Cerebral Vascular Accident (Cva) "stroke"

Front 1

What is "Cerebral Vascular Accident"?

Back 1

1. Stroke.
2. Focul neurological disorder.
3. Usually one hemisphere = one artery.
4. #1 cause of disability in US and #3 cause of death in US.

Front 2

List 2 types of stroke.

Back 2

1. Embolic/Ischemic stroke
2. Hemorhagic stroke

Front 3

What is "Ischemic" stroke?

Back 3

1. 80% of stroke.
2. Caused by blockage of blood vessel producing ischemia, resulting in infract.

Front 4

Describe difference between ischemia and infract.

Back 4

1. Ischemia is a restricted blood supply vs. infract is a complete blockage of blood supply.
2. Ischemia can be reversed vs. infract cannot be reversed.

Front 5

What are causes of Ischemic/embolic/occlusive stroke?

Back 5

1. Artherosclerosis = Narrowing of the blood vessels in the neck and head.
2. Blood clots in the heart = due to irregular heart beat, heart attack or abnormalities of the heart valves.

Front 6

Describe recovery of Ischemic stroke?

Back 6

The most rapid and spontaneous recovery occurs 1st week after the stroke.

Front 7

What are 3 classifications of Ischemic stroke?

Back 7

1. Transient Ischemic Attack (TIA).
2. Completed stroke.
3. Progressive stroke.

Front 8

What is "Transient Ischemic Attack (TIA)"?

Back 8

1. Mini stroke.
2. Local and temporary lack of blood supply due to obstrucion.
3. Complete recovery after 24 hours.
4. Risk of stroke increase after TIA.

Front 9

What is "Complete Stroke"?

Back 9

1. Neurologic deficits from vascular disorders that persist more than 1 day and are stable.
2. Non progressive.
3. No improvement.

Front 10

What is "Progressive Stroke"?

Back 10

1. Deficits increase intermittenly over time.
2. Due to repeated emboli or continued formation of thromus.

Front 11

What is "Thrombosis"?

Back 11

Formation of blood clot within an artery.

Front 12

What is "Embolism"?

Back 12

1. Thrombosis or blood clots that is formed dislodges and travels in bloodstream.
2. It becomes trapped in arteris closer to the brain.

Front 13

What is "Carotid Occulusion"?

Back 13

1. Not 100% blockage.
2. Plaque build up in the artery and narrows the artery opening.

Front 14

What is "Hemorrhagic Stroke"?

Back 14

1. Rupture of blood vessel, with bleeding into or around cerebral tissue.
2. Bleeding irritates the brain tissue, causing swelling (edema).
3. The surrounding tissues of the brain resisit the expansion of the bleeding by forming a mass (hematoma).
4. Both swelling (edma) and hematoma (mass formation) compress and displace normal brain tissue.
5. 20% of stroke.

Front 15

What are causes of "Hemorrhagic Stroke"?

Back 15

1. Hypertension.
2. Aneurysm - A weak spot in the artery wall baloon out and eventually burst.
3. Amyloid protein makes vessels more prone to bursting.

Front 16

Aneurysm often happens in...?

Back 16

Circle of Willis.

Front 17

List symptoms of "hemorrhagic stroke"? List 9.

Back 17

1. Weakness or inability to move a body part.
2. Numbness or loss of sensation.
3. Decreased or lost vision (pay be partial).
4. Speech difficulites.
5. Inability to recognize or identify familiar things.
6. Sudden headache.
7. Dizziness, loss of coordination.
8. Swalling difficulties.
9. Sleepy, lethargic, uncounscious.

Front 18

What is the prognossis with stroke?

Back 18

1. If infract (cell death), permanent impairment.
2. Spontaneous recovery after edema subsides.

Front 19

What is the prediction is based on for stroke recovery? List 7.

Back 19

1. Extent of brain damage.
2. Type of CVA.
3. Premorbid personality.
4. Motivation.
5. Age = Younger the better.
6. Those with good sensation and minimal spasticity make greatest improvement.
7. Most recovery in first 6 months.

Front 20

What is the strategy of occupational therapy after stroke?

Back 20

1. Remedial therapy to help regain control for first 6 months.
2. Adoptive/compensatory strategy after 6 months = Not rebuilding but adopting to the impairment.

Front 21

What is acute treatment for Ischemic stroke?

Back 21

Clot busters (TPA) = Must be administered within 3 hours to work the best. Only about 3-5% of people reach the hospital to be considered for this treatment.

Front 22

What are preventative treatments for Ischemic stroke? List 3.

Back 22

1. Anticoagulatants/antiplatelets/Aspirin.
2. Carotid Endarterectomy = Remove clot.
3. Angioplasty/Stents = Mesh wire unit insert in the blood vessel.

Front 23

What are common motor deficits after stroke? List 6.

Back 23

1. Low muscle tone = Flaccidity (UMN injury).
2. Spasticity.
3. Reflexes/reactions = hyperreflexia due to no descending inhibition.
4. Paralysis/paresis.
5. Apraxia (Lt. hemisphere) = Loss of the ability to execute or carry out learned purposeful movements, despite having the desire and the physical ability to perform the movements.
6. Dyspraxia (Lt. hemisphere) = Difficulty in mortor coordination

Front 24

What are common sensory deficits after stroke? List 2.

Back 24

1. Rarely in isolation = Usually have motor deficit too.
2. Contralateral homonymous hemianopsia.

Front 25

What are common emotional deficits after stroke?

Back 25

1. Depression (30-50% of stroke survivors).
2. fear, anxiety, frustration.
3. Emotional lability = Excessive emotional reactions and frequent mood changes.
4. Apathy (ACA) = State of indifference, or the suppression of emotions such as concern, excitement, motivation and passion.

Front 26

What are common perception deficits after stroke? List 5.

Back 26

1. Usually Rt. MCA.
2. Agnosia.
3. Body scheme.
4. Visual-spatial.
5. Constructional praxis.

Front 27

What are common cognition deficits aftr stroke? List 2

Back 27

1. Associated with more severe stroke = Frontal lobe.
2. ACA.

Front 28

What are common language deficits after stroke?

Back 28

1. aphasia (MCA).
2. Damage to Lt. side.

Front 29

What is "Diaschisis"?

Back 29

1. Functional standstill or abolition of electrical activity in areas surrounding or related to the damaged part ot the brain.
2. No more action potential in damaged area.

Front 30

What contribute to recovery?

Back 30

1. Neuroplasticity = Ability of neurons to change their function, chemical profile, or structure.
2. Functional reorganizaion of brain = Even in adult.

Front 31

How "Synaptic Changes" contribute to stroke recovery?

Back 31

1. Synaptic effectveness = once edema resolves, synaptic effectiveness returns.
2. Denervation hypersensitivity = New receptor sites develop on post-synaptic membrane in response to neurotransmitter released from nearby neurons.
3. Unmasking of silent synapes = Injury can result in activation of other pathway.

Front 32

What impairments are expected when stroke attack RIGHT hemisphere?

Back 32

1. Language/aprosodia.
2. Construction apraxia.
3. Spatial relationships

Front 33

What impairments are expected when stroke attack LEFT hemisphere?

Back 33

1. Language/aphasia.
2. Possible alexia, agraphia = Deficiency in the ability to write, regardless of the ability to read.
3. Limb apraxia = affect arms & legs.