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Neuro 1 > Week 1 - CVA > Flashcards

Week 1 - CVA Flashcards

1
Q

Non-modifiable risk factors for stroke

A
  • woman > men
  • age (Incidence rate doubles >55)
  • Race - AA/Hispanic > white (2:1 between AA/hispanic and white and increases 4:1 between 45-54 y/o), Native Americans, Alaskan Natives
  • Prior stroke - 23% have another stroke
  • genetics - HTN, stroke, genetic disorders
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2
Q

What are the 3 most common modifiable risk factors for stroke?

A

HTN >140/> 90
Type 2 diabetes
CV disease

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3
Q

What are modifiable risk factors? (13)

A
  • HTN - most common
  • diabetes - leads to plaque buildup
  • CV disease
  • obesity
  • Obstructive sleep apnea - 72% of stroke patients have sleep apnea and severe sleep apnea doubles risk for stroke
  • physical inactivity
  • diet
  • blood disorders - clotting disorders
  • arrhythmias - a-fib increases CVA risk 5x
  • hyperglycemia - leads to plaque buildup
  • smoking - 2-4x increased risk
  • alcohol
  • recreational drug use
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4
Q

What are the 2 major types of strokes? What causes them?

A

ischemic strokes - caused from fatty deposits in lining of artery (atherosclerosis)

hemorrhagic - rupture of artery due to weakening of vessel wall

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5
Q

What is the difference between embolic and thrombotic strokes?

A

embolic - blockage from clot that travels from elsewhere

thrombotic - blockage from clot within involved artery

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6
Q

Explain the difference between ischemia and infarction.

A

ischemia - the diminished volume of perfusion

infarction - cellular response to lack of perfusion

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7
Q

What are the two major types of hemorrhagic strokes? For each, what are the major causes?

A

Intracerebral hemorrhage - caused by HTN

Subarachnoid hemorrhage -caused by aneurysm and arteriovenous malformation (AVN)

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8
Q

What is TIA? What are its causes?

A

transient ischemic attack - mini-stroke or warning signs

  • caused by focal brain, spinal cord, or retinal ischemia w/o acute infarction
  • temporary blockage that dissolves on its own or gets dislodged naturally
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9
Q

What are the steps of the ischemic cascade?

A

1) Loss of ATP production
2) Stoppage of Na/K pump
3) Excess intracellular Na+ leads to influx of H2O, causing cytotoxic edema (swelling)
4) Excess intracellular Ca2+ build up due to stoppage of Na/K pump
- leads to increase in glutamate and hyper-excitability of neurons - this is toxic to neuron
- activates degradative enzymes that breakdown neuron
- free radicles released
5) Breakdown of mitochondria in response to toxins and unstable cell membrane
- release apoptotic factors - programmed cell death

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10
Q

What parts of the ischemic cascade are considered part of the necrotic responses versus apoptotic stages of stroke pathophysiology?

A

Necrosis

1) Loss of ATP production
2) Stoppage of Na/K pump
3) Excess intracellular Na+ leads to influx of H2O, causing cytotoxic edema (swelling)
4) Excess intracellular Ca2+ build up due to stoppage of Na/K pump

Apoptosis
5) Breakdown of mitochondria in response to toxins and unstable cell membrane

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11
Q

What is meant by the term, ‘penumbra?’

A

area of programmed cell death

- the area around stroke that is no longer salvageable due to apoptosis

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12
Q

How does the onset of a stroke differ based on the type of stroke occurring?

A

thrombotic - gradual onset, days to weeks
- most common in late Pm or first thing in AM (wake up strokes)

embolic - minutes to hours

hemorrhagic - immediate, severe

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13
Q

What does BEFAST stand for?

A 
Balance
Eyes
Face
Arms
Speech
Time
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14
Q

What does NIHSS measure?

A 
Consciousness
Vision 
Motor & Coordination
Sensory & Perception 
Language & Fluency
Behavior
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15
Q

What are NIHSS cut off scores?

A

> 25 very severe - typically require long-term skilled care
15-24 severe
5-14 mild-moderately severe - typically require acute patient rehab
1-5 mild - 80% discharged home from acute hospital

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16
Q

What is typically involved in the medical workup when a stroke is suspected?

A
  • diagnostic imaging (CT, MRI, angiogram, ultrasound, arteriography)
  • EKG
  • Chest radiography
  • CBC
  • 24-hour cardiac monitoring
17
Q

Under what specific circumstances is a CT preferred over an MRI? (8)

A
  • head trauma
  • financial concerns
  • acute hemorrhage
  • speed needed
  • skull fx
  • calcified lesion
  • claustrophobic patient
  • pacemaker or other metallic implants
18
Q

Under what specific circumstances is an MRI preferred over a CT? (5)

A
  • subtle areas of the tumor, infarct demyelination, etc
  • brainstem lesion
  • ischemia
  • subacute or chronic hemorrhage
  • anatomy detail needed
19
Q

What is the major goal of ischemic stroke? How is this done?

A

revascularization using clot buster (tPA) or permissive HTN to push clot through

20
Q

What is the major goal of hemorrhagic stroke? How is this done?

A

reduce intracranial pressure with anti-hypertensives (strict BP parameters)

21
Q

What are some general PT considerations for intracranial pressure management post-stroke?

A
  • monitor S & S
  • avoid activity that may exacerbate
  • mobility contraindicated if > 20 mmHg
22
Q

Explain what a midline shift is. Why is it problematic post-stroke?

A
  • shifting of structures into contralateral hemispheric space due to fluid buildup
  • is a poor prognostic indicator for functional recovery
23
Q

What are some general PT considerations for midline shifts seen post-stroke?

A
  • evaluate for bilateral symptoms

- monitor closely for neurological decline

24
Q

What are some general PT considerations when a patient is diagnosed with a brain herniation?

A

PT not indicated

25
Q

What are vasospasms? What type of strokes are they most commonly associated with?

A
  • Persistent vasoconstriction and dilation of the blood vessels
  • most commonly seen post subarachnoid hemorrhages
26
Q

How are vasospasms monitored and typically managed?

A
  • monitored through transcranial doppler

- managed with permissive HTN - forceful blood flow through artery

27
Q

What are some general PT considerations for a patient who is experiencing vasospasms post-stroke?

A
  • mobility contraindicated with moderate to severe vasospasm

- consult MD prior to mobility

28
Q

What types of strokes are seizures most commonly associated with? When are patients most at risk?

A
  • most common with intracerebral hemorrhages

- greatest risk during first 48 hours

29
Q

How are seizures monitored and typically managed?

A
  • monitored through electroencephalogram (EEG)

- treated with anti-seizure medication

30
Q

What are some general PT considerations when a patient has a history of seizures post-stroke?

A
  • mobility deferred until > 24 hours after quiet EEG

- monitor closely for seizure activity

31
Q

What are the 2 forms of apraxia?

A

ideomotor - can tell you how to do something, but can’t do it

ideational - can’t tell or do something/task

32
Q

What are the cut off scores for apraxia scale of TULIA?

A

max score = 12
cut off - < 9
severe apraxia - < 5

Neuro 1 (11 decks)

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