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Neuromuscular 1 > Test 2 > Flashcards

Test 2 Flashcards

1
Q

Warning Signs of a Stroke

A

Face Drooping
Arm Weakness
Speech Difficulty
Time to Call 911
Sudden numbness or weakness of the leg
Sudden confusion or trouble understanding
Sudden trouble seeing in one or both eyes
Sudden trouble walking, dizziness, loss of balance or coordination
Sudden severe headache with no known cause
Nauseous
Vomiting

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2
Q

Time period that a person having a stroke should get to the hospital by

A

Ideal is less than 2 hours but less than 3 hours is critical

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3
Q

Modifiable Risks for Stroke

A 
HTN
BP > 160/95
Reducing Diastolic by 5-6 mmHg reduces risk by 40%
Smoking
Weight
Atrial Fibrillation increases risk by 6x
Decreased Physical Activity
CAD- cholesterol
Apnea
Alcohol
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4
Q

American Heart Association Life’s Simple 7

A 
Get Active
Control Cholesterol
Eat Better
Manage BP
Lose Weight
Reduce Blood Sugar
Stop Smoking
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5
Q

Types of Strokes

A

Ischemic (87%):
Embolic
Thrombotic
Lacunar

Hemorrhagic
TIA (not a stroke, a warning sign)

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6
Q

Ischemic Stroke`

A

A clot blocks blood flow to an area of the brain reducing oxygen

3-4 minutes of hypoxia is when brain cells die

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7
Q

Embolic Ischemic Stroke

A

Most common type of ischemic stroke

Blood clot forms somewhere else and travels to the brain

Cardiac origin (carotids and aorta) most common and 80% of emboli occlude the MCA

Other forms: paradoxical, congenital (foramen oval), DVT

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8
Q

Thrombotic (Ischemic) Stoke

A

Thrombosis (obstruction of a blood vessel by a blood clot forming locally)

Typically related to abnormalities within the vessel wall such as atherosclerosis, arteritis, dissections and external compression of the vessels

HTN is the common precusor

Large vessel thrombosis that occurs in extrracranial vessels (carotid, vertebral a) can lead to severe strokes

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9
Q

Lacunar (Ischemic) Stroke

A

Lacunar stroke or lacunar infarct (LACI) is a type of stroke that results from occlusion of one of the penetrating arteries that provides blood to the brain’s deep structures. Infarct is 2mm to 3cm in size

Typically associated with chronic HTN and diabetic microvascular disease

25% of ischemic strokes

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10
Q

Types of Lacunar Strokes

A 
Only Sensory
Only motor
Sensorimotor
Ataxic hemiparesis (mild form, less than cerebellar)
Dysarthria (trouble swallowing)
Clumsy-hand syndrome
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11
Q

Hemorrhagic Stroke

A

Account for approx 13% of strokes

Common causes:
HTN bleed
ICH due to AVM or tumor
Ruptured aneurysm

Cellular destruction caused by ischemia 2ndary to trauma. Mechanical injury caused by edema and pressure of blood collection

75% of ppl with Hemorrhagic stroke due to HTN

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12
Q

Anterior Cerebral Artery (ACA) supplies…

A

Medial aspect of the frontal and parietal lobes, and subcortical structures like Basal Ganglia

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13
Q

Middle Cerebral Artery (MCA)

A

Entire lateral aspect of cerebral hemisphere (frontal, temporal, parietal)

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14
Q

Posterior Cerebral Artery (PCA)

A

Occipital Lobe, medial/inferir temporal lobe, UPPER BRAIN STEM, Midbrain, Thalamus

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15
Q

Transient Ischemic Attack (TIA)

A

Symptoms include focal deficits of an ischemic stroke and typically follow a vascular pattern

Are REVERSIBLE, NO Infarct of the tissue

Within 5 yrs 35% of ppl with a TIA have a stroke

Workup necessary for prevention of future stroke
Pt will be monitored for 24 hours

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16
Q

Hemorrhagic Conversion

A

Ischemic infarct that converts to a hemorrhagic lesion

Thrombi/Emboli can migrate, lyse and reperfuse into an ischemic area, leading to small hemorrhages

Damaged capillaries and small blood vessels no longer maintain their integrity

More common in large infarcts like an occluded MCA

17
Q

Tissue Plasminogen Activator (TPA)-strong thrombolysis med-Guidelines

A

Must rule out hemorrhagic stroke
Must have clinical diagnosis of ischemic stroke
No recent trauma, surgery, bleeds
If TIA, rapidly improving sx will occur, do NOT give TPA
BP <185/110
Must be within 3 hours of onset
CT without ICH or major early infarct signs
Normal glucose and platelet counts

18
Q

Temporal Lobe Fxns

A

Personality, Behavior, Emotions, Judgement, Planning, Problem Solving, Intelligence, Speaking, Writing, Concentration, and Self Awareness

19
Q

Parietal Lobe Fxns

A

Interpretation of Language, Sensation of Touch Pain, and Temperature, Vision, Hearing, Memory, and Visual/Spatial Perception

20
Q

Temporal Lobe Fxns

A

Understanding Language, Memory, Hearing, Sequencing, and Organizing

21
Q

Occipital Lobe Fxns

A

Interprets Vision (Light, Color, Movement)

22
Q

Left sided Strokes

A 
Right Sided Weakness
Right Sided Sensory Deficits 
Speech and Language Deficits
Slow, Cautious Behavior Style
Memory Deficits
23
Q

Right Sided Strokes

A

Left Sided Weakness
Left Sided Sensory Deficits
Spatial Perceptual Deficits
Quick, Impulsive Behaviors Style

24
Q

Brain Stem Strokes

A

Changes in breathing, movement, sensation, eye movement, heart rate, blood pressure

25
Q

Cerebellar Strokes

A

Abnormal reflexes of the head and torso

Impaired Coordination, Ataxic Movement/Gait, Balance Issues, Dizzyness, Vomiting

26
Q

Signs and Sx of Occlusion of the ACA

A

Contralateral hemiparesis involving mainly LE
Contralateral hemisensory loss involving mainly LE
Urinary Incontinenece
Slowness, Delay, Motor Inaction

27
Q

Signs and Sx of Occlusion of the MCA

A

Contralateral hemisensory loss & hemiparesis (mainly UE & face)
Motor Speech Impairment (Broca’s or nonfluent aphasia with slow speech impairment)
Receptive Speech Impairment (Wernicke’s or fluent aphasia)
Global Aphasia
Perceptual Deficits and limb kinetic apraxia
Ataxia of Contralateral limbs

28
Q

Signs and Sx of Occlusion of the Vertebral Arteries- Medial Medullary Syndrome or”Dejerine Syndrome”

A

Ipsilateral impairments of:
Paralysis with atrophy of 1/2 of tongue with deviation to the paralyzed side

Contralateral Impairments of:
Paralysis of UE and LE
Impaired tactile and proprioceptive sense

29
Q

Signs of Occlusion of the Posterior Cerebellar Artery or Vertebral Artery- Lateral Medullary Syndrome or “Wallenburg’s Syndrome”

A 
Ipsilateral impairments:
Decreased pain/temperature sensation to face
Cerebellar Ataxia
Vertigo/Nausea
Nystagmus
Dysphagia

Contralateral Impairments:
Impaired pain and thermal sense over 50% of the body

30
Q

Signs of Occlusion of Basilar Artery or “Locked in Syndrome”

A

Hemiparesis-Quadriplegia
Bilateral Cranial Nerve Palsy
Consciousness and Sensation are spared
Pt can not move or speak but remains alert & oriented

31
Q

Occlusion of Paramedian Branch of Basilar Artery or “Foville’s Syndrome”

A 
Ipsilateral Impairments
Paralysis of conjugate gaze to side of lesion
Nystagmus
Ataxic Gait
Double Vision with Lateral Gaze

Contralateral impairments:
Pareis of face, UE, LE
Impaired tactile and proprioceptive sense over 50% of the body

32
Q

Occlusion of the Anterior Inferior Cerebellar Artery

A 
Ipsilateral Impairments:
Horizontal & Vertical Nystagmus, vertigo, nausea, vomiting
Facial Paralysis
Deafness/Tinnitus
Ataxia
Impaired sensation over the face

Contralateral Impairments:
Impaired pain & thermal sense over 1/2 the body

Neuromuscular 1 (2 decks)

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