EXAM #2: CVA-Horner's Syndrome Flashcards by Demond Fleming

what is the leading cause of long term disability?
2nd leading cause of death?

cerebrovascular accident (CVA)
aka stroke

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what is the most common type of CVA? what is it?

ischemic
blocked blood flow often due to atherosclerosis

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what is a hemorrhagic CVA?

ruptured blood vessel often due to HTN, aneurysms, and arteriovenous malformations

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what are non-modifiable risk factors of CVA?

age
african americans > european americans
women

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what are modifiable risk factors?

CV disease and HTN
diabetes
lifestyle (SAD, obesity, tobacco use, drugs)

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how does a CVA develop?

disrupted blood flow to the brain

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true or false. CVA S&S have a sudden onset

true

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what are S&S of CVA? (5)

WORST ever - severe headache
multi-segmental hemi face and/or extremity numbness and weakness/paralysis
visual disturbance
speech, swallowing impaired
unexplained dizziness or falls

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what should be included in your systems review for CVA?

history and observation
scan:
resisted testing w/ multiple joint weakness
neuro tests –> (+) babinski, clonus, DTRs, & UMN findings (multi-segmental weakness)

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what kind of referral for CVA?

emergency referral

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what are causes of posterior circulation compromise?

CVA
pathological joint instability
atherosclerosis, clot, or embolism - most commonly in internal carotid
sudden arterial dissection (excessive rot/ext/tx stress)
tumors
VBI - vertebrobasilar insufficiency
presyncope

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in PCC, ischemia of the arteries feeding the inner ear, brain stem, and cerebellum includes:

vertebral artery
basilar and posterior cerebral arteries & their branches

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what are affected functions from a PCC?

brain stem houses cranial n. and respiratory center
cerebellum regulates coordination

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the basilar artery most frequently supplies what nerve?

trigeminal nerve

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PCC S&S –>
5 Ds:
And:
3 Ns:

5 Ds:
- dysarthria (speech)
- dysphagia (swallowing)
- diplopia (double vision)
- dizziness
- drop attacks (w/o loss of consciousness)

And: (2)
- ataxia: incoordination due to cerebellar disorder
- headAche - worst ever

3 Ns:
- nausea
- nystagmus - involuntary rotary eye movement creating spinning sensation
- numbness/paresthesia’s in face/extremities

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what kind of referral for PCC?

emergency

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what is presyncope dizziness?

near fainting/light headedness just before LOC without illusion of spinning

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how is presyncope dizziness caused?

cardiovascular or non-cardiovascular (i.e. high stress or medication)

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how is presyncope dizziness developed?

reduction of blood flow from heart to brain

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what are S&S of presyncope dizziness?

generalized weakness
giddiness
sweating
pallor (pale, not looking well)
5 Ds And 3 Ns

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what kind of referral for presyncope dizziness?

emergency referral

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what is vertigo?

illusion of spinning or rotary motion caused by asymmetries in the vestibular system

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what are the two types of vertigo?
which one is 90% of the cases?

peripheral and central
peripheral

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what is the most common type of peripheral vertigo?

benign paroxysmal positional vertigo (BPPV)

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what is the primary cause of peripheral vertigo?

unknown

How does peripheral vertigo develop? ____________ becomes free floating in ______________

crystals become free floating in semi circular canals

what is the primary cause of central vertigo?

CVA or tumor

what are secondary causes of central vertigo?

trauma creating a brain injury or upper cervical instability infection demyelination (MS) migraine HAs

how does central vertigo develop? Due to ______ to what 3 structure?

due to ischemia to cerebellum, brainstem or vestibular nuclei

which vertigo presents with UMN signs like 5Ds And 3Ns? which has severe nausea, possible vomiting?

central peripheral

which vertigo has severe perception of linear motion? which has greater spinning?

central peripheral

which vertigo is worsened with head movements? which occurs at rest?

peripheral central

which vertigo is often with hearing loss? which is severe imbalance?

peripheral central

which vertigo requires emergency referral? which begin a trial of PT with vestibular specialist?

central peripheral

what is dysequilibrium dizziness?

unsteadiness without illusion of spinning

what are the 3 primary afferent systems that contribute to postural perception and control and make up the balance triad?

MOSTLY somatosensory system (pressure, P!, position, motion, vibration, temp, joints, skin, etc) vestibular system visual pathways

what causes dysequilibrium?

brain degeneration biomechanical restraints with aging (less ROM and muscle weakness) progressions of neuromusculoskeletal diseases

how does disequilibrium develop? Dysfunction of __________________

dysfunction of balance triad

what are the two options for referring out or not for disequilibrium?

1. begin trial PT - assess & treat to improve somatosensory function & balance triad 2. potential urgent referral for vestibular or vision component

what can non-specific dizziness be due to?

psychophysiological or cervical origins

what causes psychophysiological non-specific dizziness?

psychological disorders (anxiety, phobias, depression)

how is psychophysiological non-specific dizziness developed?

vasoconstriction with SNS response

what are S&S of psychophysiological non-specific dizziness?

motion sickness giddiness feeling removed from their body sensations of floating subjective postural imbalances with normal balance testing

what kind of referral is needed for psychophysiological non-specific dizziness?

urgent referral for psychological consult

what causes cervicogenic dizziness (CGD)?

cervical spine dysfunction, esp. C2-3 segment

how is cervicogenic dizziness (CGD) developed?

abnormal afferent input from the neck to the trigeminocervical nucleus

what are S&S of cervicogenic dizziness (CGD)?

dizziness with neck motion often accompanied by head and face as well as parasympathetic symptoms no illusion of spinning or nystagmus

what should your referral process look like for cervicogenic dizziness (CGD)?

begin trial PT to assess and address cervical dysfunction

cervical myelopathy is _______, ________ and often _________ compression on the cord

slow, gradual and often progressive

where is the least common area in the spine for myelopathy?

cervical

what is the most common cause of cervical myelopathy?

degenerative spinal changes which are: - lax and buckling ligamentum flavum - age related joint changes - age related disc changes - vertebral body collapse - pathological instability (spondylolisthesis)

what are two more rare causes of cervical myelopathy?

malignancy (20%) central disc herniation (rare)

what are S&S of cervical myelopathy?

neuro findings (slow onset) multiple directions of weak/painful resisted testing wide based gait incoordination cooks CPR (+)

what kind of condition would we consider cervical myelopathy to be?

"do not want to miss" condition emergency referral

what is meningitis?

infection leading to inflammation of the brain and spinal cord meningeal membranes

although rare, viral meningitis is most common in _______ bacterial meningitis is most common in ______

adults young children due to strep

viral meningitis is caused by what?

enteroviruses from GI tract

what is the most common bacterial meningitis?

streptococcus pneumonia

meningeal inflammation causes scar tissue that increases risk of:

- restricted CSF that can lead to hydrocephalus - decreased blood flow that can lead to stroke

viral meningitis S&S resemble what two system S&S? bacterial meningitis?

infection and GI S&S infection and respiratory S&S

what are typical S&S of meningitis?

constitutional and infection S&S neck P!/stiffness photophobia HA

what are S&S of increased intracranial pressure in meningitis?

increased HA with looking down, lifting, bending over altered mental status cranial n. deficits seizures

what is the most sensitive clinical test to rule OUT meningitis?

jolt accentuation of HA test HA worsened by neck rotation 2-3x in a second

what are the two best clinical tests to rule IN meningitis while supine?

Kernig test: low back and posterior thigh P! with combined hip flexion and knee extension Brudzinski test: neck flexion produces hip and knee flexion

what type of referral is meningitis?

emergency

mean age for brain tumors:

60 years old

brain tumors: 2nd most common primary tumor in _______ most common intracranial metastatic tumor in ______

children adults

how do brain tumors develop? (3)

compression of cerebral tissue at times erosion of bone with growth leads to edema and increased intracranial pressure

are brain tumors asymptomatic or symptomatic in early stages? due to what?

asymptomatic due to brains ability to adapt to slow growing tumors

what system S&S do brain tumors have?

cancer S&S plus S&S related to area of brain

S&S of brain tumors:

HA this is increased with activities further increasing ICP (looking down, straining, exercise, coughing) UMN S&S (ataxia) tinnitus seizures speech impairment

what are 3 causes of horner's syndrome? -_________ tumor that compresses _________________ -__________ pathology -_______ artery & _________ sinus

pancoast tumor in apical portion of lung that compresses sympathetic ganglion at cervicothoracic junction intracranial pathology conditions influencing carotid artery and venous sinus

how does horner's syndrome develop? -interruption of?

interruption of sympathetic nerve supply to the eye

ipsilateral S&S of horner's syndrome?

ptosis (droopy eye lid) lack of face sweating sunken eyeball miosis (constricted pupil) possibly P! in T2-4 dermatomal region due to shared spinal n. innervation

EXAM #2: CVA-Horner's Syndrome Flashcards

(74 cards)