CVA Flashcards by Eden McDaniel

Brain attack

Sudden loss of neurological function caused by an interruption of the blood flow to the brain (with effects lasting more than 24 hours)

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Early warning signs of stroke

Sudden:

numbness/weakness of face/arm/leg esp on one side of body
confusion, trouble speaking or understanding
trouble seeing in one eye
walking/dizzy/LOB/coordination
severe headache with no known cause

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Is stroke a leading cause of death?

yes.

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Which type of stroke is “more survivable”? More prevalent?

Ischemic for both.

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Thrombolic ischemic stroke

Atherosclerotic plaques form  
Intermittent blockage (cerebral vasospasm) may progress to permanent damage. Often take several hours to occlude the artery

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Embolic ischemic stroke

From a traveling blood clot into the brain. May come from heart, internal carotid artery, plaque of carotid sinus. Sign of cardiac disease.

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What is a hemorrhagic stroke?

Usually causes massive bleeding in oval or round mass that displaces midline structures, linked to HTN.

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Types of Ischemic stroke

Cerebral thrombosis
Cerebral infarction
Cerebral embolis

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Types of hemorrhagic stroke

Intracerebral hemorrhage
Aneurysm
Subarachnoid hemorrhage
Arteriovenous malformation

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What is a TIA?

Transient Ischemic Attack: thrombolic build up paired with vasospasm temporarily cuts off the blood supply. Sx

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Which artery is most often occluded with an embolic infarction?

Middle cerebral artery (direct continuation from internal carotid)

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Intracranial hemorrhage

rupture of cerebral vessel

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Subarachnoid hemorrhage

bleeding into subarachnoid space from saccular or berry aneurysm

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What is the leading cause of chronic disability?

Strroke

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What are some factors that make you more at risk?

Advanced age, male, AA > Mexican > native american > caucasion, atherosclerosis, hypertension, heart disease/cardiac disorders, diabetes.
high cholesterol, LDL, hematocrit, TIA
Smoking, obesity, sedentary, diet, excess alcohol, family Hx

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Ischemic umbra

Core area of focal infarction

Irreversible cellular damage

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Ischemic penumbra

Viable, but metabolically lethargic cells

Potentially damaged by ischemic cascade, thus becoming an area of extension of infarction

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When does cerebral edema reach its max? When does it resolve?

3-4 days.

2-3 weeks.

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What is subclavian seal syndrome?

Narrowing of proximal subclavian artery. blood flows up CL vertebral artery –> circle of WIllis –> ipsilateral vertebral artery to distal subclavian artery

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Signs/Symptoms of subclavian steal syndrome

Dizziness, arm claudication

BP difference > 20 mmHg

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What does the anterior cerebral artery supply?

Medial aspect of the cerebral hemisphere. (Frontal, parietal lobes, basal ganglia)

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What does anterior cerebral artery syndrome cause?

Contralateral hemiparesis, ESP LE. Sensory loss greater in LE than UE.

What does the middle cerebral artery supply?

lateral aspect of the cortex
Frontal, temporal, parietal lobes
Subcortical structures (internal capsule, globus pallidus, caudate nucleus, putamen)

What does middle cerebral artery syndrome cause?

CL hemiparesis (UE/face > LE), CL sensory loss, Aphasia (type depends on location), Homonymous hemianopsia

What does the internal carotid artery supply?

both the anterior and middle cerebral arteries. Can cause extensive cerebral infarction, cerebral edema, uncal herniation, death. Really major.

What does posterior cerebral artery syndrome cause?

CL homonymous hemianopsia, visual agnosia, prospagnosia, dyslexia, memory deficit, topographic disorientation. Central post-stoke (thalamic) Pain (constant, burning, intermittent sharp pain, increased with noxious stimuli)

What is involved in a pure motor lacunar stroke?

Posterior limb of internal capsule, pons, pyramids

What is involved in a pure sensory lacunar stroke?

Ventrolateral thalamus or thalamocortical projections

What happens in vertebrobasilar artery syndromes?

paralysis of UE/LE, impaired tactile/proprioceptive sense, cerebellar or limb ataxia, vertigo/nausea/balance, nystagmus, horners syndrome, involvement of CN V--> XII

What does horners syndrome involve?

Miosis (constricted pupil), ptosis, anhidrosis

What is locked in syndrome?

Complete basilar artery thrombosis & bilateral infarction of pons. VERY large stroke.

What happens with locked in syndrome?

Paralysis (tetra/guadriplegia, lower bulbar paralysis) | Mutism (anarthria)

What is preserved in locked in syndrome?

Consciousness, sensation, vertical eye movements, blinking

What's the primary goal of medical management of CVA?

Prevent ischemic tissue from becoming infarcted tissue. (maintain BP, CO, fluids etc.) Control seizures, ICP and herniation

What is tPA?

Tissue plasminogen activator. | Clot bluster, thrombolytic

Types of medical surgical management

Neurosurgical: endarterectomy, craniotomy, embolectomy

What structures are exposed in a fronto-temporal craniotomy?

Optic nerve and internal carotid

What is important for PT's to know post-op a craniotomy?

HEAD ELEVATED ~ 30 degrees.

What is the major vessel that supplies blood to the brain?

Carotid artery (splits into internal and external)

Which is better a carotid endarterectomy or stent?

Equally effective

What is MERCI?

Mechanical Embolus Removal in Cerebral Ischemia. Used to remove blood clots from vessels deep inside the brain Can be used for up to 8 hours after an acute ischemic stroke

Types of attention

Sustained, selective, divided, alternating

Ideational apraxia

unable on command/automatically

Ideomotor apraxia

unable on command

Why will there be some spontaneous recovery in these pts?

resolution of cerebral edema

What improves prognosis?

``` Minor vs major initial grade of paresis less motor/perceptual problems high social support/motivation Intensive training with repetition ```

Acute phase rehab

Acute care hospital 3-7 days | Early mobilization, edu, support

CARF

Governing body for INPATIENT rehab. have 3 hour rule, 3 hours must be PT, OT or speech ONLY.

What determines where a pt goes after acute phase?

Discharge disposition

JHACO

accredit acute hospitals and inpatient rehab. 2 or more disciplines at lease 5 days a week. Must be able to tolerate 3 hrs per day and need to actively tolerate.

What facilities provide less intense rehab services?

TCU, SNU, SNF

Chronic phase rehab

3-6 months or more after onset | Outpatient rehab, outpatient PT, home

What is the definition of home bound?

you can leave the home to visit your physician but you can’t go grocery shopping, to church, out to dinner, etc.