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Physical Conditions in Adults > Cerebrovascular Accident (CVA) > Flashcards

Cerebrovascular Accident (CVA) Flashcards

1
Q

What is a CVA?

A

sudden or gradual onset of neurological symptoms cause by diminished supply of blood to the brain

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2
Q

What is the 2nd leading cause of death and the third leading cause of disability in the world; 5th leading cause of death in the US?

A

Stroke

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3
Q

Risk factors for stroke

A

race

age

region

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4
Q

2 major subtypes of stroke

A

Ischemic and hemorrhagic

majority are ischemic

hemorrhagic are more severe

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5
Q

What are the layers of the skull/brain from superficial layers to deep layers?

A 
skin of scalp
periosteum
bone of skull
dura matter (periosteal and meningeal)
subdural space
arachnoid matter
subarachnoid space (containing blood vessels)
Pia matter
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6
Q

What happens if there is bleeding in subdual and subarachnoid space?

A

may result from an injury and causes pressure and swelling to the brain

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7
Q

What are the meninges of the brain?

A
  • dura matter
  • arachnoid matter
  • pia matter
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8
Q

What are the extracranial vessels?

A
  • 2 carotid arteries; located front of neck

- Vertebral arteries; located C6 – C2

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9
Q

What are the intracranial vessels?

A
  • Carotid siphon
  • Middle cerebral arteries
  • Basilar artery
  • Occipital lobes
  • Temporal lobes
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10
Q

What are the communicating arteries?

A
  • Anterior / posterior
  • Circle of Willis
  • Protects brain if blockage occurs
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11
Q

What functions/skills does the frontal lobe control?

A
  • Movement
  • Intelligence
  • Reasoning
  • Behavior
  • Memory
  • personality
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12
Q

What functions/skills does the cerebellum control?

A
  • balance
  • coordination
  • fine muscle control
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13
Q

What functions/skills does the insular cortex control?

A
  • pain perception
  • speech production
  • temperature sensation
  • memory
  • processing of social emotions
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14
Q

What functions/skills does the temporal lobe control?

A
  • hearing
  • language
  • word recognition
  • smell
  • memory
  • emotions
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15
Q

What functions/skills does the parietal lobe control?

A
  • intelligence
  • reasoning
  • telling right from left
  • language
  • sensation
  • reading
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16
Q

What functions/skills does the brain stem control?

A
  • breathing
  • blood pressure
  • heartbeat
  • swallowing
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17
Q

What functions/skills does the occipital lobe control?

A

vision

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18
Q

What may be seen in a patient with a cerebellar stroke?

A

-abnormal reflexes of the head and torso
-coordination and balance problems
-dizziness, nausea and vomiting
-Difficulty moving or feeling sensation in all four limbs.
-Clumsiness in an arm or leg, or unsteady walking or movement.
-Difficulty forming words.
-Eyes may look in different directions, gaze may be shaky, may be
unable to see in one or more directions

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19
Q

What may be seen in a patient with a brain stem (midbrain, pons, medulla) stroke?

A

Since all brain activity in both halves of the brain must go through the brain
stem on their way to the arms and legs, patients with a brain stem stroke
may not be able to move part or all of their bodies

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20
Q

Major types of ischemic strokes

A
  • Cryptogenic stroke
  • cardiogenic embolic stroke
  • small penetrating artery thrombosis (lacunar stroke)
  • large artery thrombosis (atherosclerotic disease)
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21
Q

Major types pf primary hemorrhagic strokes

A
  • subarachnoid hemorrhage

- intracerebral hemorrhage

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22
Q

What is an ischemic stroke?

A
  • Thrombotic; blood clot (thrombus) gradually builds, blocking artery
  • Embolic; clot in artery moves up bloodstream; formed elsewhere, occur during daytime activity
  • Lacunar (aka small strokes); small infarcts occurring in deep brain structures; small tertiary arteries in brain get blocked and lose blood supply to small part of brain
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23
Q

What is a hemorrhagic stroke?

A
  • Rupture in blood vessel (aneurysm)

- Bleeding into or around cerebral tissue (Intracerebral & subarachnoid)

24
Q

Signs and symptoms of a stroke

A

BEFAST: Balance issues, eyes, facial droop, arm weakness, speech difficulty, and time

sudden confusion or severe headache w/ no known cause

25
Q

Do patients who survive ischemic strokes or hemorrhagic strokes have better outcomes?

A

hemorrhagic

26
Q

What is Arteriovenous Malformation?

A

Arteries and veins usually terminate in capillaries but in av, there is a direct connection btwn arteries and veins causing high pressure which can cause it to burst- causes stroke

27
Q

What are the nonmodifiable risk factors for strokes?

A
  • Age-Stroke risk doubles after the age of 55 in both men and women
  • Gender- more common in women
  • Race/heredity- most common in African American and Hispanic b/c of their predisposition to issues like heart disease, etc
  • Prior stroke
28
Q

What are the modifiable risk factors for strokes?

A
  • high blood pressure- bp 160/90 are 10x more likely to have a stroke than those with 120/80
  • smoking- 2-3x more likely
  • diabetes- triples ridk
  • high cholesterol
  • inactivity
  • obesity
  • artery disease
  • TIAs
  • atrial fibrillation/heart disease- 5x more likely to have stroke
  • some blood disorders
  • alcohol intake
  • stress
29
Q

What condition affects 1/3 of stroke survivors?

A

depression

30
Q

Which pediatric age group is stroke more common?

A

younger than 2 years of age

50% ischemic

50-90% experience residual neuro deficits

31
Q

What are the signs and symptoms of a left-sided cerebral injury: middle cerebral artery?

A
  • right hemiplegia
  • Right side loss of voluntary movement / coordination (right side of face, trunk, extremities)
  • Impaired sensation (pain, temp, proprioception r. side)- hemianesthesia
  • Blind spots (usually right side of visual field)
  • Aphasia: language issue; speech, vocab issues
  • Dysarthria: coordination of mouth and tongue
  • Memory deficits, recent / past events
  • Slow, cautious, disorganized personality
32
Q

What are the signs and symptoms of a right-sided cerebral injury: middle cerebral artery?

A
  • Hemiparesis – weakness- left side of body
  • Hemiplegia – paralysis- left side of body
  • Impairment of sensation (touch, pain, temp, proprioception left side)
  • Spatial / perceptual deficits
  • Unilateral inattention- neglect
  • Dressing apraxia
  • Impaired left half of visual field in both eyes–(left homonymous hemianopsia )
  • Impulsivity – disorganized
  • overconfident
  • Impaired learning
33
Q

What are the signs and symptoms of an anterior cerebral artery stroke?

A
  • Paralysis of the lower extremity, (contralateral)
  • Can have UE paralysis as well, but less severe
  • Loss of sensation (contralateral)- toes, foot, leg
  • Loss of conscious control of bowel or bladder
  • Balance problems
  • Memory impairment
  • Whispered speech, or loss of all communication
  • Lack of spontaneity of emotion
  • May speak in whispered speech or lose al communication
34
Q

What are the signs and symptoms of a vertebrobasilar stroke?

A
  • Impaired coordination of the eyes
  • Loss of memory
  • Impaired temperature sensation
  • Clumsy movements of the hands
  • Vertigo, dizziness
  • Impaired ability to read and/or name objects
  • Dysphagia, drooling
  • Paralysis of the face, limbs, or tongue
35
Q

What are the signs and symptoms of Wallenberg’s Syndrome?

A
  • Brainstem stroke; occlusion of a vertebral or cerebellar artery
  • Impacts contralateral pain / temperature loss
  • Ipsilateral Horner’s syndrome: disruption of a nerve pathway from the brain to the face and eye on one side of the body; results in a decreased pupil size, a drooping eyelid and decreased sweating on the affected side of your face
  • Ataxia: degenerative disease of the nervous system
  • Dysphagia: inability to manage swallowing food
  • Facial sensory loss
36
Q

What are the signs and symptoms of Transient Ischemic Attacks (TIAs)?

A
  • Symptoms occur rapidly and last for <24 hours
  • 75% of TIA’s last < 5 min
  • High chance of having a major stroke within 5 years
  • Fleeting blindness in one eye
  • Hemiparesis
  • Dizziness
  • Double vision
  • Staggering
37
Q

What are the signs and symptoms of small strokes?

A
  • TIAs but last longer
  • May last longer than 24 hours
  • Results in only minor neurological deficits
  • RIND- Reversible Ischemic Neurological Deficit
  • PRIND- Partially Reversible Ischemic Neurological Deficit
38
Q

What is RIND- Reversible Ischemic Neurological Deficit?

A

A small stroke that will completely resolve and deficits

39
Q

What is PRIND- Partially Reversible Ischemic Neurological Deficit?

A

A small stroke episode lasting more than 72 hours leaving minor neurological impairments

40
Q

Prognosis following a stroke?

A
  • Depends where blood supply was lost and duration
  • May be Irreparable / permanent
  • Plasticity = recovery
  • ~ 90% of neuro recovery occurs within 3 months
  • Hemorrhagic strokes recover more slowly
  • Recovery of function greater in young clients
  • Possible spasticity, shoulder subluxation, depression, abnormal muscle tone, contractures
  • 3/4s of people who have a stroke will have one physical or cognitive issue w/in one year
41
Q

Techniques used to diagnose a stroke?

A
  • Computed Tomography (CT)
  • Magnetic Resonance Imaging (MRI)
  • Positron Emission Tomography (PET scan)
42
Q

Why is a Computed Tomography (CT) used to detect a stroke?

A
  • Radiographic
  • Differentiate between hemorrhagic and ischemic stroke
  • Can clarify location, mechanism and severity, but does not detect subtle changes
  • Most common tool used to diagnose CVA caused by hemorrhage
43
Q

Why is a Magnetic Resonance Imaging (MRI) used to detect a stroke?

A
  • More sensitive that CT and no radiation exposure
  • Better detection of ischemic areas (than CT)
  • Can distinguish between acute and chronic hemorrhage
44
Q

Why is a Positron Emission Tomography (PET scan) used to detect a stroke?

A
  • Not readily used to manage acute CVA

- Can help assess CVA progression to determine management

45
Q

What invasive technique is used to detect a stroke?

A

Cerebral angiography: Dye injection/ radiography of vascular system

46
Q

What kind of medical/surgical managements are used in stroke patients?

A

-Antiplatelet Therapy (aspirin therapy;
Low doses as preemptive therapy found to help prevent cardiovascular disease)

-Anticoagulants (Heparain- short term; Warfarin-longer term)

-Thrombolytics Therapy (tPA) (Used for dissolution of occluding thrombi;
Used acutely for MI and CVA; Acute CVA within 3 hours of onset)

  • Carotid artery stenting (CAS)
  • Surgical clipping or coiling (Effective for ruptured aneurysms or AVMs)
  • Superficial temporal artery bypass (Challenging to perform)
47
Q

What occurs in stage 1 of stroke recovery?

A

flaccidity; no voluntary movement

48
Q

What occurs in stage 2 of stroke recovery?

A

spasticity appears; minimal voluntary movement w/ synergistic pattern

49
Q

What occurs in stage 3 of stroke recovery?

A

increase in spasticity; patients gains voluntary control over synergy

50
Q

What occurs in stage 4 of stroke recovery?

A

decrease in spasticity; some movement outside synergy appears, but synergy dominates

51
Q

What occurs in stage 5 of stroke recovery?

A

further decrease in spasticity; more complex movement combinations are learned; synergies lose their dominance

52
Q

What occurs in stage 6 of stroke recovery?

A

Disappearance of spasticity; individual joints movements possible; coordination approaches normal

53
Q

What occurs in stage 7 of stroke recovery?

A

normal function

54
Q

What kind of impact can a CVA have on occupational performance?

A

Grooming

Bathing

Driving

Maintaining employment

Loss of leisure participation

Reading

Attention to task

Remembering important dates, people, time

Social engagement

Education / play

Sensory Functions: Protective Tactile, Proprioceptive, Visual field deficits, Perceptual deficits

Motor Functions: Abnormal tone

Mental Function

Emotional Function

55
Q

What are the 3 most common types of aphasia following a stroke?

A

global aphasia; speech isnt fluent, cannot comprehend spoken messages, cannot repeat words or phrases

broca’a aphasia: speech isnt fluent, can comprehend spoken messages, cannot repeat words or phrases

wernicke’s aphasia: fluent speech, cannot comprehend spoken messages, cannot repeat words or phrases

Physical Conditions in Adults (7 decks)

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