Cerebrovasular Accident (CVA)

Question 1

What is a CVA?

Answer 1

Occurs when the blood supply to the brain is interrupted or reduced resulting in a lack of oxygen supply to a specific area of the brain.

Question 2

______ strokes occur in 80% of cases.

Answer 2

Ischemic strokes

Question 3

What are 4 types of ischemic strokes?

Answer 3

Cerebral thrombosis
Cerebral embolism
Hemorrhagic stroke
Transient ischemic attack (TIA)

Question 4

What is a cerebral thrombosis?

Answer 4

Formation or development of blood clot or thrombus within the cerebral arteries or their branches

Question 5

What is a cerebral embolism?

Answer 5

Traveling bits of matter (thrombi, tissue, fat, air, bacteria) that produce occlusion and infarction in the cerebral arteries

Question 6

What is a hemorrhagic stroke?

Answer 6

Abnormal bleeding as a result of rupture of a blood vessel

Question 7

What is a transient ischemic attack (TIA)?

Answer 7

A temporary period of symptoms resulting from decrease blood supply to the brain; there is no permanent damage

Question 8

What is a major precursor for stroke in one-third of patients?

Answer 8

Transient ischemic attack (TIA)

Question 9

List 5 primary risk factors for stroke.

Answer 9

Hypertension
Cardiac disease or arrhythmias 
Diabetes 
Cigarette smoking 
Atherosclerosis

Question 10

What is cerebral anoxia?

Answer 10

Lack of oxygen supply to the brain (irreversible anoxic damage to the brain begins after 4-6 minutes)

Question 11

What is cerebral infarction?

Answer 11

Irreversible cellular damage

Question 12

What is cerebral edema?

Answer 12

Accumulation of fluids within the brain; causes further dysfunction; elevates intracranial pressures, can result in herniation and death.

Question 13

List 8 characteristics of CVA affecting the left hemisphere.

Answer 13

1. Weakness, paralysis of the right side
2. Increased frustration
3. Decreased processing
4. Possible aphasia
5. Possible dysphagia
6. Possible motor apraxia
7. Decreased discrimination between left and right
8. Right hemianopsia

Question 14

List 10 characteristics of CVA affecting the right hemisphere.

Answer 14

1. Weakness, paralysis of the left side
2. Left hemianopsia
3. Left in attention
4. Decreased attention span
5. Decreased awareness and judgement
6. Decreased abstract reasoning
7. Decreased spatial orientation
8. Memory deficits
9. Emotional lability
10. Impulsive behaviors

Question 15

List 5 characteristics of CVA affecting the brainstem.

Answer 15

1. Unstable vital signs
2. Decreased consciousness
3. Decreased ability to swallow
4. Weakness on both sides of the body
5. Paralysis on both sides of the body

Question 16

List 6 characteristics of CVA affecting the cerebellum.

Answer 16

1. Decreased balance
2. Ataxia
3. Decreased coordination
4. Nausea
5. Decreased ability for postural adjustment
6. Nystagmus

Question 17

What deficits are expected with a stroke affecting the cortex and internal capsule? (3)

Answer 17

Contralateral hemiplegia
Contralateral hemisensory loss
Homonymous hemianopsia

Question 18

What areas of the body are spared with an infarct to the MCA versus the ACA?

Answer 18

MCA syndrome = LE more spared

ACA syndrome = UE more spared

Question 19

What deficits are expected with a stroke affecting the primary visual cortex/occipital lobe (PCA syndrome)?

Answer 19

Contralateral sensory loss
Involuntary movements (choreoathetosis, tremor, hemiballismus)
Transient contralateral hemiparesis
Homonymous hemianopsia

Question 20

What deficits are expected with a stroke affecting the midbrain? (2)

Answer 20

Contralateral hemiplegia

Possible contralateral CN III palsy

Question 21

What deficits are expected, ipsilateral to the lesion, with medial inferior pontine syndrome?(4)

Answer 21

Cerebellar ataxia
Nystagmus
Paralysis of conjugate gaze to side of lesion
Diplopia

Question 22

What deficits are expected, contralateral to the lesion, with medial inferior pontine syndrome? (2)

Answer 22

Hemiparesis UE, LE

Impaired sensation

Question 23

What deficits are expected, ipsilateral to the lesion, with lateral inferior pontine syndrome? (5)

Answer 23

Cerebellar: ataxia, nystagmus, vertigo 
Facial paralysis
Paralysis of conjugate gaze to side of lesion
Deafness, tinnitus 
Impaired facial sensation

Question 24

What deficits are expected, contralateral to the lesion, with lateral inferior pontine syndrome? (1)

Answer 24

Impaired pain and temperature sensation half of body

Question 25

What deficits are expected with locked in syndrome? (5)

Answer 25

``` Tetraplegia Lower bulbar paralysis (CN V-XII) Mutism Preserved consciousness Preserved vertical eye movements and blinking ```

Question 26

What deficits are expected, ipsilateral and contralateral to the lesion, with medial medullary syndrome?

Answer 26

``` Ipsilateral = paralysis of half of the tongue Contralateral = Hemiplegia of UE/LE and impaired sensation ```

Question 27

Describe the position of the UE with a flexor synergy (7).

Answer 27

``` Scapular elevation and retraction Shoulder abduction and ER Elbow flexion Forearm supination Wrist flexion Finger flexion and adduction Thumb flexion and adduction ```

Question 28

Describe the position of the UE with a extensor synergy (7).

Answer 28

``` Scapular depression and protraction Shoulder adduction and IR Elbow extension Forearm pronation Wrist extension Finger flexion with adduction Thumb flexion and adduction ```

Question 29

Describe the position of the LE with a flexor synergy (4).

Answer 29

Hip abduction and ER Knee flexion Ankle DF and supination Toe extension

Question 30

Describe the position of the LE with a extensor synergy (4).

Answer 30

Hip extension, adduction and IR Knee extension Ankle PF and inversion Toe flexion and adduction

Question 31

List 4 outcome measures that are used specifically to assess impairments secondary to CVA.

Answer 31

1. National Institute of Health (NIH) Stoke scale: assessment of an acute CVA relative to impairment 2. Functional Independence Measure (FIM): provides a level of burden through assessment of mobility and ADL management 3. Stroke Impact Scale: assessment of physical and social disability or level of impairment secondary to CVA 4. Fugl-Meyer Assessment of Physical Performance: motor, sensory, and balance impairment; also assesses pain and ROM

Question 32

List Brunnstrom's seven stages of recovery.

Answer 32

Stage 1: No volitional movement initiated, flaccid Stage 2: Emergence of spasticity, hyperreflexia, synergies Stage 3: voluntary movement possible, but only in synergies, spasticity increases. Stage 4: voluntary control in isolated joint movements emerging, decrease in spasticity and synergies Stage 5: increasing voluntary control out of synergy; coordination deficits present Stage 6: isolated joint movements are performed with coordination Stage 7: normal motor function is restored