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102 Cards in this Set
- Front
- Back
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What structures of the brain are supplied by the anterior cerebral artery?
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Primary motor and primary sensory cortex, corpus callosum, superior frontal gyrus
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CVA involving the anterior cerebral artery, what would you expect to find?
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-LE hemiparesis and loss of sensation
-Incontinence -Slowness, delay |
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What structures of the brain are supplied by the posterior cerebral artery?
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-Visual cortex, occipital lobe, CN3, corpus callosum, thalamus
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CVA involving the posterior cerebral artery, what would you expect to find?
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-Vision problems, Weber's syndrome, visual agnosia, dyslexia/color naming, involuntary movements such as chorea and athetosis, post stroke pain, memory difficulties
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What structures of the brain are supplied by the middle cerebral artery?
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Primary motor and sensory cortex, internal capsule, Premotor cortex, parietal and frontal/temporal lobes.
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CVA of middle cerebral artery, what would you expect to find?
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-UE and face paresis/sensory loss
-R parietal: perceptual deficiets, agnosia -L temporal/parietal: Broaca/Wernicke's aphasia -Ataxia, limb kinetic apraxia -Impaired auditory |
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What structures in the brain does the Internal Carotid artery supply?
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Interupts flow to the MCA and ACA
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What would you expect to see with a Internal Carotid CVA?
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Coma, uncal herniation, death, edema
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What does the Vertebrobasilar artery supply in the brain?
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Mostly cranial nerves (5-12, except for 11), corticospinal tract, spinothalamic tract, reticular system, medial lemniscus
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What deficiets would you expect to see with a Vertebrobasilar artery CVA?
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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
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Is a person with a R CVA aware or unaware of their impairments?
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Unaware
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If a patient has a CVA and is anxious about their performance, is it a R or L CVA?
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L - anxiety about poor performance
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Broca's cortical area would most likely be affected by a stroke involving what artery?
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Middle Cerebral Aterty on the L side
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Hemiparesis of what side and of what structures would indicate a CVA involving the middle cerebral artery?
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Contralateral side, UE and face
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A stroke affecting individual cranial nerves is most likely the result of which arterial syndrome?
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Vertebrobasilar
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Is a stroke progressive or non-progressive?
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Non-progressive disorder of the CNS aquired in adolescence or adulthood
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Why would someone have a stroke in early age?
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Family genetics indicating a hx of strokes and/or due to a heart condition
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How much time do you have to get help if someone is having an ischemic stroke?
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3 hour windom to get medical intervention
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What are some risk factors for having a stroke (7)?
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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 |
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What are some early warning signs for a CVA?
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Headache, weakness, numbness (usually in face and UE), trouble speaking, slurred speach, vision problems, dizziness, unsteadiness
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What is a CVA?
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Sudden loss of brain function caused by death of brain cells (neurons)
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There are two kinds of strokes, what are they?
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1. Ischemic
2. Hemorrhagic |
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What is an ischemic stroke and how common is it?
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An interruption of blood flow caused by blood clot. Most common kind of stroke, about 80% of strokes
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What is a hemorrhagic stroke and how common is it?
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A rupture of a blood vessel, 20% of strokes
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What is an thrombotic ischemic stroke?
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Blood clot within cerebral arteries or branches
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What is an embolic ischemic CVA?
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When a clot forms elsewhere in the body and travels to the brain.
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What is a TIA?
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Transient Ischemic Attack that lasts less than 24 hours and has no residual effects
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What is the purpose of meninges?
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They are a suspension system in which the brain and spinal cord are in.
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What are the three layers of meninges?
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1. Pia
2. Arachnoid 3. Dura |
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What is a subdural hematoma? How does it happen?
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Below the dura there is a cerebral vein tear, which causes a decrease in pressure, and slow onset of symptoms
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What is an epidural hematoma?
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"Around or surrounding the dura". Meingeal arteries tear and bleed. Rupture of blood vessels causes blood to go into the spaces.
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What happens as a result of a epidural hematoma?
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Increase in ICP which makes the brainstem be pushed through the foramen magnum causing brainstem dysfunction.
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Which of the two types of strokes is most common?
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Thrombotic stroke, 80% vs. Embolic 20%
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What happens during a hemorrhagic stroke?
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Uncontrolled bleeding in the brain, interruption of blood flow distally.
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What happens as a result of a hemorrhagic stroke?
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Increased ICP due to flooding.
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What is a subarachnoid hemorrhage?
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Aneurysm in walls of large blood vessels.
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What is a intracerebral hemorrhage?
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Rupture of cerebral blood vessel.
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Name two reasons why there would be structural problems with the blood vessels in the brain.
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Linked to chronic hypertension and arteriovenous malformation.
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Chronic hypertension could lead to...
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Weakening in blood vessel wall causing dilation causing an aneurysm.
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What are arteriovenous malformations?
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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.
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How are Arteriovenous Malformations diagnosed?
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MRI
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Medical management for a stroke depends on four things...what are they?
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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 |
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What are four interventions used with strokes?
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1. Drug therapy to dissolve clots
2. Surgery 3. Non-surgical procedures 4. Rehabilitation |
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What could be done with a surgery for a stroke?
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-Remove clot
-Repair vessels -Remove plaque from carotid artery via carotid endarterectomy |
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What are the requirements for getting a carotid endarterectomy?
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Has to have >70% blockage and have to have had a stroke or TIA.
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What types of drugs would be good for stroke?
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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.
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What type of stroke is drug therapy effective for? And within what time frame?
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Ischemic stroke, within 3 hours of onset
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What is the biggest KEY to address when dealing with strokes?
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PREVENTION!!
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What are three methods that are non-surgical for treatment of strokes?
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1. Angioplasty
2. Stent 3. Coiling aneurysms |
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How does an angioplasty work?
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Used to widen narrowed blood vessels via insertion of a balloon to smoosh plaque to sides and open up the vessel.
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How does a stent work?
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Wire mesh tube insertion into the vessel. Used to prevent blood vessel from collapsing or renarrowing.
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How does a coiling aneurysm work?
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Fills the blood vessel with a tiny flexible platinum coil to support it and try to keep it open.
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Generally speaking, what lobes of the brain does the MCA supply?
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Frontal, temporal, parietal.
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Generally speaking, what lobes of the brain does the ACA supply?
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Frontal and parietal
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Generally speaking, what lobes of the brain does the PCA supply?
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Occipital
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Generally speaking, what lobes of the brain does the Vertebrobasilar artery supply?
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Brainstem, medulla, pons, cerebellum
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The circle of Willis could help with a stroke in what artery?
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Anterior Cerebral Artery
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What artery is the most common to have a CVA in?
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Middle Cerebral Artery
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What are the classic manifestations of a MCA stroke?
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-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) |
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What are the classic manifestations of a ACA stroke?
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-LE > UE
-Contralateral hemiparesis -Sensory loss -Urinary incontinence -Apraxia (corpus callosum) |
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What are the classic manifestations of a PCA stroke?
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-Thalamic sensory syndrom, lots of pain
-Homonymous hemianopsia -Visual agnosia -Cortical blindness if bilateral -Amnesia (temporal lobe), memory issues |
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What are the clinical manifestations of a Vertebrobasilar artery stroke?
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"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 |
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Either side R or L stroke will present with:
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-Pain
-Visual field deficits (homonymous hemianopsia) -Motor deficits (weakness) -Abnormal synergy patterns, abnormal tone, abnormal reflexes, paresis |
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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 |
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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 |
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What are some of the systems involved in a stroke? (6)
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1. Cognitive
2. Behavioral 3. Communication, esp. in LCVA 4. Perceptual, esp. in RCVA 5. Visual: hemianopsia 6. Neuromuscular tone, balance, coordination |
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What are 3 ways you could assess cognition?
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1. Orientation x3
2. Mini Mental 3. Observation/Conversation |
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How would you assess behavior?
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Observe or ask them to do something.
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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 |
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How will you assess unilateral neglect?
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1. Line bisection
2. Cancellation test 3. Observe |
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Name three perceptual deficits you could see with a stroke patient.
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1. Apraxia
2. Spatial relationship 3. Somatoagnosia |
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What is apraxia? Name two types
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Inability to perform purposeful movement.
Ideational apraxia and Ideomotor apraxia |
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What is an example of spatial relationship deficit?
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Right-left discrimination
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What is somatoagnosia?
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Impairement in body scheme.
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How will you assess tone, flaccidity vs spasticity?
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1. Observe
2. ROM, spasticity is velocity dependent |
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How will you assess sensory deficits?
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Check dermatomes, peripheral nerves, hot vs. cold, eyes closed
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How will you assess coordination problems?
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Finger to nose, heel to shin, dysdiaokinesia, movements, walking.
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What types of things are you looking for when assessing coordination?
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1. Timing
2. Accuracy 3. Speed 4. Initiation/Termination |
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How can you assess motor planning?
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Ask them to do a task. Do they know how to stand up? Do they know how to dress themselves?
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What types of things should you look at when assessing balance?
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1. Static vs Dynamic
2. Motor strategies 3. Sitting vs Standing 4. Berg, POMA Observe initially |
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If someone has a hemiparesis, what do you want to look at and assess?
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1. ROM
2. Strength - agonists, antagonists 3. Synergies - stage of recovery |
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When doing a functional test, you should select a test that focuses on...(4)
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1. Transfers
2. Locomotion 3. Bed mobility 4. Gait - balance and coordination are more important here |
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Name two Quality of Life Assessment tests to use on stroke patients.
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1. SF-36 health status measure via questionnaire
2. Stroke-Impact Scale, after stroke |
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Name three Activity assessment tests to use on stroke patients.
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1. Functional Independence Measure (FIM)
2. Barthal 3. Berg Balance Scale |
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Name two Stroke specific assessment tests.
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1. Fugl Meyer
2. Modified Motor Assessment Scale (mMAS) |
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What level does the Fugl Meyer test at?
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Impairment level
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What types of things does the Fugl Meyer specifically look at?
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Can the patient move out of the synergy patterns?
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What movements happen with an UE FLEXION synergy? (Not spasticity)
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Scapula: retraction, elevation
Shoulder: ER, abduction Elbow: flexion Forearm: supination Wrist/Finger: flexion |
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What movements happen with an UE EXTENSION synergy? (Not spasticity)
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Scapula: protraction
Shoulder: IR, adduction Elbow: extension Forearm: pronation Wrist/Fingers: flexion |
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What movements happen with an LE FLEXION synergy? (Not spasticity)
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Hip: flexion, ER, abd
Knee: flexion Ankle: DF, inversion Toes: DF |
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What movements happen with an LE EXTENSION synergy? (Not spasticity)
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Hips: extension, IR, adduction
Knee: extension Ankle: PF, inversion Toes: PF |
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Describe Stage I of the Brunnstrom's Stages of Recovery.
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Stage I: flaccidity during acute phase, no movement can be elicited.
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Describe Stage II of the Brunnstrom's Stages of Recovery.
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Stage II: Basic limb synergies, minimal voluntary movement, spasticity
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Describe Stage III of the Brunnstrom's Stages of Recovery.
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Stage III: Some voluntary control of movement synergies, minimal movement out of synergy pattern, spasticity has increased. (Highest level)
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Describe Stage IV of the Brunnstrom's Stages of Recovery.
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Stage IV: Movements out of synergies, spasticity begins to decrease
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Describe Stage V of the Brunnstrom's Stages of Recovery.
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Stage V: More difficult movement combinations, limb synergies not dominant anymore.
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Describe Stage VI of the Brunnstrom's Stages of Recovery.
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Stage VI: Disappearence of spasticity, individual joint movements and coordination near normal.
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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 |
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What are the three impairment sections of the Fugl Meyer?
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1. Balance
2. Voluntary mvmts of UE/LE 3. Sensations |
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3 things to remember about the Fugl Meyer.
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1. Impairement level
2. Synergy patterns 3. The ability to move OUT of synergies |
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What are some Secondary Impairments as a result of a CVA?
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-Contractures
-Mobility deficits due to spasticity -Decreased endurance -Infection/Pneumonia -DVT -Shoulder Sublux/pain -Shoulder-hand syndrom aka RSD |
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When managing the rehabilitation of a patient w/ a CVA, who should be included?
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Patient and family, PT, OT, speech, Physician, Nurse, Case manager, medical social worker, neuropsychologist, recreational therapist.
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