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CVA Flashcards

1
Q

Stats for ischemic and hemorrhagic stroke

A

Ischemic: 87%
Hemorrhagic: 13%

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2
Q

Mortality prognosis: 7/30/90 days

A

Higher mortality in hemorrhagic stroke

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3
Q

Recurrence prognosis: 30 days/1 year/5 years/10 years

A

30 days = 3%
1 year = 11.1%
5 years: 25%
10 years: 40%

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4
Q

Cerebral thrombosis/embolism

A

Thrombosis - forms in the brain

Embolism - travels to the brain

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5
Q

Zone of injury: core ischemic + ischemic penumbra zones

A

Core ischemic - severe ischia with blood flow between 10-25% = death of neurons
Ischemic penumbra - regions surround severe, considered mild to moderate = where neuroplasticity is targeted

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6
Q

Crescendo TIA

A

2 occurrences within 24 hours
3 within 3 days
4 within 2 weeks

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7
Q

ABCD2 Prediction Rule

A 
Age >60 years 
Blood pressure >140/>90
Clinical presentation - unilateral weakness with or without speech impairment OR speech impairment without weakness
Duration >60 minutes OR 10-59 minutes
Diabetes
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8
Q

Hemorrhagic risk factors

A

HTN (not DM, obesity, previous stroke, oral contraceptives)
Alcohol and drug abuse
Use of anticoagulants

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9
Q

Saccular aneurysm

A

Roused or irregular swellings in arteries - commonly occurs at sides of vessel bifurcation

**>10 mm are at critical risk to rupture

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10
Q

CT

A

Serves to rule out hemorrhagic stroke; may identify ischemic lesion (may not be detected in early hours after stroke)

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11
Q

CT Angiogram

A

Provide clear images of cerebral blood vessels to allow identification of stenosis, occlusion, aneurysms, and vascular abnormalities

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12
Q

MRI

A

Detects edema in the sub-acute phase

**Takes 1 hour to complete

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13
Q

Magnetic Resonance Angiogram

A

Can detect high grade atherosclerotic lesions and less common causes of ischemic stroke (vertebral after dissection, venous thrombosis, etc)

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14
Q

PET

A

Imaging of blood flow and cerebral metabolism

**Used to determine where areas of tissue are reversible

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15
Q

tPA

A

Administered within 3 hours of sx onset (up to 4.5 hours in some patients)

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16
Q

MCA stroke

A
  • Contralateral weakness (UE/face)
  • Contralateral sensory impairment (UE/face)
  • Aphasia
  • Neglect
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17
Q

Lacunar stoke

A
  • **Deep branches of MCA; supplying the BG and IC

- Contralateral weakness

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18
Q

PCA stroke

A
  • *Supplies occipital lobe, inferior temporal lobe
  • Contralateral homonymous hemianopsia
  • Contralateral sensory impairment/weakness
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19
Q

ACA stroke

A
  • *Primary motor/sensory, supplementary motor, prefrontal cortex
  • Contralateral LE weakness/sensory
  • Frontal lobe behavioral abnormalities (poor judgement, attention, motivation, regulating emotions)
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20
Q

Watershed strokes

A
  • *Distal branches of major cerebral arteries (MCA/ACA and MCA/PCA)
  • Results from hypoperfusion
  • Proximal arm and leave weakness with distal preservation of strength (man in a barrel syndrome)
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21
Q

PICA stroke

A
  • *Cerebellum and medulla
  • LATERAL MEDUALLRY SYDNROME
  • Loss of pain/temp on contralateral side of body and ipsi face
  • Ataxia
  • Dizziness/diploplia/dysphagia/dysarthria
  • Horner’s syndrome
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22
Q

Horner’s syndrome

A
  • *Damage to sympathetic trunk lateral to vertebral bodies
  • Ptosis
  • Decreased sweating
  • Miosis (pupil constriction
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23
Q

AICA stroke

A
  • *Cerebellum and cranial nerves 7 and 8
  • LATERAL PONTINE SYNDROME
  • Ispi ataxia
  • Contralateral weakness/sensory
  • Dizziness/vertigo
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24
Q

Thalamic pain syndrome

A
  • Initially presents as numbness but evolves into a burning sensation
  • May be accompanied by allodynia
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25
Visual tracts
Optic nerve - optic chiasm - opic tract - lateral geniculate nucleus - primary visual cortex
26
Right optic nerve lesion
Blindness of right eye
27
Optic chiasm lesion
Loss of temporal fields in both eyes = bitemporal hemianopsia
28
Lesion to uncrossed fibers from right eye
Loss of nasal field of right eye = right nasal hemianopsia
29
Right optic tract lesion
Loss of left visual field (temporal field of left eye, nasal field of right eye) = left homonymous hemianopsia
30
Lesion to the right optic radiation projecting directly to the occipital lobe
Loss of inferior quadrant of left visual field
31
Lesion to right optic radiation in Meyer's loop
Loss of superior quadrant of left visual field
32
Lesion to entire right optic radiation
Loss of left visual field = left homonymous hemianopsia
33
Lesion to medial surface of right visual cortex
Loss of left visual field with macular sparing
34
Muscles not involved in synergies
``` Finger extensors Lats Ankle evertors Teres major Serratus anterior **FLATS ```
35
MAS
0 No tone 1 Slight increase in muscle tone, manifested by catch and release 1+ Slight increase in tone, manifested by catch and minimal resistance through less then half of range 2 Marked increase in tone through entire range but easily moved 3 Considerable increase in tone, passive movement difficult 4 Rigid
36
Sogue's phenomenon
Finger ext and abduction when arm is elevated above horizontal
37
Raimiste's phenomenon
Resisted hip abduction elicits abduction in contralateral limb
38
Bilateral simultaneous extinction
- Failure to respond to stimuli on affected side when both sides are stimulated concurrently (able to identify unilaterally though)
39
Unilateral neglect brain involvement
R posterior inferior parietal lobe
40
Anosognosia
* *Associated with damage to R posterior insula | - Denial of sxs
41
Somatotopagnosia
* *Damage to the left parietal or posterior temporal lobe | - Lack of awareness of body structure
42
Gerstmann syndrome
* *Damage to parietal lobe of region of angular gyrus - Right-left discrimination disorder - Finger agnosia - Agraphia - Acalculia
43
Ideomotor apraxia
- Difficulty planning or completing actions on command
44
Ideational apraxia
- Difficulty conceptualizing and performing tasks, either on command or automatically
45
Recommended parameters for resistance training
1-RM at 60-80% 3 sets each, 8-10 sessions 3x per week for 6-12 weeks
46
Contraindications to resistance training
- Hemophilia and other blood disorders - Severely limited ROM - Severe osteoporosis
47
Results of FTP and power
- Both FTP and power improve movement accuracy - FTTP: Shoulder flexion and elbow extension AROM decreased were associated with increased trunk displacement = compensations - POWR: Shoulder flexion and elbow extension AROM increased were associated with decreased trunk displacement = normal movement patterns - POWER then FTTP
48
Dose effect on CBF
Moderate intensity increases CBF | Low intensity decreases CBF
49
Requirements of CIMT
- 20 degrees wrist ext | - 10 degrees finger ext
50
CIMT training protocol
6 hrs per day for 2 weeks, 90% waking hours
51
Balance and self-efficacy conclusions
- Women reported lower levels of balance self efficacy - Number of co-morbid conditions didn't effect balance self-efficacy - Lower balance self-efficacy in those with cognitive impairments - Functional walking capacity contributed little to perception of health unlike balance-efficacy
52
Intensity of balance training
- 2-3x/week sufficient | * *90 minutes, 5x week NOT recommended
53
NMES improvements
- Gait speed but not other functional activities - Shoulder pain/sub-luxation - Improves motor impairment in UE
54
Unilateral neglect and visual scanning
- 20 hours of reading task | - Improvements remain at 1 year follow-up
55
Unilateral neglect and sensory awareness and spatial organization
- 20 hours of locating light touch | - Improvements noted over control
56
Unilateral neglect and external/internal stimulus
- Loud auditory sound or knocking on desk to promote attenuation - Improvement in attention to task, 2/4 measures
57
Unilateral neglect and visual and movement imagery
- Visualize items in home and spell words backwards - Imagine the examiner changing posture - Improvements lasted at 6 month follow-up
58
Unilateral neglect and prisms/patching
- Possible improvement, more likely compensatory/improvement in awareness vs functional improvement
59
StrokEDGE II Acute Care
- Orpington Prognostic Scale - PASS - STREAM
60
Orpington Prognostic Scale
Scoring of cognition, balance, proprioception, and motor function **Ranges from 1.6-6.8
61
Orpington Prognostic Scale cut-off scales
Mild to moderate: <3.2 Moderate to severe: 3.2-5.2 Severe of major deficit: >5.2
62
Functional Reach
Less then 15 centimeters indicates fall risk
63
StrokEDGE II Inpatient/Outpatient Rehab
- Fugl-Meyer Assessment of Motor Performance - FIM - PASS - Stroke Impact Scale - STREAM
64
Fugl-Meyer Assessment of Motor Performance
Evaluates and measures recovery post-stroke ``` FIVE DOMAINS: 1. Motor function 2. Sensory function 3. Balance 4. Joint ROM 5. Joint Pain MAX SCORE 226 points ```
65
Stroke Impact Scale
- 59 items based on 1-5 Likert scale (1: could not do at all, 5: not difficult at all) - Lower the score the higher the impact

NCS (19 decks)

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