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PHTY2030 Neurological Physiotherapy > Week 1 & 2 - Stroke Management > Flashcards

Week 1 & 2 - Stroke Management Flashcards

1
Q

Posterior Circulation Syndrome (POCS)

A
  • Ipsilateral cranial nerve palsies with contralateral sensory/motor loss
  • Vestibular/occular signs
  • Isolated cerebellar dysfunction
  • Isolated homonymous hemianopia
  • Brainstem and cerebellar deficits: vertigo, ataxia, CN signs
  • 24%
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2
Q

Lacunar Syndrome (LACS)

A
  • Pure motor stroke (posterior limb of internal capsule)
  • Pure sensory stroke (infact to thalamus)
  • Sensory motor stroke
  • Ataxic hemiparesis
  • Dysarthria (slurred speech), Clumsy hand syndrome
  • 25%
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3
Q

Partial Anterior Circulation Infarct (PACI)

A
  • 2/3 components from TACI
  • Aphasia typically related to expressive (speak) or receptive (understand)
  • Typically no drowsiness
  • ACA/MCA - 34%
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4
Q

Total Anterior Circulation Infarct (TACI)

A
  • Hemiparesis and/or hemisensory loss
  • Homonymous hemianopia
  • Global aphasia/visuospatial neglect (unaware of half the environment)
  • ACA and MCA - 17%
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5
Q

What is a Transient Ischaemic Attack (TIA)?

A
  • Rapidly developed clinical sign of focal or global disturbance in cerebral function
  • Is a warning sign to stroke
  • Last <24 hours
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6
Q

What are the subtypes of stroke?

A
  • Ischemic (85%)
  • Intracerebral Haemorrhage (10%)
  • Subarachnoid Haemorrhage (5%)
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7
Q

What are the signs of an Upper Motor Neurone (UMN) syndrome?

A
  • Weakness/paralysis of movement (corticospinal not working)
  • No profound wasting (more generalised)
  • Spasticity and hyperreflexia (no dscending output from brain to calm reflexes down)
  • Primitive reflexes
  • Cortex, cerebellum, basal ganglia, BS motor nuclei
    Cell body lesion will be in the brain
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8
Q

What are signs of a Lower Motor Neurone (LMN) Syndrome?

A
  • Weakness or paralysis of individual muscles
  • Wasting (specific muscles)
  • Fasiculation (spontaneous firing of neurones)
  • Hypotonia & hyporeflexia/areflexia
  • Anterior horn cells, motor cranial nerve, peripheral nerves
    Cell lesion will be in spinal cord
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9
Q

What does the lateral corticospinal tract do?

A

Controls fine movement of ipsilateral limbs, innervate distal muscles

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10
Q

What does the anterior corticospinal tract do?

A

Controls axial and girdle muscles, innervates proximal muscles (eg. trunk)

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11
Q

What does the rubrospinal do?

A

Facilitates activity of flexor muscles, cells orignate in red nucleus (gross motor)

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12
Q

What are the descending tracts for tone, posture, and balance?

A
  • Reticulospinal
  • Tectospinal
  • Vestibulospinal
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13
Q

What is the foramen magnum and tentorium?

A
  • Foramen magnum separates brain and spinal cord
  • The tentorium separates the cerebral lobes with the brainstem and cerebellum
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14
Q

What does glioma, meningioma, schwannoma, haemangioblastoma, and neuromas arise from?

A

Glioma - brain tissue
Meningiomas - surrounding meninges/membrane
Schwannomas - cranial nerves
Haemangioblastoma - blood vessels
Neuromas - nerve sheaths

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15
Q

What is a haemorrhagic stroke?

A

It is the bleeding into the brain by rupture of blood vessels of an intracerebral artery
- 10-15% of all strokes

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16
Q

What is an ischaemic stroke?

A

Inadequate blood supply to part of the brain as a result of:
- An embolosm: blood clot formation which travels via bloodstream to brain
- Thrombosis: narrowing of blood vessels
- 85% of all strokes, blockage of artery

17
Q

What is thrombolysis (tPA - tissue plasminogen activator) and what does it do?

A
  • It re-canalise blocked vessels, restore penumbra
  • Restore blood supply to region within therapeutic time frame (~<5 hours)
17
Q

What are some primary exclusion criteria for tPA?

A
  • History of haemorrhage stroke (if bleed and give thrombolytic medication, patient will die)
  • AVM or aneurysm, cancer
  • Elevated BP
  • Seizure at onsent
  • Pregnancy
  • Patient >85 years
18
Q

What are the gradings of NIHSS? (The National Institute of Health Scale Stroke)

A

0: no stroke
1-4: minor stroke
5-15: moderate stroke
16-20: moedrate to severe stroke

19
Q

What are the gradings for the Modified Rankin Scale (mRS)?

A

0 = no symptoms
1 = no significant symptoms
2 = slight disability, can look after themselves
3 = moderate requiring some help
4 = moderate disability; unable to walk without assistance
5 = severe disability; incontinent, requires nursing
6 = death

20
Q

What is the function of the frontal lobe?

A

Motor function, problem solving, memory, language, planning, reasoning, social, personality, judgement (Broca’s aphasia)

21
Q

What is the function of the parietal lobe and its deficits?

A

Function: sensory information
Deficits: contralateral neglect, aphasia (language), agnosia, anasognosia

22
Q

Which lobe is responsible for processing auditory information from ears to understand meaningful speech and memory?

A

The temporal lobe

23
Q

What are some deficits of the temporal lobe?

A

Wernicke’s aphasia (difficulty understanding words), prosopagnosia (diffucluty recognising face)

24
Q

What does the occipital lobe do?

A

Processes visual information

25
Q

What does the cerebellum do and its deficits?

A

Function: coordination of voluntary motor movements, balance, equilibrium, muscle tone
Deficits: vertigo, loss of coordination fine movements, walking, rapid movements, dysarthria (slurred speech), poor postural control

26
Q

Function of basal ganglia and its deficits?

A

Function: voluntary motor control, procedural learning to routine behaviours/habits, cognitive and emotional functions
Deficits: difficulty initiating movements, increased muscle tone, posture

27
Q

Which part of the brain relays motor and sensory signal to the cerebral cortex and receives signal as sensation which passes on to the cortex for interpretation?

A

Thalamus

28
Q

What is the function of the brainstem (midbrain, pons, medulla) and its deficits?

A

Function: controls heart rate and lungs. Regulates vital body functions
Deficits: decreased breathing, dysphagia (swallow), balance & movement, vertigo, sleeping difficulty, ipsilateral CN findings, contralateral motor & sensory signs

29
Q

Which artery supplies the medial part of the brain?

A

ACA - lower limbs

30
Q

The MCA supplies the…

A

Lateral areas of the brain and face & upper limbs

31
Q

Which artery supplies 80% of the brain and its anterior and posterior?

A

Internal carotid artery (ICA)
Anterior: optic nerves, frontal lobes, parietal & temporal lobes
Posterior: cerebellum, brainstem, thalamus, occipital lobe, medial temporal lobe

32
Q

What is encephalitis?

A

Acute inflammation of brain tissue (viral or bacterial)

33
Q

What happens if the ACA is damaged?

A
  • Contralateral hemiplegia and sensory loss of lower limb
  • Dysarthria and aphasia
  • Prefrontal cortex: emotions, bevaiours, decision making
34
Q

What happens if the MCA is damaged?

A
  • Contralateral hemiparesis & sensory loss of upper limb and face
  • Dominant: Broca’s aphasia (expressive, speech not fluent/not expressed), Wernicke’s aphasia (receptive, can’t understand words)
  • Non-dominant: apraxia (willing to perform but can’t figure out), contralateral visual & sensory hemispatial neglect
35
Q

What happens if the PCA is damaged?

A

Contralateral visual field deficits - homonymous hemianopia, visual agnosia

36
Q

How would an occupational therapist help a stroke patient?

A

They help people regain function and re-learn how to perform everyday tasks that person needs or wants to do

Promotes health and wellbeing

Re-education

Cognition assessment

PHTY2030 Neurological Physiotherapy (8 decks)

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