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102 Cards in this Set

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What structures of the brain are supplied by the anterior cerebral artery?
Primary motor and primary sensory cortex, corpus callosum, superior frontal gyrus
CVA involving the anterior cerebral artery, what would you expect to find?
-LE hemiparesis and loss of sensation
-Incontinence
-Slowness, delay
What structures of the brain are supplied by the posterior cerebral artery?
-Visual cortex, occipital lobe, CN3, corpus callosum, thalamus
CVA involving the posterior cerebral artery, what would you expect to find?
-Vision problems, Weber's syndrome, visual agnosia, dyslexia/color naming, involuntary movements such as chorea and athetosis, post stroke pain, memory difficulties
What structures of the brain are supplied by the middle cerebral artery?
Primary motor and sensory cortex, internal capsule, Premotor cortex, parietal and frontal/temporal lobes.
CVA of middle cerebral artery, what would you expect to find?
-UE and face paresis/sensory loss
-R parietal: perceptual deficiets, agnosia
-L temporal/parietal: Broaca/Wernicke's aphasia
-Ataxia, limb kinetic apraxia
-Impaired auditory
What structures in the brain does the Internal Carotid artery supply?
Interupts flow to the MCA and ACA
What would you expect to see with a Internal Carotid CVA?
Coma, uncal herniation, death, edema
What does the Vertebrobasilar artery supply in the brain?
Mostly cranial nerves (5-12, except for 11), corticospinal tract, spinothalamic tract, reticular system, medial lemniscus
What deficiets would you expect to see with a Vertebrobasilar artery CVA?
CN 5-12 loss except for 11, ataxia, paralysis to face, UE, LE, impaired tactile proprioception, contralateral to lesion is pain/temp., Horner's syndrome, coma
Is a person with a R CVA aware or unaware of their impairments?
Unaware
If a patient has a CVA and is anxious about their performance, is it a R or L CVA?
L - anxiety about poor performance
Broca's cortical area would most likely be affected by a stroke involving what artery?
Middle Cerebral Aterty on the L side
Hemiparesis of what side and of what structures would indicate a CVA involving the middle cerebral artery?
Contralateral side, UE and face
A stroke affecting individual cranial nerves is most likely the result of which arterial syndrome?
Vertebrobasilar
Is a stroke progressive or non-progressive?
Non-progressive disorder of the CNS aquired in adolescence or adulthood
Why would someone have a stroke in early age?
Family genetics indicating a hx of strokes and/or due to a heart condition
How much time do you have to get help if someone is having an ischemic stroke?
3 hour windom to get medical intervention
What are some risk factors for having a stroke (7)?
1. High BP and cholesterol
2. Atherosclerosis and heart disease
3. Diabetes
4. Smoking, alcohol use
5. Overweight
6. Previous stroke or TIA
7. Family history
What are some early warning signs for a CVA?
Headache, weakness, numbness (usually in face and UE), trouble speaking, slurred speach, vision problems, dizziness, unsteadiness
What is a CVA?
Sudden loss of brain function caused by death of brain cells (neurons)
There are two kinds of strokes, what are they?
1. Ischemic
2. Hemorrhagic
What is an ischemic stroke and how common is it?
An interruption of blood flow caused by blood clot. Most common kind of stroke, about 80% of strokes
What is a hemorrhagic stroke and how common is it?
A rupture of a blood vessel, 20% of strokes
What is an thrombotic ischemic stroke?
Blood clot within cerebral arteries or branches
What is an embolic ischemic CVA?
When a clot forms elsewhere in the body and travels to the brain.
What is a TIA?
Transient Ischemic Attack that lasts less than 24 hours and has no residual effects
What is the purpose of meninges?
They are a suspension system in which the brain and spinal cord are in.
What are the three layers of meninges?
1. Pia
2. Arachnoid
3. Dura
What is a subdural hematoma? How does it happen?
Below the dura there is a cerebral vein tear, which causes a decrease in pressure, and slow onset of symptoms
What is an epidural hematoma?
"Around or surrounding the dura". Meingeal arteries tear and bleed. Rupture of blood vessels causes blood to go into the spaces.
What happens as a result of a epidural hematoma?
Increase in ICP which makes the brainstem be pushed through the foramen magnum causing brainstem dysfunction.
Which of the two types of strokes is most common?
Thrombotic stroke, 80% vs. Embolic 20%
What happens during a hemorrhagic stroke?
Uncontrolled bleeding in the brain, interruption of blood flow distally.
What happens as a result of a hemorrhagic stroke?
Increased ICP due to flooding.
What is a subarachnoid hemorrhage?
Aneurysm in walls of large blood vessels.
What is a intracerebral hemorrhage?
Rupture of cerebral blood vessel.
Name two reasons why there would be structural problems with the blood vessels in the brain.
Linked to chronic hypertension and arteriovenous malformation.
Chronic hypertension could lead to...
Weakening in blood vessel wall causing dilation causing an aneurysm.
What are arteriovenous malformations?
Developmental abnormalities with arteries connected to veins by thin walled vessels. Constant dilation of vessels can lead to a rupture. Arteries and veins interconnected without a capillary bed. Weak, poor blood flow.
How are Arteriovenous Malformations diagnosed?
MRI
Medical management for a stroke depends on four things...what are they?
1. Type of stroke via CT scan within 3 hours of onset of Sx
2. Time Elapsed determines what medications are given in ER
3. Severity
4. Age and general status via PLOF, health condition
What are four interventions used with strokes?
1. Drug therapy to dissolve clots
2. Surgery
3. Non-surgical procedures
4. Rehabilitation
What could be done with a surgery for a stroke?
-Remove clot
-Repair vessels
-Remove plaque from carotid artery via carotid endarterectomy
What are the requirements for getting a carotid endarterectomy?
Has to have >70% blockage and have to have had a stroke or TIA.
What types of drugs would be good for stroke?
Thrombolytics to dissolve the clot if administered within the right amount of time. t-PA Tissue Plasminogen activator. Anticoagulant (heparin/coumadin), antiplatelet drugs (asprin), medications for HBP, cholesterol, etc.
What type of stroke is drug therapy effective for? And within what time frame?
Ischemic stroke, within 3 hours of onset
What is the biggest KEY to address when dealing with strokes?
PREVENTION!!
What are three methods that are non-surgical for treatment of strokes?
1. Angioplasty
2. Stent
3. Coiling aneurysms
How does an angioplasty work?
Used to widen narrowed blood vessels via insertion of a balloon to smoosh plaque to sides and open up the vessel.
How does a stent work?
Wire mesh tube insertion into the vessel. Used to prevent blood vessel from collapsing or renarrowing.
How does a coiling aneurysm work?
Fills the blood vessel with a tiny flexible platinum coil to support it and try to keep it open.
Generally speaking, what lobes of the brain does the MCA supply?
Frontal, temporal, parietal.
Generally speaking, what lobes of the brain does the ACA supply?
Frontal and parietal
Generally speaking, what lobes of the brain does the PCA supply?
Occipital
Generally speaking, what lobes of the brain does the Vertebrobasilar artery supply?
Brainstem, medulla, pons, cerebellum
The circle of Willis could help with a stroke in what artery?
Anterior Cerebral Artery
What artery is the most common to have a CVA in?
Middle Cerebral Artery
What are the classic manifestations of a MCA stroke?
-Cerebral edema, increase ICP
-Contralateral spastic hemiparesis and sensory loss
-Face and UE > LE
-Aphasia (if L)
-Perceptual (if R)
-Homonymous hemianopsia (visual field defect)
What are the classic manifestations of a ACA stroke?
-LE > UE
-Contralateral hemiparesis
-Sensory loss
-Urinary incontinence
-Apraxia (corpus callosum)
What are the classic manifestations of a PCA stroke?
-Thalamic sensory syndrom, lots of pain
-Homonymous hemianopsia
-Visual agnosia
-Cortical blindness if bilateral
-Amnesia (temporal lobe), memory issues
What are the clinical manifestations of a Vertebrobasilar artery stroke?
"Locked-In" Syndrome: tetraplegia, preserved consciousness and sensation, vertical gaze is only voluntary movement.

Cerebellar and Cranial Nerve impairments. Coordination and balance issues.

Coma, death
Either side R or L stroke will present with:
-Pain
-Visual field deficits (homonymous hemianopsia)
-Motor deficits (weakness)
-Abnormal synergy patterns, abnormal tone, abnormal reflexes, paresis
A R Cva will have:
-What kind of behavior?
-Awarenss of impairments?
-Difficulty processing what kind of cues?
-What kind of deficits?
-Quick impulsive behavior at risk for falls and fx
-Safety/judgement
-UNaware of impairments
-Difficulty processing visual cues, so demonstration with them may not be the best teaching method
-Perceptual deficits via disturbance in body image, and body scheme, neglect
A L CVA will have:
-What kind of movements?
-Awareness of impairments?
-Difficulty processing what kind of cues?
-Major deficit if on this side...
-Slow, cautious
-Aware of impairments/realistic and hesitent about movements
-Difficulty processing verbal cues, so demonstration would work with them
-Aphasia
-Anxiety about movements
What are some of the systems involved in a stroke? (6)
1. Cognitive
2. Behavioral
3. Communication, esp. in LCVA
4. Perceptual, esp. in RCVA
5. Visual: hemianopsia
6. Neuromuscular tone, balance, coordination
What are 3 ways you could assess cognition?
1. Orientation x3
2. Mini Mental
3. Observation/Conversation
How would you assess behavior?
Observe or ask them to do something.
How will you assess:
1. Receptive aphasia?
2. Expressive aphasia?
3. Motor speech/dysarthria?
4. Auditor deficits
1. Can speak, can't comprehend
2. Can't speak, can comprehend, ask them to write!
3. Speech impediment, can comprehend, ask them to write!
4. Conversation
How will you assess unilateral neglect?
1. Line bisection
2. Cancellation test
3. Observe
Name three perceptual deficits you could see with a stroke patient.
1. Apraxia
2. Spatial relationship
3. Somatoagnosia
What is apraxia? Name two types
Inability to perform purposeful movement.

Ideational apraxia and Ideomotor apraxia
What is an example of spatial relationship deficit?
Right-left discrimination
What is somatoagnosia?
Impairement in body scheme.
How will you assess tone, flaccidity vs spasticity?
1. Observe
2. ROM, spasticity is velocity dependent
How will you assess sensory deficits?
Check dermatomes, peripheral nerves, hot vs. cold, eyes closed
How will you assess coordination problems?
Finger to nose, heel to shin, dysdiaokinesia, movements, walking.
What types of things are you looking for when assessing coordination?
1. Timing
2. Accuracy
3. Speed
4. Initiation/Termination
How can you assess motor planning?
Ask them to do a task. Do they know how to stand up? Do they know how to dress themselves?
What types of things should you look at when assessing balance?
1. Static vs Dynamic
2. Motor strategies
3. Sitting vs Standing
4. Berg, POMA
Observe initially
If someone has a hemiparesis, what do you want to look at and assess?
1. ROM
2. Strength - agonists, antagonists
3. Synergies - stage of recovery
When doing a functional test, you should select a test that focuses on...(4)
1. Transfers
2. Locomotion
3. Bed mobility
4. Gait - balance and coordination are more important here
Name two Quality of Life Assessment tests to use on stroke patients.
1. SF-36 health status measure via questionnaire
2. Stroke-Impact Scale, after stroke
Name three Activity assessment tests to use on stroke patients.
1. Functional Independence Measure (FIM)
2. Barthal
3. Berg Balance Scale
Name two Stroke specific assessment tests.
1. Fugl Meyer
2. Modified Motor Assessment Scale (mMAS)
What level does the Fugl Meyer test at?
Impairment level
What types of things does the Fugl Meyer specifically look at?
Can the patient move out of the synergy patterns?
What movements happen with an UE FLEXION synergy? (Not spasticity)
Scapula: retraction, elevation
Shoulder: ER, abduction
Elbow: flexion
Forearm: supination
Wrist/Finger: flexion
What movements happen with an UE EXTENSION synergy? (Not spasticity)
Scapula: protraction
Shoulder: IR, adduction
Elbow: extension
Forearm: pronation
Wrist/Fingers: flexion
What movements happen with an LE FLEXION synergy? (Not spasticity)
Hip: flexion, ER, abd
Knee: flexion
Ankle: DF, inversion
Toes: DF
What movements happen with an LE EXTENSION synergy? (Not spasticity)
Hips: extension, IR, adduction
Knee: extension
Ankle: PF, inversion
Toes: PF
Describe Stage I of the Brunnstrom's Stages of Recovery.
Stage I: flaccidity during acute phase, no movement can be elicited.
Describe Stage II of the Brunnstrom's Stages of Recovery.
Stage II: Basic limb synergies, minimal voluntary movement, spasticity
Describe Stage III of the Brunnstrom's Stages of Recovery.
Stage III: Some voluntary control of movement synergies, minimal movement out of synergy pattern, spasticity has increased. (Highest level)
Describe Stage IV of the Brunnstrom's Stages of Recovery.
Stage IV: Movements out of synergies, spasticity begins to decrease
Describe Stage V of the Brunnstrom's Stages of Recovery.
Stage V: More difficult movement combinations, limb synergies not dominant anymore.
Describe Stage VI of the Brunnstrom's Stages of Recovery.
Stage VI: Disappearence of spasticity, individual joint movements and coordination near normal.
The Fugl Meyer tests is:
1. ____ specific
2. ____ based
3. Based on ________
4. Why is it good scientifically from a research stand point?
1. Disease specific to CVA
2. Performanced based
3. Based on Brunnstrom's stages of recovery
4. Reliable, content validity, predictive validity, criterion-based
What are the three impairment sections of the Fugl Meyer?
1. Balance
2. Voluntary mvmts of UE/LE
3. Sensations
3 things to remember about the Fugl Meyer.
1. Impairement level
2. Synergy patterns
3. The ability to move OUT of synergies
What are some Secondary Impairments as a result of a CVA?
-Contractures
-Mobility deficits due to spasticity
-Decreased endurance
-Infection/Pneumonia
-DVT
-Shoulder Sublux/pain
-Shoulder-hand syndrom aka RSD
When managing the rehabilitation of a patient w/ a CVA, who should be included?
Patient and family, PT, OT, speech, Physician, Nurse, Case manager, medical social worker, neuropsychologist, recreational therapist.