 of Brunnstrom

A

some difficult fractionations from primitive synergies,
DTRs decrease
spasticity starts to decrease

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27
Q

Describe stage 5 of Brunstrom

A

primitive synergies lose dominance, and more fractionation is mastered, DTRs normalize
spasticity decreases

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28
Q

Describe stage 6 of Brunstrom

A

full fractionated movement is possible

decreased coordination and automaticity are still possible

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29
Q

What defines the hyperacute stage of the continuum of recovery

A

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

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30
Q

What is the PT managment of an acute ischemic stroke after tPA?

A

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

31
Q

What defines the acute state of the continuum of recovery

A

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

32
Q

What amount of time shows the steepest and greatest recovery for a stroke

A

first 30 days

33
Q

What defines the subacute stage of the continuum of recovery

A

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

34
Q

What defines the chronic stage of the continuum of recovery

A

6+ months
assessment of discharge environment– functional needs, motivation and preferences, intensity of tolerable treatment, equipment, availability , transportation, home safety assessment

35
Q

What types of imagain is commonly used for stroke?

A

CT scan, MRI, and angiograms

36
Q

what types of meidcations are used for phsycial sequelae (anti-spasticity)

A

oral agents= baclofen, alpha 2 agaonists (Tizandine or Zanaflex),
dantrolene, gabapentis, bensodiazepines
botox

37
Q

what types of medications are used to prevent future stroke (anti- coagulation)

A

anti-platelets= aspirin, clopidogrel

anti-coagulants– warfarin (coumadin) or DOAC

38
Q

participation restrictions for stroke patients

A

difficulty with self-care, mobility in the home and community, engaging in socail settings and at risk for falling

39
Q

activity restrictions for stroke patients

A

benchmark tasks, sitting, walking, transitional movements, stair negotiation, higher level gross mototr tasks

40
Q

What is STREAM?

A

stroke rehabilitation assessment of movement– assesses motor control

41
Q

What is PASS?

A

postural assessment for stroke patients – assesses balance

42
Q

What is SIS

A

stroke impact scale

43
Q

What is ARAT

A

action research arm test

44
Q

What is ARAT

A

action research arm test

45
Q

What does SERMAS stand for

A 
sensation/pain 
endurance/fatigue
ROM/joint mobility 
Motor control/coordination 
awareness/cognition
strength/force production/power
46
Q

How do you test sensation and pain of SERMAS>

A

light touch unilaterally, distal to proximal, not dermatome specific
test for extinction
proprioception
pain scales (Faces)

47
Q

How do you test for endurance/fatigue of SERMAS?

A

6 MWT, 2MWT (measure distance wlaked in alotted time, count rest breask/rest time, not if AD is used

48
Q

How do you test for ROM/joint mobility of SERMAS?

A

PROM, AROM, AAROM

49
Q

How do you test for Motor control/coordination of SERMAS?

A

STREAM, observation

coordination if cerebellar stroke– finger to nose, heel to shin, rapid alternating movement

50
Q

How do you test awareness/cognition of SERMAS?

A

pusher syndome (CPS)
neglect
communication

51
Q

How to test strength/force produciton. power of SERMAS?

A

MMT with motor control assessment

52
Q

What type of hemorrahgic stroke is twice as common as a SAH

A

intracerebral hemorraghic

53
Q

What type of hemorrhagic stroke is common in elderly population?

A

subdural hemorrhagic

54
Q

What are non-modifiable risk factors?

A

age, sex, race

55
Q

What is Tension attained at any moment between the origin and the insertion of a muscle?

A

tone

56
Q

What is increased resistance felt as one manupulates a joint through a range of motion, with the subject attempting to relax?

A

hypertonicity

57
Q

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?

A

spasticity

58
Q

What is persistent increased tension and shortness in a muscle or group f muscles that cannot be releases voluntarily?

A

spasm

59
Q

How do you confirm the presence of spaticity?

A

perform a quick passive movement and find resistance to this movement

60
Q

What is the most current and accurate acronmym for early stroke detecition from a public health campaign?

A

BE FAST– ballance, eyes, face, arm, speech, time

61
Q

What is the most common type of stroke?

A

arterial, ischemic

62
Q

What early findings would you expect after an anterior cerbral artery stroke?

A

contralateral hemiplegia and hemianesthesis with the LE more involved

63
Q

What vessels could be involved in a a Posterior circulation stroke?

A

basilar artery, vertebral artery , posterior cerebral artery

64
Q

What are the modifiable risk factors for stroke>

A

HTN, DM, physical inactivity, obesity, high cholesterol, A-fib, alcohol, drug use, tobacco use

65
Q

What are the non-modifiable risk factors for stroke?

A

previous stroke, over age 55, previous TIA, over age 55, family history, male, AA, Hispanic, genetic factors

66
Q

What is the definition of the transient ischemic (TIA) ?

A

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

67
Q

What does the NIH Stroke scale?

A

level of consciousness, best gaze, visual fields, facial paresis, lower score is better?

68
Q

Glasgow Coma Scale is used when?

A

after initial 911 call, higher score is better

69
Q

What is the neurosurgery for hemorrghic stroke?

A

evacutation of hematoma

70
Q

What is the neurosurgery for ischemic stroke?

A

thrombectomy, remove blood clot from artery

71
Q

What is an aneurysm?

A

bulge and weakening of the vessel wall

72
Q

What is the arteriovenous malformation

A

tangle of abnormal arteries and veins with no capillaries in between

73
Q

Treatment of hemorrhagic stroke?

A

supportive care, aneurysm: coil clip/diversion, aspiration to remove blood, craniectomy to relieve pressure

Neuroconditions 2022 (14 decks)

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