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210 Cards in this Set
- Front
- Back
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What is an absolute contraindication for using TPA in acute stroke?
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History of stroke or MI within past 3 months
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What factor is associated with improved outcome in hemorrhagic stroke?
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Intracranial hemorrhage in the parietal lobe less than 3 cm
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Hoarse voice and dysphagia indicate a stroke in what brain area?
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Nucleus ambiguous
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Stroke in the spinal trigeminal nucleus would cause what 2 symptoms?
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ipsilateral loss of pain and temperature sensation from the face
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Palatal myoclonus is caused by a stroke in what brain area?
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central tegmental tract
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Combination of what two drugs are considered first line therapy for preventing recurrent noncardioembolic ischemic stroke?
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aspirin plus dipyridamole extended release
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Those with hemorrhagic stroke are how many more times likely to exprience DVT and/or PE?
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twice
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Post stroke urinary incontinence is associated with which outcome?
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greater fatality rate
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In stroke patients, how is hyponatremia and decreased serum osmolility treated?
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free water restriction
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What is an independent predictor of fatigue and depression in stroke?
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previous history of mood disorder
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What is typical pattern of motor recovery after stroke in left MCA distribution?
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nonfunctional synergistic contraction followed by voluntary control
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What factor is associated with unfavorable stroke outcome?
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poor upper extremity motor funtion
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Ipsilateral hand and foot weakness more than ipsilateral proximal weakness and intact sensation and cognition is associated with stroke in what brain area?
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Internal capsule
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Transcortical motor aphasia is associated with a lesion in what brain area with what vascular supply?
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Prefrontal area - anterior cerebral artery
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A metal AFO provides more of what than a plastic AFO at the ankle?
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less control at the ankle
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What is the mechanism of action of baclofen?
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GABA B agonist
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What is the mechanism of action of tizanidine
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Alpha-2 agonist
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What is the mechanism of action of diazepam?
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GABA A agonist
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What is the mechanism of action of dantrolene?
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peripherally acting - blocks calcium release from sarcoplasmic reticulum h
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What characteristic predicts the least success in return to work after stroke?
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aphasia
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What are 4 factors correlated with successful return to work after stroke?
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age 55 or younger
income $30,000 higher Barthel Index scores shorter rehabilitation lengths of stay |
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What factor is most likely to predict successful return to driving after stroke?
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On-road driving evaluation
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Sexual activity correlates with what MET cost?
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4.5
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What percent of stroke survivors suffer from ED?
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75%
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In a stroke patient with ED and premorbid nitrate use for CAD what class of meds is contraindicated?
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phosphodiesterase inhibitors
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What NIH Stroke Scale score is associated with a favorable outcome?
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10
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What NIH Stroke Scale score is associated with a higher risk of hemorrhage following TPA administration?
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20
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MRI imaging study is superior to CT for detecting strokes in what area?
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Small cortical and subcortical infarcts.
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What are blood pressure criteria for TPA?
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Systolic<185
Diastolic<110 |
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What is the platelet minimum for TPA?
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100,000
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"Last Seen Normal" time frame for TPA?
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less than 3 hours
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Blood glucose level minimum for TPA?
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50 mg/DL
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INR maximum for TPA?
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1.7 INR
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What are the 4 leading acute causes of death in stroke?
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Preexisting heart failure
arrhythmias MI respiratory failure |
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What is malignant middle cerebral artery syndrome?
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Cerebral edema causing subsequent herniation
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What is the mortality rate of intracerebral hemorrhage within 30 days?
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50%
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ICP monitoring is warranted for Glasgow Coma Score less than what
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<9
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What is the gold standard imaging for hemorrhagic stroke?
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CT
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What metric of hemorrhagic stroke has been shown to be a strong predictor of outcome?
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volume of hemorrhage
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What is the leading cause of intracerebral hemorrhage?
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Hypertension
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In intracerebral hemorrhage what is the target range for cerebral perfusion pressures?
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60 - 80mm Hg
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Most common type of cerebellar infarctions?
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cardioembolic
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Most common type of pons and thalamus infarctions?
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stenotic
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Ischemic infarctions of the posterior circulation most commonly occur at what portion of what artery?
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proximal portion of basilar artery
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Locked-In syndrome results from an occulsion of what artery in what brain area?
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Bilateral basilar artery to the ventral pons
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What two functions are spared in locked in syndrome?
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vertical gaze
eyelid control |
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Infarction of the bilateral cortical spinal tracts results in what 2 deficits?
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weakness of the upper and lower extremities
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Infarction of the bilateral corticobulbar tract results in what deficit?
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bilateral facial weakness
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Infarction of the bilateral CN VI results in what deficit
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bilateral lateral gaze weakness
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Infarction of the bilateral corticobulbar tract results in what defiict?
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dysarthria
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What two brain areas area spared in locked-in syndrome?
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reticular activating system - conciousness
supranuclear ocular motor pathways- vertical eye motion and eye blinking |
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Lacunae strokes result from what activity?
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macrophage activity absorbing necrotic tissue leaving a small cavity
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What are the four most common areas for lacunar strokes?
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basal ganglia, thalamus, internal capsule, and brain stem
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Pure motor strokes result from involvment of what area?
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posterior limb of the internal capsule
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Lacunar infarcts of the thalamus result in what general symptom?
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pure sensory
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What are the 4 symptoms of dysarthria clumsy hand syndrome?
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facial weakness
dysarthria dysphagia weakness and clumsy hand |
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Where do sensori-motor lacunae occur?
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thalamus and posterior limb of the thalamus
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Infarct of the corona radiata and anterior limb of the internal capsule produce what two symptoms?
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ipsilateral ataxia and weakness
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Ipsilateral ataxia and weaknes are caused by an infarct of what two brain areas?
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corona radiata
anterior limb of the internal capsule |
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In ataxic hemiplegia which symptoms resolves sooner
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weakness
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What are two independent risk factors for lacunar and non-lacunar strokes
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HTN and DM
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Multiple lacunae is related to what two systemic disease?
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DM and HTN
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What are three features of medial medullary syndrome?
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1.contralateral arm or leg weakness
2. contralateral decreased position and vibration sense 3. ipsilateral tongue weakness |
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Infarct of what brain area with what vascular supply causes medial medullary syndrome?
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medial medulla
paramedian branches of vertebral and anterior spinal arteries |
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What 4 structures are affected in medial medullary syndrome?
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pyramidal tract
medical meniscus hypoglossar nucleus CN 12 fascicles |
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What are the 4 features of Wallenberg syndrome?
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1. Ipsilateral ataxia, vertigo, nystagmus, nausea
2. Ipsilateral decreased pain and temperature sense on face 3. contralateral decreased pain and termperature sense on body 4. ipsilateral honer syndrome |
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Wallenberg syndrome is also known by what name?
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lateral medullary syndrome
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What region is affected by Wallenberg syndrome?
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lateral medulla
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What is vascular supply causing Wallenberg syndrome?
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Vertebral artery or PICA
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What are the 5 structures affected by lateral medullary syndrome?
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1. inferior cerebellar peduncle, vestibular nuclei - ataxia, nausea
2. trigeminal nucleus and tract - ipsilateral decreased pain and temp on face 3. Spinothalamic tract - contralateral decreased pain and temp on body 4. Descending sympathetic fibers - Ipsilateral horner syndrome 5. nucleus ambiguous - hoarseness and dysphagia |
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A pure motor ipsilateral hemiparesis is caused by injury to what structures?
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corticospinal and corticobulbar tracts
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What brain region is involved in a pure motor hemiparesis?
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medial pontine basis
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What are the 2 primary features of an infarction of the paramedian branches of the basilar artery, verntral territory?
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contralateral face, arm and leg weakness
dysarthria |
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Infarction of what artery causes contralateral face, arm and leg weakness and dysarthria?
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paramedian branches of basilar artery, ventral territory
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Medial pontine basis infarction causes what symptoms?
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contralateral face, arm and leg weakness and dysarthria
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Contralateral face, arm and leg weakness and dysarthria indicate a stroke of what brain region?
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medial pontine basis
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Millard Gubler syndrome is a stroke of what brain regions?
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medial pontine basis and tegmentum
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What anatomical structures are involved in Millard Gubler syndrome?
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corticospinal and corticobulbar tracts
fascicles of facial nerve |
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What arteries are involved in Martin Gubler syndrome?
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paramedian branches of basilar arthery, ventral and dorsal territories
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What are the main features of Millard Gubler syndrome?
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contralateral arm, and leg weakness
ipsilateral facial weakness |
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What are the 2 clinical features of AICA syndrome?
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Ipsilateral ataxia
Contralateral body decreased pain and temp sense |
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What brain region is affected by an infarct of the anterior inferior cerebellar artery?
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Lateral caudal pons
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What two anatomic structures and symptoms are involved in AICA syndrome?
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middle cerebellar peduncle - ipsilateral ataxia
spinothalamic tract-contralateral body decreased pain and temperature sense |
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Ipsilateral ataxia alone is called what syndrome?
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Superior cerebellar artery syndrome
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What 2 anatomic structures are affected by an infarct of the superior cerebeller artery?
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Superior cerebellar peduncle and cerebellum
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What brain area is involved in superior cerebellar artery stroke?
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Dorsolateral rostral pons
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What is another name fo a stroke of the dorsolateral rostral pons?
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SCA syndrome
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What single symptom is caused by an infarct of the superior cerebellar peduncle and cerebellum
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Ipsilateral atazia
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Weber syndrome affects what brain region?
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Midbrain basis
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What artery is involved in Weber syndrome?
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Branches of PCA and top of basilar artery
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What are the anatomic structures and symptoms features in Weber syndrome?
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1. oculomotor nerve fascilcles - ipsilateral CN 3 palsy
2. corticospinal tracts/cerebellar peduncle - contralateral hemiparesis |
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What region of the brain is involved in Claude syndrome?
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Midbrain tegmentum
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What are the symptoms of Claude syndrome?
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Ipsilateral CN 3 palsy
Contralateral ataxia |
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What artery is involved in Claude syndrome?
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Branches of PCA and top of basilar artery
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What anatomic structures and symptoms are associated with Claude syndrome?
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1. oculomotor nerve fascilcles - ipsilateral CN 3 palsy
2. red nucleus/superior cerebellar peduncle - contralateral ataxia |
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Ipsilateral CN 3 palsy and contralateral ataxia are caused by an infarct of what artery?
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Branches of PCA and top of basilar artery
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Ipsilateral CN 3 palsy, contralateral hemiparesis, and contralateral ataxia, tremor and involuntary movements are caused by an infarct of what artery in what brain area?
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branches of PCA and top of basilar artery; Midbrain basis and tegmentum
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Benedikt syndrome is an infarct of what artery?
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branches of PCA and top of basilar artery
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What are the three features of Benedikt syndrome?
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ipsilateral CN 3 palsy
contralateral hemiparesis contralateral ataxia, tremor, and involuntary movements |
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Dejerine-Roussy syndrome is a stroke of what brain region?
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Thalamus
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What anatomic structure and artery are affected in Dejerine-Roussy?
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Thalamic nuclei/branches of the PCA
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What are the 2 features of Dejerine-Roussy?
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1.Contralateral hemisensory loss to all sensory modalities
2.Contralateral hemibody pain |
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Contralateral hemisensory loss to all sensory modalities
and contralateral hemibody pain is what syndrome? |
Dejerine-Roussy syndrome
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Lesion of the occipital cortex is called what syndrome?
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Anton syndrome
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What are the 2 features of Anton syndrome?
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cortical blindnes
anosognosia |
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What artery is infarcted in Anton Syndrome?
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bilateral PCAs or top of the basilar artery
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What anatomic region is affected in Anton syndrome?
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primary visual cortex
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Cortical blindness and anosognosia is called what syndrome in what brain region?
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Anton Syndrome/Occipital cortex
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A lesion in what brain region and anatomic structure results in being able to write, but unable to read?
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Occipital cortex/Optic Pathway
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A lesion in the occipital cortex is called what syndrome?
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Alexia without agraphia
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What is the artery infarcted in a lesion resulting in being able to write, but unable to read?
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PCA
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A lesion in the optic pathway results in what 2 symptoms?
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Able to write
unable to read |
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A lesion of the bilateral ventral pons results in what syndrome?
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Locked-in syndrome
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An infarct in what artery results in locked-in syndrome?
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basilar
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What are the three anatomic structures and corresponding deficits in a bilateral basilar artery infarct?
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1. Corticospinal tracts - quadruplegia
2. Corticobulbar tracts - bilateral facial weakness and dysarthria 3. Bilateral CN6 fascicles - lateral gaze weakness |
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Cardioembolism accounts for what percentage of ischemic strokes?
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20%
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Stroke is correlated as well with what sleep disorder?
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Obstructive sleep apnea
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There is a significant reduction in ipsilateral stroke among those patients with what percentage carotid stenosis?
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70%
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What are the 3 elements of Virchow's triad?
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venous stasis
hypercoagulability endothelial injury |
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What are two studies to evaluate PE?
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spiral CT
V/Q scan |
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What lab test evaluates for CHP?
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brain natriuretic protien
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Does bed rest have an effect on development of PE after DVT?
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No
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Those patients returned to physical therapy few than ____ hours after discovery of DVT were at a higher risk for PE
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48 hours
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What two medical complications of stroke are associated with higher mortality rates?
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UTI
pneumonia |
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What is the most common imaging study for hydocephalus?
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CT
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What are two CT findings in hydrocephalus?
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dilatation of lateral ventricles
periventricular lucency |
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What is a major stroke location risk factor for hemorrhagic stroke seizures?
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cortical location of bleeding
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In ischemic stroke seizures are associated with what two features?
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cortical infarction
stroke severity |
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What stroke medical complicaton is a potent predictor of poor outcome?
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urinary incontinence
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What is the etiolgy of SIADH?
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lack of suppression of vasopressin release to hyposmolar serum
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What is the first line treatment of SIADH?
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free water restriction
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What medical condition is associated with poor functional outcomes after stroke?
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hyperglycemia
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What percentage of persons with a new stroke will have a second stroke within one year?
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14%
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What is the percentage of cerebral infarcts that convert to hemorrhagic strokes?
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8.5%
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What are the 5 risk factors for hemorrhagic stroke conversion?
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1. large infarcts
2. mass effect 3. hypodensity early on 4. exposure to thrombolytic drugs 5. age greater than 70 |
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CT scan in stroke is best at detecting what two conditions?
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hemorrhage and hydrocephalus
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What laboratory test is associated with an increased rate of medical complications in stroke?
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hypoalbuminemia
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What percentage of stroke patients have aspiration?
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42%
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What are two swallowing deficits caused by cortical strokes?
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decreased oral motor control
decreased pharyngeal peristalis |
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What are two swallowing deficits caused by brainstem or cerebellar strokes?
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decreased swallowing initiation
decreased swallowing coordination |
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In stroke, early tube feeding compared to withholding tube feeding was associated with what percentage reduction in risk of death?
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5.8%
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PEG tube feeding are superior to NGT in what laboratory metric?
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higher serum albumin
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What percentage of acute stroke patients have dysphagia on admission
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51%
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Those who require tube feedings at the end of their rehab stay carry a higher rate of what outcome?
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mortality
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What percentage of stroke patients have endocrine abnormalities?
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79% with 36% having thyroid dysfunction
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Flattened affect, hypophonia, and shortened responses are associated with lesions in what
3 brain areas? |
frontal
anterior temporal posterior limb of the internal capsule |
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What is the prevelence of stroke in the first three months?
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25 - 30%
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What is the prevelence of of depression in stroke at 1 to 2 years?
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16-19%
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What is the prevelence of depression in stroke at 3 years?
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29%
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What is an independent predictor of poststroke depression?
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previous history of mood disorder
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In stroke, recovery of muscle function tends to occur first from distal or proximal muscle groups?
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proximal
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Within what time period does most recovery in stroke occur?
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6 months
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What percentage of stoke survivors reach their maximal function recovery level within 6 weeks?
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80%
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What are the 7 flexor synergy patterns of the upper extremity?
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shoulder retraction
shoulder abduction shoulder external rotation elbow flexion forearm supination wrist flexion finger flexion |
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What are the 7 flexor synergy patterns of the lower extremity?
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hip flexion
hip abduction hip external rotation knee flexion ankle eversion dorsiflexion toe extension |
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What are the 6 extensor synergy patterns in the upper extremity?
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shoulder protraction
shoulder adduction elbow extension forearm pronation wrist extension finger flexion |
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What are the 6 extesor synergy patterns of the lower extremity?
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hip extension
hip adduction knee extension ankle inversion plantar flexion toe flexion |
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How many stages of recovery are there in Brunnstrom's staging?
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6
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What are the 9 predictors of unfavorable outcome in stroke?
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1. severity of stroke
2. history of previous stroke or commorbidities 3. poor cognition 4. urinary or bowel dysfunction 5. presence of visuospatial deficit such as hemianopsia or hemineglect 6. poor sitting balance 7. poor upper extremity motor 8. function of lack of motor recovery after 1 month low function score on admission 9. older age |
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What is the main basis of Bobath's method of stroke rehab?
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Reflex or synergy inhibition
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What is the basis of "Constraint-Induced Movement Therapy"?
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forced use of hemiparectic limb
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What is another name for Bobath's method?
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neurodevelopmental training (NDT)
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What is the basis of "body weight-supported treadmill training" (BWSTT)?
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use of harness to reduce load on the weak limb
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Is there any proven advantage to BWSTT?
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no
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There is strong evidence that "Therapeutic Electrical Stimulation" significantly improves what metric of stroke recovery?
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Walking speed
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What are two types of noninvasive cortical stimulation?
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transcranial magnetic stimulation
transcranial direct current stimulation |
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What side effect of noninvasive cortical stimulation is preventing patient recruitment?
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seizure risk
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What is the most common type of aphasia?
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transcortical global
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What is the second most common type of aphasia?
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anomic
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Global aphasia can evolve into what type of aphasia?
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Wernicke
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Broca aphasia can evolve into what type of aphasia?
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anomic
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What are the two best predictors of language outcome?
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initial stroke severity
initial severity of aphasia |
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By what time frame is there a statistical plateau of aphasia recovery?
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3 months
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What are the two commonly used methods for treating aphasia?
|
Function communication
Stimulation |
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What is the basis of the function communication therapy?
|
envi
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What are the 5 fluent aphasias?
|
Wernicke
Conduction TC conduction Anomic Optic |
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What are two associated signs of Brocas aphasia?
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right arm weakness
apraxia of speech |
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What is an associated visual symptom of Wernicke's aphasia?
|
superior visual field cut
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What is an associated sign of conduction aphasia?
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poor working memory
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What is an associated sign of TC motor aphasia?
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abulia
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What is an associated sign of TC Sensory aphasia?
|
Right visual field cut
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What is an associated sign of TC Mixed/Global aphasia?
|
right hemiplegia
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What 3 aphasias spare reading ability?
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Conduction
TC Motor Anomic |
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What 4 aphasias spare spelling ability?
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Conduction
TC Motor Anomic Optic |
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What is an associated sign of optic aphasia?
|
Right hemianopsia
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What aphasias have noun naming deficits?
|
Wernicke
Anomic |
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What aphasia has a poor verb naming ability?
|
Broca
|
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What 2 aphasias have good naming ability?
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Conduction
TC motor |
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What 3 aphasias have poor repetition ability?
|
Broca
Wernicke Conduction |
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What 2 aphasias have good comprehension?
|
Anomic
Optic |
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What 3 aphasias have intact words and simple sentences?
|
Broca
Conduction TC Motor |
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What 3 aphasias have poor comprehension?
|
Wernicke
TC Sensory TC Mixed/Global |
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A lesion to the left inferior frontal gyrus cause what type of aphasia?
|
Broca
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What is the vascular supply for Brocas aphasia?
|
MCA
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A lesion to the left posterior superior portion of the temporal gyrus causes what type of aphasia?
|
Wernicke
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A lesion to left arcuate fasciculus causes what type of aphasia?
|
Conduction
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What is the vascular supply in a conduction aphasia?
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MCA
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What is the vascular supply in a Wernicke aphasia?
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MCA
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A lesion to the left prefrontal area causes what type of aphasia?
|
TC Motor
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A lesion to the parieto-occipital area adjacent to the posterior temporal isthmus causes what type of lesion?
|
TC Sensory
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What is the vascular supply for a TC motor aphasia?
|
Anterior cerebral artery
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What is the vascular supply for a TC sensory aphasia?
|
Posterior cerebral artery
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TC mixed/global aphasias are caused by infarcts in what 3 arteries?
|
ACA, MCA , PCA
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Anomic aphasias are caused by a lesion in what area served by what artery?
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left angular gyrus/MCA
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Optic aphasias are caused by a lesion in what area served by what artery?
|
left occipital lobe/PCA
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TC sensory aphasias are caused by a lesion in what area served by what artery?
|
parieto-occipital area/PCA
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TC motor aphasias are caused by a lesion in what area served by what artery?
|
left prefrontal area/ACA
|
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Conduction aphasias are caused by a lesion in what area served by what artery?
|
left arcuate fasciculus/MCA
|
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Wernicke aphasias are caused by a lesion in what area served by what artery?
|
temporal gyrus/MCA
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Broca aphasias are caused by a lesion in what area served by what artery?
|
left inferior frontal gyrus/MCA
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