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Aphasia > Aspects of Stroke > Flashcards

Aspects of Stroke Flashcards

1
Q

Stroke

A 
Brian Attack 
CVA
Mini-stroke 
Pin-Stroke 
TIA (transit ischemic attack) (transit=passing)
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2
Q

Stroke Awareness

A
  • 19% are unaware that stroke is preventable
  • 38% do not know where in the body a stroke occurs
  • 42% cannot identify the most common s/s of stroke (weakness/numbness)

-92% do not realize what a TIA represents
(smaller stroke is sign of something more to come)

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3
Q

Stroke Defined

A

Describes the clinical consequences of a focal or diffuse disruption of brain circulation secondary to an ischemic or hemorrhagic event

*Interruption of blood flow in the brain

50% of the general population is at risk
>50% of healthcare workers are at risk

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4
Q

Stroke Statistics

A
  • 3rd leading cause of death in the USA(Heart Disease is #1; Cancer is #2)
  • 750K new cases each year; 500K are preventable (Roughly 1 every 45s)
  • Every 3m a person dies from stroke
  • Leading cause of disability; 90% of survivors have deficits
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5
Q

Stroke Epidemiology

A

Age: risk for stroke doubles each decade after age 55y

Race: African Americans: 233/100K
Hispanics: 196/100K
Whites: 93/100K

Heredity: Paternal Stroke: 2x as likely for stroke
Maternal Stroke: 1.4x as likely for stroke

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6
Q

Time is brain…

A
  • 2 million brain cells die every minute during a stroke
  • 80% of strokes are preventable

Based on ~730K strokes annually:

  • Decrease heavy alcohol use: 34K
  • Decrease smoking: 90K
  • Decrease cholesterol: 145K
  • Decrease Hypertension: 360K; 130/85 is HTN
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7
Q

Atrial Fibrillation

A

Risk factor for stroke

AF is a type of irregular heartbeat resulting in ineffective pumping of one of the chambers of the heart
(a quivering in one of the chambers; can cause clot and therefore a stroke)

Impacts 2 million Americans:

  • 9% of persons age 65y+ have AF
  • s/s: rapid heartbeat, irregular heartbeat
  • tx: blood thinners; proper tx prevents stroke
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8
Q

Risk Factors for Stroke

A 
Diabetes
Physical Inactivity
Obesity (Metabolic Syndrome)
Oral Contraceptives
Alcohol Abuses
Illicit Drug Use
Hypercoagulable States
Dietary Factors
Infection/Inflammation
Hyperhomocysteinemia
Vascular Inflammation
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9
Q

Modifiable Risk Factors

A 
DM
HTN (120/80 is a sign of possible high blood pressure) 
Smoking
Alcohol Consumption
Obesity/Overweight
AF
High Cholesterol
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10
Q

Non-Modifiable Risk Factors

A 
Age
Race
Gender
Previous TIA/CVA
Family Hx
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11
Q

Common Stroke Symptoms

A
  • Sudden numbness or weakness
  • Sudden confusion trouble
  • Sudden trouble seeing in one
  • Sudden trouble walking dizziness loss
  • Sudden severe headache
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12
Q

Rapid Detection of Stroke

A

Follow the acronym FAST:

[F] FACE: Ask the Patient to smile; Any drooping?

[A] ARM: Ask the Person to raise both arms; Any drifting?

[S] SPEECH: Ask the Person to repeat simple sentences; Any dysarthria?

[T] TIME: Observe any signs; Call 911!

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13
Q

Stroke Classifications

A
  1. Ischemic
  2. Hemorrhagic
    - SAH
    - ICH
    - IVH
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14
Q

Ischemic Strokes

A

Occur when arteries are blocked by blood clots or by the build up of plaque and other fatty deposits

As such, blood flow is insufficient to a given area

*80%+ of strokes are ischemic in nature

Thrombotic
Embolic

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15
Q

Thrombotic (Ischemic Stroke)

A

blood clot forms within a blood vessel in the brain; vessel supplying blood to the brain

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16
Q

Embolic (Ischemic Stroke)

A

blood clot forms with in the heart or elsewhere, dislodges, and becomes lodged in the brain

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17
Q

Pulmonary Embolism

A

PE from a DVT

Lungs= pulmonary
PE is blood clot blocking the arteries of the lungs

s/s: SOA (shortness of air/breath); pain (can look like a heart attack)

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18
Q

Lacunar Infarct (Ischemia)

A

Obstruction of blood flow in the small, deep brain arteries; occur frequently in the BG, IC, TH, BS

-more focal

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19
Q

Ischemic Penumbra

A

The penumbra is an area of dysfunctional ischemic tissue; suggests a possible lacunar state

-the area that surrounds the blood clot (hyporefused) blood is not getting to this area; the area that is dying

20
Q

Hemorrhagic Stroke

A

Occurs when a blood vessel in the brain breaks leaking blood into the brain; accounts for ~15-17% of all stroke but are responsible for more than 30% of deaths

  • Intracerebral Hemorrhage
  • Subarachnoid Hemorrhage
  • Intraventricular Hemorrhage
21
Q

Intracerebral Hemorrhage

A

(inside the cortex)
Bleeding inside the brain

Results from chronic HTN

Often coincides w/severe headaches

22
Q

Subarachnoid Hemorrhage

A

Bleeding that occurs within the meninges

Possible rupture of an aneurysm

Sudden headaches with LOC

Women>Men

23
Q

Intraventricular Hemorrhage

A

Extension of both intracerebral hemorrhages and/or subarachnoid hemorrhages into the ventricular spaces

24
Q

Aneurysm

A

Localized, blood-filled dilation of a blood vessel caused by disease or weakening of a vessel wall

Commonly occur in arteries at the Circle of Willis or the aorta; bifurcation of vessel

Most common complaint is “pain behind the eyes”

  • can happen anywhere in the brain; it bursts and causes a hemorrhagic stroke
  • the blood is circling where it is pooled at and causes more pressure; high blood pressure causes more pressure
25
Q

Clipping an Aneurysm

A

-a way to fix an aneurysm

clip off the aneurysm and let it stay and blood will clot

-it is in violation of MKH but the brain will just work around it; leave clip in

26
Q

Coiling an Aneurysm

A

-another way to fix an aneurysm

put a mesh material up into the blood vessel till it fills the aneurysm and then makes a blood clot that “remakes” the wall

27
Q

Arteriovenous Malformation

A

(AVMs or AV Malformations)

The majority of cases involve a congenital disorder comprised of snarled tangles of arteries and veins

Impacts ~300K Americans occurring in males/females of all racial or ethnic backgrounds at equal rates

28
Q

AVMs damage the brain and/or spinal cord through three basic mechanisms:

A

Reducing the amount of oxygen reaching neurological tissue

Causing bleeding (hemorrhaging) into surrounding brain tissues

Compressing/Displacing parts of the brain or spinal cord

29
Q

Brainstem Stroke

A

Brainstem strokes are especially devastating

The brainstem controls all of our involuntary, life-support functions:

  • Breathing rate, BP, and heartbeat
  • Eye movements, Speech, Audition, and Deglutition
  • Patients may incur paralysis on unilateral or bilateral paralysis of the UE/LE due to cortical pathways

(hemorrhagic stroke is more devastating in brainstem than ischemic )

30
Q

Locked-In Syndrome

A

Neurological disorder characterized by paralysis of voluntary muscles in all parts of the body except for those that control eye movements

May result from TBI, diseases of the circulatory system, demyelinating diseases, or medication overdose

Persons are conscious with intact cognition but are unable to speak or move

Disorder leaves the patient completely mute/paralyzed

31
Q

Cerebellar Stroke

A

The cerebellum aids in control of our reflexes and assists in maintaining balance and coordination

A stroke that occurs at the cerebellar level may:

  • Abnormal reflexes of the head and torso
  • Coordination and balance problems
  • Vertigo
  • Nausea/Vomiting
32
Q

Strokes Can Happen in:

A
  • Cortical
  • Subcortical
  • Brainstem
  • Cerebellar
  • Spinal
33
Q

Medical Management of Hemorrhagic Strokes

A

Prevention is paramount through reducing modifiable risk factors

Identify s/s of CVA early: “Time is Brain”

GLUCOSE: Hypoglycemia mimics stroke

Control BP

Frequent neuro checks via NSG, MDs, Therapists

34
Q

Medical Management of Ischemic Strokes

A

Prevention is paramount through reducing modifiable risk factors

Identify s/s of CVA early: “Time is Brain”

GLUCOSE: Hypoglycemia mimics stroke

Identify etiology and reverse if able.

Frequent neuro checks via NSG, MDs, Therapists

Thrombolytic therapies (tPA)

35
Q

tPA (Tissue Plasminogen Activator)

A

(clot bluster)

Tissue plasminogen activator

Extreme criteria must be met before administration

  • Must be given (if IV) 180m post onset s/s of stroke
  • For some patients, tPA can be given at 4.5h
  • May be given within 6h if administered via intra-arterial catheter
  • tPA IS CONTRAINDICATED FOR HEMORRHAGIC STROKES
36
Q

tPA Contraindication

A 
Evidence of intracranial hemorrhage
Suspicion of subarachnoid hemorrhage
Recent ABI/TBI
Hx of CVA
Hx of intracranial hemorrhage
Uncontrolled HTN
Seizure at onset of CVA
Active internal bleeding
AVM
Aneurysm
37
Q

Other Ischemic Therapies

A

Catheter directed tPA

Endovascular retrieval

MERCI system

38
Q

MERCI system

A

-treatment for blood clots

put tube in blood vessel and find clot put screw in it then suck up the clot into the tube

-have to be careful because a piece can break off can causes a stroke

39
Q

Prognostic Indicators

A
  • YOUNG or Old with outgoing personalities
  • Treatment programs that were started EARLY or Late
  • Receptive or EXPRESSIVE aphasia
  • Patient’s that Do or DO NOT have perceptual or sensory impairments
  • ABIITY or Inability to self-correct
  • SINGLE or Multiple lesions
  • Patients whose treatment program was initiated BEFORE or After six month window (post stroke)
  • HIGHER or Lower intelligence
  • MILD-MODERATE or Severe Impairments
  • ABILITY or Inability to point to pictures when named
  • GOOD or Poor comprehension
  • Rigid or GO-WITH-THE-FLOW personality
  • Patient is INDEPENDENT or Dependent Upon the SLP
40
Q

Brodmann’s Areas Frontal Lobe

A

Area 4
Area 6
Area 44 and 45

41
Q

Brodmann’s Area Parietal Lobe

A

Area 3,1,2
Area 39
Area 40

42
Q

Brodmann’s Area Temporal Lobe

A

Area 41

Area 21 and 22

43
Q

Brodmann’s Area Occipital Lobe

A

Area 17

Area 18 and 19

44
Q

Functional Pathways

A 
Primary Visual Perception 
Wernicke's Area 
Auditory Perception 
Somatosensory Perception 
Primary Motor Function 
Broca's Area
45
Q

Pathways 1

A

The connection between Wernicke’s and Broca’s Areas mediates expression of language utterances in speech

The connection between Broca’s Area and the Primary Motor Strip mediates speech sound production

The connection between the Primary Auditory Cortex and Wernicke’s Area mediates language comprehension

46
Q

Pathways 2

A

The connection between Wernicke’s Area and the Visual Areas mediates reading ability

The connection between the Somatosensory Perception Area and Wernicke’s Area would mediate language reception via tracing letters on the skin or reading braille

Aphasia (7 decks)

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