FINAL EXAM - CVA

Question 1

TIA (5)

Answer 1

1. damage may be non-existent
2. symptoms more focal in nature
3. recover rapidly without permanent deficits
4. typically last 5-20mins - severe symptoms
5. recover with in 24 hrs.

Question 2

TIA caused by

Answer 2

blockage, decrease period of time. Clot sits briefly, gets jostled, and moves pass

Question 3

TIA Risk Factors Untreatable (4)

Answer 3

advanced age
african american
male
Family hx of stroke

Question 4

TIA Risk factors (10)

Answer 4

HTN
Atrial fib.
valve abnormalities
structural abnormalities
myocardial disease and peripheral artery disease
diabetes
Cholesterol
obesity
smoking
oral contraceptives

Question 5

Risk factors for a TIA are the same causes as an

Answer 5

MI - cardiac output is not smooth and damages blood cells which causes them to begin to clot in circulation

Question 6

Signs of an acute CVA -5

Answer 6

1. sudden weakness or numbness
2. sudden dimness or loss of vision
3. sudden difficulty speaking or understanding speech
4. sudden severe headache
5. facial droop or tongue misalignment
   * Call 911 Treatment is based on time*

Question 7

What does FAST stand for

Answer 7

Face -drooping
Arm - can they raise their arm and keep them symetrical
Speech - can person speak and understand speech
Time - Call 911

Question 8

Diagnosis of CVA

Answer 8

1. examination - severity; focal vs global
2. Hx of event - sudden onset vs gradual progression
3. Imaging - CT; MRI/MRA
4. Ischemic (blockage) vs hemorrhagic (bleeding) - each managed differently

Question 9

Ischemic CVA treatment

Answer 9

1. w/in 4hrs clot busting drugs are administered - save brain tissue
2. Resotre blood flow
3. asprin
4. intravenous TPA
5. INtra-arterial TPA
6. Mechanical Clot removal
7. Carotid angioplasy and stenting
8. Carotid endarterectomy - open vessel, scrape plaque out - can cause stroke (done to decrease severity b/c it’s inevitable)
9. Maintain perfusion via higher BP (keep blood flowing)

Question 10

Management of Ischemic - Cerebral Edema

Answer 10

larger ischemic strokes associated with cerebral edema which can increase intracranial pressure (ICP)

Question 11

Signs of high ICP(4)

Answer 11

vomiting without nausea (no warning)
ocular palsies (one eye turns in)
altered consciousness
pupillary dilation

Question 12

Symptoms of high ICP (2)

Answer 12

1. headache

2. low back pain

Question 13

Characteristics of CVA syndromes

Answer 13

1. named according to the artery that feed the area
2. can be parital or complete
3. more proximal clot, closer to the heart, the greater the damage
4. if the area has secondary supply, damage is less

Question 14

shoulder hand syndrome

Answer 14

sensation perceived as pain with non noxious stimuli - treatable, usually goes away

Question 15

Internal Carotid Artery - Most Common (3)

Answer 15

Clinical picture depends on the cause of ischemia (varies)
Lesions involving both MCA and ACA
Cortex supplied by MCA is most affected - UE

Question 16

Middle Cerebral Artery (MCA) Syndrome 1

Answer 16

Contralateral hemiplegia - Damaged Right side, impaired Left side and vice versa

Question 17

Dominant MCA CVA impact on body structures and functions

Answer 17

1. Speech and language impairments
2. timid
3. hyper-aware of impairments
4. poor processing verbal cues

Question 18

Non-Dominant MCA CVA impact on body structures and functions

Answer 18

1. spatial-perceptual impairments & sensory
2. impulsive
3. decreased insight/judgement
4. poor processing visual cues
5. Unaware of what they are capable of actually doing

Question 19

Pusher syndrome (vertical orientation)

Answer 19

shift wt onto impaired side causing resistance, guard differently, difficult on therapists body

Question 20

Anterior Cerebral Artery (ACA) Syndrome- 5

Answer 20

1. less common
2. has good collateral flow so damage is minimal
3. contralateral hemiparesis and sensory loss
4. LE more involved
5. Abulia: delay in verbal and motor response , SLOW

Question 21

Posterior Cerebral Artery (PCA) syndrome - 5

* Patients generally don’t survive

Answer 21

1. prox. occulded abnormal sensation of pain, temp, proprioception
2. completely occluded at origin- contralateral ataxia (loss of control of bodily movement)
3. Memory issues
4. Agnosia - decreased awareness
5. occuleded at periphery-cortical blindness - eye fn normally, no recognition
6. occuleded at stem-coma, decerbrate rigidity

Question 22

Posterior Cerebral Artery Syndrome - Weber’s Syndrome

*Very Rare

Answer 22

Contralateral hemiplegia & parkinsonism - not progressive live parkinson’s and may recover

Question 23

Posterior Cerebral Artery Syndrome - Claude’s Syndrome

*Very Rare

Answer 23

contralateral hemiplegia & ataxia (loss of full control of bodily movements)

Question 24

Posterior Cerebral Artery Syndrome - Hemiballismus

*Very Rare

Answer 24

flailing of extremities; not good at grading - Sit to supine; fly away from you

Question 25

Superior Cerebellar Artery (4)

Answer 25

ipsilateral ataxia=oscillations - disoriented movement dysmetria=inaccuracy contralateral loss of pain/temp

Question 26

Basilar Artery - affects brainstem and pons - 5

Answer 26

``` "locked in" syndrome unable to speak can not move does have eye movement able to receive and understand speech ```

Question 27

Anterior Inferior Cerebellar Artery - 8

Answer 27

1. ipsil. deafness 2. facial weakness 3. verigo 4. nausea 5. vomiting 6. nystagmus -eyes make repetitive, uncontrolled movements, often resulting in reduced vision 7. ataxia 8. contralateral loss of pain/temp

Question 28

Vertebral and Post. Inf. Cerebellar Artery Syndrome -2

Answer 28

1. vestibular | 2. ataxia

Question 29

Vertebral and Post. Inf. Cerebellar Artery Syndrome: Wallenberg's Syndrome (3)

Answer 29

1. vertigo and nausea 2. ipsilateral ataxia 3. dysphagias

Question 30

Intracerebral Hemorrhage (ICH) (4)

Answer 30

1. bleeding from an arterial source into the brain NOT caused by trauma 2. Typically due to anomaly of blood vessel or changes caused by HTN 3. HTN single most important modifiable risk factor 4. Sx's occur gradually

Question 31

Symptoms of ICH (3)

Answer 31

1. headache 2. Seizure 3. Altered Consciousness

Question 32

ICH treatment (5)

Answer 32

1. Surgically repair vessel by clipping or coiling 2. AVM (genetic anomally) removal 3. Discontinue blood thinners 4. Lower BP aggressively (less blood until arteries repair) 5. monitor for and treat cerebral edema

Question 33

ICH Syndromes - Putamen (most common) -3

Answer 33

contralateral sensorimotor deficit pupillary abnormalities visual field loss

Question 34

ICH Syndromes - Thalamus (4)

Answer 34

1. sensory loss 2. some motor deficits 3. oculomotor dysfunction 4. in dominant hemisphere - apraxia - can't produce voluntary movement on demand

Question 35

ICH Syndromes - Cerebellum (3)

Answer 35

1. ataxia 2. nausea 3. dizziness

Question 36

ICH Syndromes - Pons (all motor tracts go through the pons) 4

Answer 36

1. coma 2. quadperesis 3. unreactive pupils 4. contralateral sensory and motor symptoms

Question 37

Subdural Hemorrhage (4)

Answer 37

1. tearing of bridging veins between the brain surface and dural sinus 2. accumulation of blood in dural space 3. leads to compression of brain tissue 4. spontaneous

Question 38

Common Clinical Manifestation of Stroke: sensory and or motor changes (6)

Answer 38

1. hemiparesis = weakness 2. hemiplegia = paralysis 3. spasticity = hyperactive stretch reflex 4. flaccidity 5. synergies - abnormal co activation of muscle

Question 39

hypertonicity

Answer 39

spasticity

Question 40

Common Clinical Manifestation of Stroke: Flaccidity (4)

Answer 40

1. immediately after a CVA (Stage 1) 2. complete absence of muscle tone 3. most common in UE 4. Longer pt is flacid the less recovery 5. be aware of dislocation

Question 41

Common Clinical Manifestation of Stroke: Synergies

Answer 41

1. abnormal co activation of muscle groups related to active movement 2. proximal loading/activation 3. only seen when in AROM Ex. shoulder loaded in flexion = contraction of elbow, wrist - All muscles fire at the same time = synergistic

Question 42

UE Flexion Synery in MCA stroke presents as

Answer 42

``` elevation retraction abduction elbow flexion supination radial deviation wrist and finger flexion ```

Question 43

LE extension Synergy in ACA stroke presnets as

Answer 43

``` hip extension adduction IR knee extension planter flexion inversion toe flexion ```

Question 44

Brunnstrom Stages of Recovery (7)

Answer 44

Stage I- Flaccidity - no resting muscle tone early after stroke, usually resolves Stage II - Spasticity and Synergies emerge Stage III - voluntary control of synergies; spasticity increases Stage IV - movements in synergy will dominate; movements out of synergy emerge, spasticity decreases Stage V - Dominance of synergies decrease, isolated movement increases, spasticity decreases Stage VI - no spasticity, isolated movement dominates, coordination emerges Stage VII - Normal

Question 45

CVA impact on body str. and fn : perceptual impairments - 3

Answer 45

1. visual inattention/neglect 2. sensory inattention/neglect (oral commands opposite ear) 3. motor neglect

Question 46

CVA impact on body str. and fn : Coordination deficits -3

Answer 46

1. ataxia 2. dysmetria 3. dysdiadodyskinesia (rapid change of movement)

Question 47

CVA impact on body str. and fn : Visual system - 2

Answer 47

1. hemianopsia - peripheral on one side nasal block on other side 2. visual manifestation can prove where occlusion was in visual tract

Question 48

CVA impact on body str. and fn : Mental functions (2)

Answer 48

1. depression - pt will fn at a low level, needs to be managed for success 2. Cognitive behavioral impairments: impulsivity (SAFETY), anosognosia (lack of awareness), decreased drive

Question 49

CVA impact on body str. and fn : Voice and Speech -4

Answer 49

1. Communication deficits (dominant) 2. Dysarthria (motor) 3. Aphasia (cognitive) - receptive, expressive, global 4. Swallowing impairments - dysphagia

Question 50

Secondary complications of Stroke -6

Answer 50

1. deconditioning with increases the risk for CAD and DM 2. Loss of ROM = contractures 3. Incontinence = UTI 4. Pneumonia 5. DVT = Pulmonary emboli 6. Pressure ulcers

Question 51

Functional Prognosis after CVA -6

Answer 51

1. younger better than older 2. married better than non-married 3. employed better than not employed 4. dominant better than non-dominant 5. cognitively intact better than impaired 6. DM, CAD, HTN