Cerebrovascular Accident

Question 1

What is a cerebrovascular accident (CVA)?

Answer 1

Specific event that results in a lack of oxygen supply to a specific area of the brain secondary to either ischemia or hemorrhage

Question 2

What are the primary risk factors that can lead to CVA?

Answer 2

• Hypertension
• Cardiac Disease or arrhythmias
• Diabetes mellitus
• Cigarette smoking
• Transient ischemic attacks

Question 3

What are secondary risk factors of the development of a CVA?

Answer 3

1. Obesity
2. High Cholesterol
3. Behaviors related to hypertension (i.e. stress, excessive salt intake)
4. Physical inactivity
5. Increased Alcohol consumption

Question 4

What are the types of CVA’s?

Answer 4

1. Transient Ischemic Attack (TIA)
2. Completed Stroke
3. Stroke Evolution
4. Ischemic Stroke
5. Hemorrhage

Question 5

Describe a TIA CVA?

Answer 5

• usually linked to an atherosclerotic thrombosis which causes a temporary interruption of blood upply to an area of the brain
• symptoms resolve quickly, typically within 24-48 hours

Question 6

Where does a TIA often occur?

Answer 6

Vertebrobasilar arteries and may incite future CVA

Question 7

What is a completed stroke?

Answer 7

A CVA that presents with total neurological deficits at onset

Question 8

What is a stroke in evolution?

Answer 8

CVA usually caused by a thrombus that gradually progresses

Total neurological deficits are not seen for one to tow days after onset

Question 9

Name the type of Ischemic Strokes.

Answer 9

Embolus (20% of Ischemic CVAs)

Thrombus

Question 10

What is an Embouls Ischemic Stroke associated with?

Answer 10

CVD, the embolus may be solid, liquid or gas, and can originate in any part of the body.

Question 11

Explain what happens with an Ischemic CVA caused by an embolus

Answer 11

Embolus travels through the bloodstream to the cerebral arteries causing occlusion of a blood vessel and a resultant infarct

• occurs rapidly with no warning; often presents with a headache
• tissues nearest the occlusion sustain higher permanent damage

Question 12

What artery is most commonly affected in regards to an embolic CVA?

Answer 12

Middle cerebral artery (MCA) from the internal carotid artery most commonly affected

Question 13

what are common cardiac disorders that can lead to embolism?

Answer 13

• valvular disease (i.e. rheumatic mitral stenosis)
• Ischemic heart disease
• acute myocardial infarction
• arrhytmias (i.e. atrial fibrillation)
• patent foramen ovale
• cardiac tumors
• post cardiac cathertizationd

Question 14

What is a thrombus CVA?

Answer 14

• atherosclerotic plaque develops in an artery and eventually occluded the artery or a branching artery causing an infarct.

Question 15

T or F: A thrombus CVA is extremely variable in onset where symptoms can appear in minutes or over several days AND typically occurs during sleep or upon awakening after a MI or p/o

Answer 15

True

Question 16

What are the characteristics of a Left CVA?

Answer 16

• Weakness, paralysis of the Right Side
• increased frustration
• decreased processing
• possible aphasia (expressive, receptive, global)
• possible dysphasia
• possible motor apraxia (ideomotor and ideational)
• decreased discrimination b/t left and right
• Right hemianopsia

Question 17

What are characteristics of a Right Hemisphere CVA?

Answer 17

• Weakness, paralysis of the left side
• decreased attention span
• Left hemianopsia
• decreased awareness and judgement
• memory deficits
• Left inattention
• decreased abstract reasoning
• Emotional lability
• Impulsive behaviors
• decreased station orientation

Question 18

What are the charateristics of a brainstem CVA?

Answer 18

• Unstable vital signs
• decreased consciousness
• decreased ability to swallow
• weakness on both sides of the body
• paralysis on both sides of the body

Question 19

What are the characteristics of a cerebellum CVA?

Answer 19

• ataxia
• decreased balance
• decreased coordination
• Nausea
• Decreased ability for posture adjustment
• Nystagmus

Question 20

What are synergies?

Answer 20

Synergy patterns result when the higher centers of the brain lose control and the uncontrolled or partially controlled stereotyped patterns of the middle and lower centers emerge

Question 21

What is a Flexor synergy of the UE?

Answer 21

*Flexor synergy is seen when the patient attempts to lift up their arm or reach for an object
Scapula: Elevation and retraction
Shoulder: abduction and ER
Elbow: Flexion
Forearm: supination 
Wrist: Flexion
Fingers: flexion with adduction
Thumb: Flexion and adduction

Question 22

Describe an Extensor Synergy of the UE.

Answer 22

Scapula: Depression and protraction
Shoulder: IR and Adduction
Elbow: Extension
Forearm: Pronation
Wrist: Extension
Fingers: Flexion with adduction
Thumb: Flexion and adduction

Question 23

Describe a flexor synergy of the LE?

Answer 23

Hip: Abduction and ER
Knee: Flexion
Ankle: DF with supination
Toes: Extension

*flexor synergy is characterized by great toe extension and flexion of the remaining toes secondary to spasticity

Question 24

Describe an Extensor Synergy of the LE.

Answer 24

Hip: Extension, IR, and adduction
Knee: Flexion
Ankle: PF with Inversion
Toes: Flexion and adduction

Question 25

What are some CVA tests and outcome measures?

Answer 25

1. National Institute of Health (NIH) stroke scale
2. Functional Independence Measure (FIM)
3. Stroke Impact Scale
4. Fugl-Meyer Assessment of Physical Performance

Question 26

Describe the NIH.

Answer 26

Assessment of an acute CVA relative to impairment

Question 27

Describe FIM.

Answer 27

Provides a level of burden through assessment of mobility and ADL management

Question 28

Describe the Stroke Impact Scale.

Answer 28

Assessment of physical and social disability or levle of impairment secondary to CVA

Question 29

Describe the Fugl-Meyer Assessment of Physical Performance.

Answer 29

Motor, sensory, and balance impairment; also assesses pain and ROM