CVA

Question 1

What is a CVA?

Answer 1

1. A disturbance in cerebral circulation which causes a neurological deficit that can be permanent

Question 2

What are the risk factors for a CVA?*

Answer 2

1. hypertension
2. diabetes mellitus
3. cardiac disease
4. elevated blood lipids
5. peripheral vascular disease
6. obesity
7. cigarette smoking

Question 3

What is ataxia?

Answer 3

unable to coordinate voluntary movement

Question 4

What is aphasia?

Answer 4

the loss of ability to understand or express speech

Question 5

What is apraxia?

Answer 5

unable to carry out particular purposeful movements

Question 6

What is afferrent?

Answer 6

carry messages from body to CNS

Question 7

What is efferent?

Answer 7

carry messages from CNS to body

Question 8

What is stereognosis?

Answer 8

ability to perceive and recognize the form of an object in the absence of visual and auditory information, by using tactile information to provide cues from texture, size, spatial properties, and temperature, etc (wikipedia)

Question 9

What is hemiplegia?

Answer 9

paralysis of one side of the body

Question 10

What is hemiparesis?

Answer 10

partial paralysis limited to one side

Question 11

What is nystagmus?

Answer 11

• Rapid, rhythmic, repetitious, and involuntary eye movements.
• Nystagmus can be horizontal, vertical, or rotary. Whatever form it takes, nystagmus is an abnormal eye finding and a sign of disease within the eye or the nervous system.

Question 12

What is hemianopsia?

Answer 12

blindness in one half of the visual field of one or both eyes—called also hemiopia.

Question 13

What is hyperreflexia?

Answer 13

• overactive or overresponsive reflexes

- ie overreactive bladder

Question 14

What are the classifications of CVA?

Answer 14

1. Thrombotic
2. Embolic infarction
3. hemorrahage

Question 15

What is a thrombic CVA?

Answer 15

• caused by atherosclerotic plaques in combination with HTN
  1. plaques likely to form at branchings and curves of the arteries
  2. can be present for many years and never be symptomatic
  3. intermittent blockage can proceed to full blockage resulting in permanent damage

Question 16

What is an embolic infarction?

Answer 16

• embolus may originate in the heart, internal carotid, or carotid sinus.
  1. branches of middle cerebral artery most often infarcted; possibly due to its direct continuation from the internal carotid
• NOTE–70% of CVA’s caused by either thrombosis or embolus.

Question 17

What is a hemorrhagic CVA?

Answer 17

usually a result of prolonged and progressive HTN

1. most often affects smaller cerebral vessels
2. Anerysm which have formed over time burst spilling blood into tissue

Question 18

What are the S/S of damage to frontal lobe?

Answer 18

1. Changes in personality
2. Emotional lability
3. Judgment problems
4. Attention problems
5. Concentration problems

Question 19

What are the S/S f damage to the temporal lobe?

Answer 19

1. Memory impairments

2. Difficulty processing language

Question 20

What are the S/S f damage to the parietal lobe?

Answer 20

1. Memory deficits
2. Sensory deficits
3. Task integration deficits
   - apraxia
   - left/right discrimination
   - dysgraphia, dyscalculia

Question 21

What are the S/S f damage to the cerebellum?

Answer 21

1. Balance, coordination, equilibrium disorders
   - ataxia
   - tremors
   - dysmetria
   - dysdiadocokinesia

Question 22

What are the primary differences b/t many neuromuscular disorders?

Answer 22

the etiology and onset of symptoms.

Question 23

What side of the brain is damaged in a L CVA?

Answer 23

Damage to Left side of Brain

-will see manifestations of symptoms in the R

Question 24

What side of the brain is damaged in a R CVA?

Answer 24

Damage to Right side of Brain

-will see manifestations of symptoms in the L

Question 25

What are the S/S of hemiplegia?

Answer 25

- initially flaccid - over varying time periods, development of spasticity occurs: 1. trunk and shoulder girdle initial site 2. neck and head 3. upper extremities 4. lower extremities

Question 26

What are S/S of sensory disturbances?

Answer 26

1. usually partial impairment of the discriminatory sensation. 2. results in imbalance of sensory messages to the brain 3. incoordinated movements 4. may be so severe that it leads to loss of recognition of affected side. This is known as HEMINEGLECT.

Question 27

What are the S/S of L sided lesions?

Answer 27

1. aphasia - expressive aphasia - receptive aphasia - global aphasia - anomic aphasia 2. effects left side facial musculature and right side of neck, trunk, and right extremities (Right Hemiplegia) 3. Processing delays 4. bilateral apraxia 5. difficulty preplanning and sequencing 6. inappropriate use of objects 7. compulsive 8. low frustration tolerance

Question 28

What is expressive aphasia?

Answer 28

unable to effectively produce speech. (Broca's area--frontal lobe).

Question 29

What is receptive aphasia?

Answer 29

unable to process incoming information (Wernicke's area--temporal lobe)

Question 30

What is global aphasia?

Answer 30

Unable to process or produce speech and language.

Question 31

What is anomic aphasia?

Answer 31

able to talk and understand information, but difficulty naming objects

Question 32

What are S/S of R sided lesions?

Answer 32

1. amnesic apraxia--inability to perform tasks previously known 2. anosognosia--ignorance of the presence of disease (hemineglect) 3. spatial disorientation 4. effects right side of facial musculature and left side of neck and trunk and left extremities (Left Hemiplegia) 5. excessive verbalizations 6. short attention span/distractable 7. inability to self correct 8. poor judgment, unrealistic 9. labile 10. lethargic 11. impulsive

Question 33

What are S/S of R or L sided lesions?

Answer 33

1. decreased or absent point localization, 2 point discrimination 2. agraphaesthesia- unable to recognize writing on the skin purely by the sensation of touch. 3. astereognosis

Question 34

What are S/S of the eye post CVA?

Answer 34

1. if optic chiasm is affected, results in ipsilateral hemianopsia: loss of vision in that half of the visual field 2. gaze preference -with lesion of frontal lobe, will gaze to ipsilateral side of lesion.

Question 35

What are secondary S/S post CVA?

Answer 35

1. Respiratory Deficiencies 2. Spasticity and loss of Mobility 3. Joint and muscle pain 4. Scoliosis 5. Gait deviations 6. Mental and intellectual impairments

Question 36

How is a CVA diagnosed?

Answer 36

1. thorough history 2. angiography 3. EEG 4. Cranial CT and MRI

Question 37

How is a CVA treated?

Answer 37

1. Medication- anticoagulant or antiplatelet agents - TPA--given if thrombotic or embolitic to dissolve clot 2. Surgery - carotid endarterectomy -- removal of blood clots and improve circulation 3. Management of Bowel and Bladder Control 4. Therapy goals - re-establish postural control - normalize sensory inputs - facilitate normal movement patterns within functional skills - prevent contracture/deformity and pain through maintenance of normal joint alignment 5. Psychological Considerations

Question 38

What is the prognosis of a CVA?

Answer 38

1. Three state study of survivors of CVA's - 10% returned to work without impairment - 40% mild residual impairment - 40% disabled requiring special services - 10% need institutional care 2. Most recovery generally within first 3 months, improvements can be seen up to 2-3 years later.