CVA Flashcards
1
Q
CVA is the ______onset of _______deficit as a result of an _____ on a certain vascular territory of the brain.
A
rapid; neurological; insult
2
Q
Two reasons that CVA can occur.
A
Ischemic changes or Hemorrhagic event
3
Q
For a CVA to be categorized it must be a neurological deficit that lasts at least_____
A
24 hours.
4
Q
CVA can result in what (6) deficits?
A
HAV SAM
1- hemiplegia/paresis
2- ataxia
3- vertigo
4- sensory & vision/perceptual deficit
5- aphasia
6- memory deficits & cognitive impairment
5
Q
CVA is the ___th leading cause of death
A
4th
6
Q
How many adults >20 years old had a stroke?
A
~7 million adults
7
Q
Per year how many adults get a new stroke? how many are recurrent stroke?
A
610,000;
185,000
8
Q
How many % of stroke victims will have another one within 1 year?
A
5%-14%
9
Q
A hemorrhagic stroke will have how many % mortality at 1 month?
A
37-38%
10
Q
An Ischemic stroke will have how many % mortality at 1 month?
A
8-12%
11
Q
What are the leading causes of longterm disability for a stroke patient?
A
Hemiparesis, inability to walk without assistance, dependent in ADLs, aphasia, and depression.
12
Q
What is a major risk factor for stroke that affects the artery?
A
atherosclerosis
13
Q
What is atherosclerosis and what is being formed? accumulated (3)?and resulted in?
A
plaque is formed;
accumulation of lipids/fibrin/Ca++;
narrows the arterial walls
14
Q
(3)Risk factors other than atherosclerosis for stroke?
A
HTN, Heart Disease, and DM
15
Q
What level of HTN makes it a 2x more lifetime risk for stroke?
A
140/90 or higher
16
Q
How does LDL and HDL related to risk of stroke?
A
higher LDL and lower HDL raise risk of stroke
17
Q
What is a 5x risk factor for stroke?
A
A fib
18
Q
What are cardiac conditions that increase risk of embolic stroke? (3)
A
rheumatic heart valvular disease, endocarditis, and cardiac surgery
19
Q
What is a misc. issue that is a 2x risk factor for stroke?
A
sleep apnea
20
Q
What in women like it s 2x risk for ischemic stroke?
A
early menopause at the age of <42
21
Q
Use of what in women increase the risk of ischemic stroke by 44%?
A
estrogen
22
Q
Smokers have how many times (x) greater risk of stroke?
A
2-4x
23
Q
How many % reduction in risk does physical activity (moderate to vigorous exercise) have?
A
35%
24
Q
What are the FAST in spotting a stroke?
A
Face droop
Arm weakness
Speech difficulty
Time to call 911
25
What are some warning signs outside of the FAST clues? (4)
Sudden confusion/difficulty with language
Sudden vision issue
Sudden difficulty with walking/balance
Sudden severe headache
26
Ischemic cascade results in excess of what to be released?
Glutamate
27
During a CVA the disturbance of energy metabolism results in an inability to produce what?
ATP
28
During a CVA the failure for the Na-K pump to work results in what?
excess influx of Ca++
29
Ischemic strokes also produce what in the skull? and does it occur and when does it resolve?
cerebral edema; begins immediately; gradually resolves in 2-3 weeks.
30
Ischemic (occlusion), hemorrhagic, and others %?
80-88%
| 12-20%
31
What is a TIA?
Transient Ischemic Attack, symptoms resemble a stroke, and it's more focal in nature resolving in a few minutes and complete resolution within 24 hours. It is an important determinant of future stroke.
32
What is an evolving/deteriorating stroke?
impairment of function continues to increase in severity over time, can last an hour, day, or longer.
33
What is a major(complete) stroke?
A stroke that is stable with severe deficits
34
What is a young stroke?
when a stroke occurs <45 years of age
35
What is a subclavian steal syndrome?
a phenomenon where stenosis close to the origin of a vertebral artery, retrograde vertebral artery flow associated with transient neurological symptoms related to cerebral ischemia.
36
What is a hemorrhagic stroke? and what's it associated with?
a rupture of a cerebral vessel while bleeding into the brain parenchyma, associated with HTN or aging.
37
What is a primary hemorrhagic stroke?
a non-traumatic and spontaneous and typically occurs in small vessels weakened by atherosclerosis producing an aneurysm.
38
What is a secondary hemorrhagic stroke?
associated with trauma/impaired coagulation/toxin exposure or anatomic lesion.
39
Subarachnoid hemorrhagic stroke due to what, where, and why?
Due to Aneurysm and vascular malformations. Located in the subarachnoid space between arachnoid and pia mater. These occur by trauma, developmental deficits, neoplasms, or infections.
40
What do subarachnoid hemorrhagic stroke result in?
spontaneous, sudden severe headache in normotensive individuals
41
Subdural hemorrhagic stroke due to what and where?
Due to tearing of the bridging veins between brain surface and dural sinus.
42
What is an AVM?
arteriovenous malformation consists of a tangle of dilated blood vessels, a slow growth may produce progressive neurologic deficits secondary to compression.
43
What are the 3 main blood supplies to the brain?
Internal carotid, Vertebral artery, and Basilar artery branch.
44
What is the primary blood supply to the brain and what are it's 5 branches?
- ophthalmic artery
- posterior communicating artery
- anterior choroidal artery
- ACA anterior cerebral artery
- MCA middle cerebral artery
45
What are the 4 branches of the vertebral artery?
- posterior spinal artery
- anterior spinal artery
- PICA posterior inferior cerebellar artery
- vertebrobasilar system
46
What are the 6 branches of the basilar artery
- AICA anterior inferior cerebellar artery
- labyrinthine artery
- pontine branch
- superior cerebellar artery
- PCA posterior cerebral artery
- posterior communicating artery
47
What is the Circle of Willis formed by? (5)
Poster & Anterior cerebral arteries
Internal carotid arteries
Poster & Anterior communicating arteries
48
What occurs when the ACA is affected?
- contralateral hemiparesis/sensory
| - LE>UE
49
What occurs when the MCA is affected?
- contralateral hemiparesis/sensory with face
- UE/LE
- Aphasia (Broca's, Wernicke's, or global)
- perceptual deficits (unilateral, spacial, agnosia neglect)
50
Occlusion of the Proximal MCA produces what?
extensive damage and significant cerebral edema, increasing ICP leading to LOC and possible death.
51
What occurs when the PCA is affected?
- contralateral sensory loss or central post-stroke thalamic pain
- sensory ataxia
- occipital involvement: hemianopsia, visual agnosia, or cortical blindness.
- if temporal lobe is affected, leads to memory loss.
52
What occurs when the Basilar artery is affected?
Locked-In Syndrome secondary to ventral pontine lesions.
- Tetraplegia secondary to corticospinal tract
- aphonia secondary to corticobulbar tract
53
During Locked-in syndrome what is spared?
Sensory and Reticular formation. resulting in conscious with eye movement and blinking
54
What happens in a complete Basilar syndrome?
coma, pt survives no more than a few days.
55
What occurs in Wallenberg's Syndrome?
- occlusion of PICA (post inf cerebellar artery)
- Vertigo & Nystagmus, nausea & vomit
- Hoarseness, dysphagia, ipsilateral ataxia
- ips impaired sensation face & contra limb/trunk
- ips ptosis
- edema can cause respiratory arrest due to prox to respiratory center
56
What occurs in an AICA Syndrome?
- ips facial paralysis CN VII
- ips deafness
- ips ataxia of limb/gait
- contra pain and temp of body
- Nystagmus, vertigo, nausea *CN VIII
- Horner's syndrome
57
What is Horner's Syndrome?
Ips ptosis, miosis, and anhidrosis
58
What is ptosis?
upper eyelid droop
59
What is miosis?
excessive constriction of the pupil of the eye
60
What is anhidrosis?
inability to sweat normally
61
What occurs in a SCA Syndrome?
- Ips ataxia
- Ips dysmetria
- Intension tremors
- Contra loss of pain/temp, discriminative touch, vibration & proprioception (LE>UE)
- Ips Horner's Syndrome
- Contra superior oblique palsy
62
What occurs in a Pontine Syndrome?
- Total paralysis (Tetraplegia/paresis)
- Decerebrate rigidity, coma, locked-in syndrome
- Impaired breathing, death
63
What is unique S&S of Basal Ganglia-Internal Capsule stroke?
eye deviation away from involved side
64
What occurs in Thalamic Stroke?
- Contra hemiplegia
- Loss of all sensation
- Aphasia if left dominant
- Horner's Syndrome
- Downward eye deviation
65
What occurs in Cerebellar Stroke?
- Nausea/Vomit
- Ataxia
- Nystagmus
- Occipital headache
- Gaze towards involved side
66
What are 3 immediate Acute medical management for a stroke patient?
- complete eval
- begin thrombolytic therapy within 60 minutes of arrival in ED
- rule out hemorrhagic stroke asap
67
Is sensory deficits in stroke patient usually totally absent?
no
68
How are deeper lesion presented?
whole side symptoms
69
How are brainstem lesion presented?
crossed sensory loss
70
What is Aphasia due to?
parietal-occipital cortex dominant lesion
71
What is global deficit?
severe marked impairment in comprehension and fluency
72
What is Fluent aphasia?
auditory comprehension is impaired, speech is fluent.
73
What is Non-Fluent aphasia?
comprehension is good, but flow of speech is slow, hesitant, limited vocab
74
What is Dysarthria?
motor impairment involving the CNS, PNS, and muscles that control respiration, articulation, and phonation, garbling speech
75
What is Dysphagia?
swallowing disorder, aspiration is common resulting in pnemonia
76
Predominantly spasticity occurs in what types of muscles?
anti-gravity muscles
77
What is Clasp-Knife Response?
increase resistance to PROM then sudden give away
78
What is Cog-Wheel response?
interrupted by series of jerks to PROM
79
What is Lead pipe response?
uniform resistance through the entire PROM
80
What is Synergies?
stereotypical movement patterns that may develop
81
What is UE flex/ext synergy?
UE FLEX: scap elevation, shdr abd & ER, elbow flex, forearm supination, wrist/finger flexion
UE EXT: scap protraction, shdr add & IR, elbow ext, forearm pronation, wrist/finger FLEXION
82
What is LE flex/ext synergy?
LE FLEX: hip flex, abd, ER, knee flex, DF/INV toe DF
| LE EXT: hip ext, add, IR, knee ext, PF/INV toe PF
83
What is clonus? what is 4+ and 5+
rapid contraciton & relaxation of agonist/antagonist in response to a rapid stretch (4+ is 1-3 beats, 5+ is sustained)
84
What is Babinski?
stimulation of the plantar surface of foot to cause DF of great toe and fanning of other toes
85
What is Tonic Lumbar reflex?
rotation of upper trunk in relation to pelvis
86
What is Associated reaction and Ramiste's phenomenon?
Associated rxn is abnormal automatic response of involved limb resulting from movement of another area of the body. Ramiste's is an associated reaction in hemiplegia in which resistance to hip abduction or adduction in the noninvolved extremity evokes the same motion in the involved extremity
87
What is Ataxia?
coordination issue from cerebellar or BG lesion
88
What is Apraxia? and what are the two types?
motor planning issue
Ideomotor
Ideational
89
What is Ideomotor Apraxia?
movement not possibly on command but may occur automatically, ex show me how to hammer an invisible nail
90
What is Ideational Apraxia?
no purposeful movement either automatic or on command to everyday items or motions
91
What is pusher syndrome?
strong lean toward involved side, more common in left hemiplegia
92
With Right hemisphere stroke: where is hemipheglia/paresis/neglect?
left
93
What sided stroke results in loss of visual memory?
right brain stroke
94
What sided stroke results in impulsive, poor safety awareness, and learning impairment?
right brain stroke
95
With Left hemisphere stroke: where is hemipheglia/paresis/neglect?
right
96
What sided stroke is (aphasia) language very impaired?
left brain stroke
97
What is Homonymous hemianopsia? and how does it happen?
loss of vision in 1/2 of visual field in each eye, Contra to lesion. MCA main stem syndrome.
More common in right hemisphere, leading to left sided neglect.
98
What is perception?
ability to take sensory info and integrate it into a form that is meaningful
99
What is Anosognosia?
lack of awareness or denial of deficits more common in R Stroke and resolves in 2 weeks
100
What is Somatoagnosia?
lack of awareness of body parts and its relationship to oneself and others aka Autopagnosia, common in R stroke
101
What is R-L discrimination?
unable to identify the R & L of the body
102
What is contructional apraxia?
unable to understand the relationship of parts to a whole.
