CVA

Question 1

what is the epidemiology of stroke?

Answer 1

4th leading cause of death

leading cause of long-term disability

of ischemic stroke survivors, 65+ incidences of disabilities observed at 6 months include:

• 50% hemiparesis
• 30% unable to walk w/out AD
• 26% dependent in ADLs
• 19% aphasia
• 35% depression

Question 2

what is a major contributing factor to stroke?

Answer 2

atherosclerosis

Question 3

what are modifiable risk factors?

Answer 3

HTN
cigarette smoking
heart disease
disorders of heart rhythm
peripheral artery disease
diabetes
sickle cell disease
high blood cholesterol
poor diet
physical inactivity
obesity

Question 4

what are stroke warning signs (FAST)?

Answer 4

Face drooping/numb

Arm weakness
- ask the person to raise both arms- does 1 drift?

Speech difficulty
- slurred? ask person to repeat a simple sentence m

Time
-call quickly! check the time so you’ll know when symptoms appeared

Question 5

what are the 3 types of stokes?

Answer 5

1- ischemic stroke

2- hemorrhagic stroke

3- transient ischemic attack

Question 6

what is an ischemic stroke?

Answer 6

obstruction of BF to the brain

• thrombosis- arterial, venous
• embolism
• or caused by conditions that produce systemic perfusion pressures (cardiac failure, significant blood loss)

80% of strokes are ischemic

Question 7

what is a hemorrhagic stroke?

Answer 7

rupture of flow of blood to the brain and preventing blood flow to the brain

3 types:
1- intracerebral
2- primary cerebral
3- subarachnoid

Question 8

what is an intracerebral hemorrhage (ICH)?

Answer 8

release of blood into brain tissue from rupture of cerebral vessel

Question 9

what is a primary cerebral hemorrhage ?

Answer 9

typically occurs in the small blood vessels weakened by arteriosclerosis producing an aneurysm

Question 10

what is a subarachnoid hemorrhage?

Answer 10

rupture of an aneurysm primarily affecting large blood vessels causing a bleed into the subarachnoid space

Question 11

what is a transient ischemic attack (TIA)?

Answer 11

“mini stroke” or “silent stroke” or temporary clot

• can be a precursor to CVA or MI
• don’t last more than 24 hours

Question 12

what is tPA?

Answer 12

“tissue plasminogen activator”

clot-bursting drug

reversal of stroke symptoms

the number of acute stroke victims in low

1- tPA can only be given w/in 3 hours

• ppl ignore symptoms
• stroke occurs in sleep

2- pts must have a CT scan before receiving the drug
-tPA is only effective in ischemic strokes

3- Dr.s are reluctant to give bc of risks:
-fatal hemorrhaging in 5%

Question 13

the internal carotid artery produces a massive infarction in :

Answer 13

both MCA and ACA territories

Question 14

the middle cerebral artery supplies where?

Answer 14

the entire lateral aspect of the cerebral hemispheres (frontal, temporal and parietal lobes) and subcortical structures

Question 15

where does the anterior cerebral artery supply?

Answer 15

the medial aspect of the cerebral hemispheres (frontal and parietal lobes) and subcortical structures including the basal ganglia

Question 16

where does the vertebrobasilar artery supply?

Answer 16

the cerebellum and medulla (vertebral artery) as well as the pons, internal ear and cerebellum (basilar artery)

Question 17

where does the posterior cerebral artery supply?

Answer 17

the corresponding occipital lobe and medial and inferior temporal lobe, upper brainstem, midbrain, posterior diencephalons and most of the thalamus

Question 18

what are clinical S&S of an infarct in the MCA on the non-dominant side?

(non-dominant: R hemisphere in R handed person)

Answer 18

weakness of L side of face, arm and (to lesser extent) leg

L sensory disturbance

visual disturbance: homonymous hemianopsia

confusion, sensory and/or motor neglect

Question 19

what are clinical S&S of an infarct in the MCA on the dominant side?

(dominant: L hemisphere stroke on R handed person)

Answer 19

weakness of R side of face and R arm (R leg less affected)

R sensory impairment

speech disturbance (dysphasia), Broca’s or Wernicke’s aphasia, including difficulty in comprehending written words and writing

visual disturbance: homonymous hemianopsia

Question 20

what are clinical S&S of an infarct in the ACA?

Answer 20

paresis of opposite foot and leg and to a lesser extent the arm *

mental impairments (perseveration, confusion and amnesia)

sensory impairments (primarily in LEs)

urinary incontinence

problems with imitation and bimanual tasks, apraxia

abulia (akinetic mutism), slowness, delay, lack of spontaneity, motor inaction

Question 21

what are clinical S&S of an infarct of the internal carotid artery?

Answer 21

mixture of MCA and ACA symptoms

Question 22

what are clinical S&S of an infarct of the veretebrobasilar artery?

Answer 22

location of occlusion determines S&S. Most common are:

1- Lateral medullary syndrome (Wallenberg’s) - occlusion of vertebral, posterior inferior cerebellar and basilar

2- Basilar artery syndrome- “locked in syndrome” - combo of various brainstem syndromes

Question 23

what are S&S of lateral medullary syndrome (Wallenberg’s)?

Answer 23

ipsilateral to lesion

decreased P&T sensation to face

ataxia of limb, falling to side of lesion

vertigo

nystagmus

Horner’s syndrome (miosis, pitosis, decreased sweating)

dysphagia, hoarseness, paralysis of vocal cord, diminished gag reflex)

sensory impairment and thermal sense over 50% of body, sometimes face

contralateral to lesion:
-impaired pain and thermal sense over 50% of body, sometimes face

Question 24

what are S&S of basilar artery syndrome (“locked in”)?

Answer 24

paralysis of weakness of all extremities

diplopia, paralysis of conjugate lateral or vertical gaze, internuclear opthalmoplegia, horizontal or vertical nystagmus

blindness, impaired vision

coma

sensation may be intact

thalamic pain syndrome

Question 25

what are clinical S&S of an infarct of the PCA in the peripheral territory?

Answer 25

contralateral or bilateral homonymous hemianopsia with some degree of macular sparing prosopagnosia dyslexia without agraphia, anomia (color naming) and color discrimination problems memory defect topographic disorientation

Question 26

what are clinical S&S of an infarct of the PCA in the central territory?

Answer 26

thalamic syndrome: sensory impairments (all modalities), spontaneous pain and dysethesias involuntary movements contralateral hemiplegia weber's syndrome (oculomotor nerve palsy and contralateral hemiplegia) paresis of vertical eye movements, slight mitosis and ptosis, and sluggish papillary light response

Question 27

L hemisphere strokes present with what common intellectual deficits?

Answer 27

disorganized problem solving difficulty initiating tasks, processing delays highly distractible, perseveration memory impairments

Question 28

R hemisphere strokes present with what common intellectual deficits?

Answer 28

difficulty with abstract reading, problem solving difficulty synthesizing info and grasping whole ideas rigidity of thought, memory impairment

Question 29

L hemisphere strokes present with what common perception/cognition impairments?

Answer 29

processing and producing language dominant hemisphere: Broca's, Wernicke's or global aphasia

Question 30

R hemisphere strokes present with what common perception/cognition impairments?

Answer 30

difficulty processing visual cues visuospatial disorders agnosias L unilateral neglect disturbance of body image and scheme

Question 31

L hemispheric strokes typically present with what impairments to academic skills?

Answer 31

reading performing math calculations

Question 32

R hemispheric strokes typically present with what impairments to academic skills?

Answer 32

math reasoning and judgement alignment of numeral in calculations

Question 33

L hemispheric strokes typically present with what impairments to task performance?

Answer 33

apraxia common; difficulty planning and sequencing movements ideational, ideomotor

Question 34

R hemispheric strokes typically present with what impairments to task performance?

Answer 34

sustaining a movement or posture fluctuations in performance

Question 35

what are common emotional deficits of a L hemispheric stroke?

Answer 35

expression of positive emotions

Question 36

what are common emotional deficits of a R hemispheric stroke?

Answer 36

expression of negative emotions

Question 37

patients with an infarct in the L hemisphere tend to be:

Answer 37

``` cautious anxious disorganized hesitant to try new tasks realistic ```

Question 38

patients with an infarct in the R hemisphere tend to :

Answer 38

be quick and impulsive overestimate their abilities be unaware or in denial of deficits have poor judgement have poor insight

Question 39

people with aphasia may:

Answer 39

be disrupted in their ability to use language in ordinary circumstances have difficulty communicating in daily activities have difficulty communicating at home, in social situations or at work feel isolated

Question 40

what is Broca's aphasia?

Answer 40

injury of the frontal regions of the L hemisphere causes different kinds of language problems may have difficulty forming complete sentences may get out some basic words to get their message across, but leave out words like "is" or "the" often say something that doesn't resemble a sentence can have difficulty understanding sentences can make mistakes in following directions like "left, right, under, and after"

Question 41

people with comprehension problems:

Answer 41

know that people are speaking to them can follow some of the melody of sentences-- realizing if someone is asking a question or expressing anger may have great difficulty understanding specific words may have great difficulty understanding how words go together to convey a complete thought

Question 42

what is wernicke's aphasia?

Answer 42

often say many words that don't make sense may fail to realize they are saying the wrong words ("gleeble") may string together a series of meaningless words that sound like a sentence but don't make sense have challenges bc our dictionary of words is in a similar region of the L hemisphere, near the area used for understanding words

Question 43

what is global aphasia?

Answer 43

when a stroke affects an extensive portion of the front and back regions of the L hemisphere may have great difficulty in understanding words and sentences may have great difficulty in forming words and sentences may understand some words get out a few words at a time have severe difficulties that prevent them from effectively communicating

Question 44

what is an important distinction to make when someone has aphasia?

Answer 44

the distinction between language and intelligence: many people mistakenly think they are not as smart as they used to be their problem is that they can't use language to communicate what they do know they can think, just can't say what they're thinking can remember familiar faces can get from place to place still have political opinions may still be able to play chess

Question 45

what is apraxia?

Answer 45

unable to perform tasks or movements when asked, even though: - the request or command is understood - they are willing to perform the task - the muscles needed to perform the task work properly - the task may have already been learned * it may be motor, verbal or perceptual/functional

Question 46

what is verbal apraxia?

Answer 46

difficulty initiating and executing voluntary movement patterns necessary to produce speech when there is no paralysis or weakness of speech muscles usually coupled with aphasia may cause difficulty: - producing desired speech sound - using the correct rhythm and rate of speaking

Question 47

what is buccofacial or orofacial apraxia?

Answer 47

can't carry out movements of the face on demand, such as licking lips, sticking out tongue, whistling

Question 48

what is ideational apraxia?

Answer 48

inability of the patient to produce movement either on command or automatically

Question 49

what is ideomotor apraxia?

Answer 49

pt. is unable to produce movement on command but is able to perform automatically. for instance, the pt. may fail to walk in a traditional manner. However, if a cup of coffee is placed on a table at the other end of the room and the pt. is told to "please have coffee", they pt. is likely to walk over and get it

Question 50

what is limb-kinetic apraxia?

Answer 50

difficulty making precise movements with an arm or leg

Question 51

what is agnosia?

Answer 51

loss of ability to recognize objects, persons, sounds, shapes, or smells while the specific sense is not defective nor is there any significant memory loss 1- visual 2- auditory 3- tactile

Question 52

what is visual agnosia called?

Answer 52

simultanagnosia= inability to perceive visual stimulus as a whole prospagnosia= inability recognize ambiguous stimuli (faces, birds) color agnosia= inability to recognize colors

Question 53

what is auditory agnosia?

Answer 53

inability to recognize non-speech sounds (doorbell vs. telephone)

Question 54

what is tactile agnosia called?

Answer 54

asterognosis

Question 55

what are 3 types of neglect?

Answer 55

1- visual - "visual field deficit" or "hemianopsia" 2- sensory - numbness or loss of feeling in the face, arm or leg. It may be temporary or more severe. 3- perceptual - impairment of judgement and poor safety awareness. - The inability to take in info and make sense of the surrounding world.