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46 Cards in this Set
- Front
- Back
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What is the difference between ischemic and hemorrhagic stroke? |
ischemic - clot blocks blood flow to brain hemorrhagic - vessel rupture causes bleeding in brain |
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What is the definition of a stroke? |
the sudden loss of neurological function caused by an interruption of the blood flow to the brain |
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Who are more likely to experience a stroke? |
Males and people who are >64 years of age |
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What is the mortality rate for stroke patients, is it increasing or decreasing? and why? |
decreasing because people become more aware of the symptoms and more knowledgeable about how to treat a stroke |
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What is the FIM? |
the functional independence measure is a scale rating for stroke patients. |
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What does a low FIM score indicate? |
a lower score indicates lower functional ability. |
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What is the max score of an FIM? |
126 |
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What are the requirements to be classified as a stroke? |
neurological deficits must persist for at least 24 hours |
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What is atherosclerosis? |
plaque formation with an accumulations of lipids, fibrin, complex carbohydrates and calcium deposits on arterial walls that lead to progressive narrowing of blood vessels |
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What is the major blood pathway of the brain? |
right subclavian splits into the right common carotid and the right vertebral. The right common carotid splits into the right internal carotid. The right vertebral splits off into the basilar artery. Left side is the same. |
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What is the circle of Willis? |
posterior and anterior communication, posterior, anterior and middle cerebral, internal carotid, basilar, and vertebral arteries make up the circle of willis, these arteries are affected when having a stroke |
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What is angulation, bifurcation, dilation and constriction? |
Arterialbifurcations – small blood vessel bleeds from a larger blood vessel causingclot to form (splitting of the artery) Constriction– clots lodge in the constricted vessel Dilation– artery gets larger in some places but remains smaller in others causing clot formation Angulation– bend in the vessel |
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What is the etiology of an ischemic stroke? |
embolism - dislodged blood clot or plaque thrombosis - blood clot |
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What is the etiology of a hemorrhagic stroke? |
cerebral bleeding - rupture of cerebral blood vessel subarachnoid - bleeding into the subarachnoid space usually from an aneurysm |
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What is the pathology of an ischemic stroke? |
1. release excess neurotransmitters into synaptic cleft 2.excess causes disruption in energy metabolism 3. this causes an increase in calcium ions and failure of neuronal membrane pump 4. excess calcium causes formation of substances that further damage brain cells |
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What is the pathology of a hemorrhagic stroke? |
1. atherosclerosis and hypertension 2. this causes weakening of small blood vessels in the presence of increased blood pressure 3. micro-aneurysms or arteriolar necrosis precipitate bleeding 4. more fluid in confined space increases intracranial pressure 5. adjacent brain tissue is displaced and compressed producing ischemia |
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What is a transient ischemic attack? |
focal areas of retinal and cerebral ischemia that do NOT last 24 hours. Good indicators of an oncoming stroke though. |
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Which arteries are strokes most affected? |
anterior and middle cerebral arteries (ACA, MCA) |
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what characteristics are shown in an ACA affected stroke? |
contralateral hemiparesis - mainly in lower extremities (impaired motor function) contralateral hemisensory loss- impaired sensation mainly in lower extremities |
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Which areas of the brain does the ACA supply blood to and how are they affected with a stroke? |
parietal lobe (primary sensory cortex) - impaired sensation frontal lobe (primary motor cortex) - paresis |
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Which artery is more common for a stroke ACA or MCA? |
MCA is the most common |
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What are the characteristics of an MCA affected stroke? |
contralateral spastic hemiparesis contralateral sensory loss of face UE and LE (>UE than LE) |
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What areas of the brain does the MCA supply blood to? how are these areas affected by a stroke? |
lateral apsects of frontal (motor impairment), parietal (sensory impairment) and temporal lobes (hearing). |
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What are the impairments associated with MCA? |
pareisis of face,arm + legs = motor cortex, and internal capsule (contralateral) impaired sensation = sensory cortex and internal capsule (contralateral) Brocas area = nonfluent aphasia wernickes area = fluent aphasia perceptual impairment = sensory association area loss of conjugate gaze = frontal eye fields (contralateral) homonymous hemianopia = optic radiation in internal capsule |
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What is Broca's aphasia? |
damage to anterior or central fissure of broca's area limited vocab and slow hesitant speech |
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What is Wernicke's aphasia? |
damage to posterior to central fissure of Wernicke's area impaired auditory comprehension and fluent speech with normal rate and melody |
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What is Homonymoushemianopia? |
impaired vision - cannot see half of their visual field (contralateral impairment) |
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What is Prosopagnosia? (perceptual impairment of a stroke) |
difficulty naming people on sight (face blindness) (posterior cerebral artery (PCA) damage) |
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What is Tactile Agnosia? (perceptual impairment of a stroke) |
unable to recognize items by handling them. (MCA damage) |
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What areas of the brain are associated with Agnosia (tactile and prosopagnosia)? |
somatosensory association area - parietal lobe visual association area - frontal lobe auditory association area - temporal lobe |
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What are the cognitive impairments of a stroke? |
memory - immediate and short term deficits are common (36% of stroke patients experience STM loss). long term memory deficits are less common executive functioning - enables purposeful behaviors |
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Which artery is responsible for impaired memory function with a stroke? |
hypothalamus is responsible for memory function whose blood supply comes from the PCA |
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which artery is responsible for impaired executive functioning with a stroke? |
pre-fontal cortex is responsible for executive functioning whose blood supply comes from the MCA |
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What is Dysphagia? How common is it in stroke patients? |
difficulty swallowing, 12% |
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Which artery is responsible for dysphagia in stroke pateients? |
verterbral artery supplies blood to the medulla which is responsible for controlled swallwoing |
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which artery is resposnible for pain in stroke patients? |
PCA supplies blood to the thalamic nuclei which is responsible for control over pain/senses. |
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What are Lacunar Stroke syndromes? |
they are arterial lesion in small vessels that penetrate into cerebral white matter. |
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what type of stroke is lacunar stroke syndrome associated with? |
hemorrhagic stroke |
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What are the impairments of a lacunar stroke syndrome and what area of the brain is affected? |
pure motor hemiplegia - lesion to the pons or internal capsule pure sensory hemiplegia - lesion to the internal capusle or thalamus |
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What is the blood supply to the internal capsule? |
-MCA, -lenticulostriate arteries supply: basal ganglia, caudate, globus pallidus, putamen -Head of the caudate nucleus - globus pallidus |
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Why are Lacunar Strokes noteworthy? |
they do not affect the higher processing areas of the brain - does not effect vision, language or consciousness they are more rapid and greater degree of recovery |
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How does a lesion to the UMN effect a stroke patient? |
loss of direct motor control of distal segments (LMN) + loss of indirect (modulation) of the distal segments in the corticospinal tract of the CNS |
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What is spacticity and what causes it? |
Spasticityis hypertonicity and is rate/force dependent. It occurs because UMNs no longer inhibit LMNs |
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what is rigidity? |
rigidity is hypertonicity and is the resistance to movement that is constant |
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What is the pattern of recovery for a stroke patient? |
1. flaccidity (hypotonicity) 2. spacticity (hypertonicity) 3. relative recovery |
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what are abnormal muscle synergies? |
cannot move one limb segment withoutthe rest of the limb moving |
