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6 Neurological Dysfunction > L9 Stroke > Flashcards

L9 Stroke Flashcards

(69 cards)

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1
Q

Modifiable RF for Stroke

A

HTN
Smoking
Diabetes
Diet high in saturated, trans, and cholesterol
physical inactivity
obesity
high LDL
CAD and PAD
A-fib

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2
Q

Stroke Epidemiology

A

5 cause of death in US

leading cause of disability
up to 80% of strokes are preventable

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3
Q

Non-modifiable RF for strokes

A

age
family history
race (black has higher risk)
gender (female)
prior stroke, heart attack, TIA
rural area

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4
Q

Transient Ischemic Attack

A

sometimes called a mini-stroke
temporary blockage of blood flow to brain
often precede a full stroke

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5
Q

Acute Ischemic Stroke

A

blood vessel supplying blood to the brain is obstructed
accounts for 87% of all strokes

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6
Q

Hemorrhagic Stroke

A

weakened blood vessel ruptures causing bleeding into the brain

accounts for 13% of stroke cases

aneurysms and AVMs two most common causes of HS

most common cause of HS is uncontrolled HBP

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7
Q

BEFAST

A

balance
eyes (visiual field loss, double vision, blurry)
Face
Arm
Speech
Time

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8
Q

FAST

A

Face drooping or numbness

Arm weakness or numbness

Speech difficulty, slurred speech, seem confused

Time to call 911

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9
Q

FAST SPIN/SNOUT

A

SNOUT = 77%
SPIN = 60%

fails to recognize 40% of those with post circulation events and 14% of AIS are missed

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10
Q

BEFAST SPIN/SNOUT

A

SPIN = 85%
SNOUT = 68%

BEFAST helps to reduce the number of patients with AIS

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11
Q

Comprehensive Stroke Center

A

most demanding certification, can receive all stroke cases

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12
Q

Primary Stroke Center

A

hospitals that provide critical elements of stroke care to achieve long-term success in improving outcomes

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13
Q

Thrombectomy-Capable Stroke Center

A

hospitals that are primary stroke center and provide endovascular procedures and post-procedural care

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14
Q

Acute stroke ready hospital

A

hospitals or emergency centers that have dedicated stroke-focused program

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15
Q

ER Tx for AIS

A

-MRI with DWI most sensitivity and specificity
-tissue plasminogen activator, alteplase, within three hours
-Thrombectomy to remove clot within 6 hours

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16
Q

ER Tx of HS

A

Correct imaging, non contrast CT is gold standard

craniotomy to surgically evacuate hematoma and relieve cranial pressure

neurosurgery to perform AVM removal or clip vessel at the base of aneurysm

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17
Q

Medical Treatment for TIA

A

full medical work up to identify cause

brain imaging, ECG, ultrasound of carotid artery, assess and treat risk factors

goal to prevent future stroke

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18
Q

Post ER Care for AIS

A

BP less than 180/105 for first 24 hours

should provide early rehab that is organized and interprofessional

should NOT provide high does very early mob within 24 hours

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19
Q

R MCA Syndrome

A

R gaze deviation
L sided weakness
L neglect

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20
Q

ACA Syndrome

A

contralateral leg weakness
executive dysfunction

(blue in picture)

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21
Q

L MCA Syndrome

A

L gaze deviation
R sided weakness
Aphasia

(yellow in picture)

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22
Q

PCA Syndrome

A

contralateral hemianopsia
confusion, amnesia, disorders of consciousness

(red in picture)

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23
Q

Cerebellar Stroke

A

ipsilateral ataxia
nausea, vertigo, nystagmus, imbalance

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24
Q

Mid-basilar stroke

A

locked-in state
crossed symptoms
ocular palsies

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25
Top of basilar Stroke
acute disorders of consciousness or coma
26
Middle Cerebral Artery Stroke
more common than ACA or PCA will have unique presentation depending on R/L occlusion of proximal stem will have CP of all 3 divisions
27
L MCA Clinical Syndrome, Superior Divison
R face and arm weakness, nonfluent broca's aphasia
28
L MCA Inferior Division
fluent or wernicke's aphasia, R visual field deficit, R cortical sensory loss, some R side weakness
29
Broca's aphasia
non-fluent aphasia spontaneous speech is diminished loss of normal grammatic structure, word salad source fo frustration for patient
30
Wernicke's Aphasia
fluent aphasia impaired language comphrension speech has normal rate, rhythm, and grammar
31
R MCA Superior Division
left face and arm weakness, L hemineglect, sometimes L face/arm sensory loss
32
R MCA Inferior Divison
profound L hemineglect but normal L side strength with spontaneous movements
33
R MCA Deep Territory
left pure motor hemiparesis
34
L MCA Deep Territory
right pure motor hemiparesis
35
Unilateral Spatial Neglect
inattention to the side of body opposite of brain lesion L inattention in most common, R attention is less severe usually safety concern because patient could harm self
36
Hemianopsia S/S
-difficulty seeing items or finding them -miss details in one visual field -locate lost items once cued -attempt to make eye contact no matter where PT stands -spontaneously use both UE -Spontaneously turn head to compensate for vision loss
37
Spatial Neglect S/S
-Miss details in one visual field -walk into things on one side without noticing -lose track of limbs, doesn't reposition limbs -sees to forget position of limbs, drop or spill items
38
Test for unilateral spatial neglect
extinction on double simultaneous stimulation normal sensory function but ignores one side of environment
39
Pusher Syndrome
perceptual deficit after some strokes, with active pushing toward hemiplegic side displayed in 5% of all pts post stroke, impedes functional outcomes most common in pts with R hemispheric lesions in thalamus
40
Presentation of pusher syndrome
patients misbelieve body orientation in space, believing that upright is approx 18° tilted toward hemiplegic side patient will try to correct by pushing towards their impaired side
41
Anterior Cerebral Artery Stroke
presents as UMN weakness and cortical sensory loss affecting contralateral leg more than the arm or face sometimes motor aphasia is present or frontal lobe dysfunction
42
Frontal lobe dysfunction
grasp reflex, impaired judgement, flat affect, apraxia/dyspraxia, abulia, incontinence, perseveration, impaired judgement/logic/abstraction, lacks a filter
43
Perservation
difficulty in changing from one task to the next they will continue the former task continuously
44
Abulia
changes to drive, personality and judgement
45
Apraxia
inability to perform tasks or naturalistic actions difficulty with motor conceptualization, planning, and execution
46
Apraxia is found in patients with
diffuse lesions of the cortex focal lesions affecting the frontal or L parietal lobe pts will present with language comphrension, gross motor, and sensation still intact
47
Apraxia Screen of Tulia
MDC = 1.79 points has a 100% positive predictive value and 92% negative predictive value
48
Cut-off scores of Apraxia Screen of Tulia
10-12 = no praxis errors 6-9 = abnormal praxis or mild 5 or less = severe apraxia
49
Posterior Cerebral Artery Stroke
causes a contralateral homonymous hemianopia small branches occluded causes thalamus or posterior limb of IC to be affected also known as alexia without agraphia
50
S/S of thalamus/post limb of IC stroke
contralateral sensory loss contralateral hemiparesis dominant hemisphere can cause thalamic aphasia
51
Contralateral homonymous Hemianopia
Losing both L visual fields of both L/R eyes impact on the optic tract, optic radiation, primary visual cortex
52
Alexia
inability to read or comprehend written language remains capable of spelling and writing words, unable to comprehend seen after stroke affecting dominant hemisphere
53
Agraphia
loss of previous ability to write often occurs concurrently with alexia, apraxia, or hemispatial neglect
54
Stage 1 of Brunnstrom's Stages of Stroke Recovery
Flaccid tone no motor control/active movement
55
Stage 2 of Brunnstrom's Stages of Stroke Recovery
Mild spasticity weak synergies and weak associated reactions
56
Stage 3 of Brunnstrom's Stages of Stroke Recovery
Increasing spasticity, may be severe voluntary movement within basic synergies, demonstrates small determinable joint movement
57
Stage 4 of Brunnstrom's Stages of Stroke Recovery
Spasticity begins to decrease active movement begins to occur outside of basic limb synergies
58
Stage 5 of Brunnstrom's Stages of Stroke Recovery
Spasticity decreasing able to perform more difficult isolated movement patterns
59
Stage 6 of Brunnstrom's Stages of Stroke Recovery
no spasticity movements are generally selective, but may require performance at decreased velocities with diminished coordination
60
Stage 7 of Brunnstrom's Stages of Stroke Recovery
not universally recognized normal tone returns normal isolated movements
61
Brunnstrom's Stages of Stroke Recovery
pts may progress through all stages or remain in a stage severity and length of time in each stage varies on stroke severity and the age of patient
62
Fugl Meyer Assessment
motor score helps to quantify the patient's recovery through Brunnstrom stages
63
Contemporary PT
focusing on neuroplasticity, like repetition and intensity and that it is ok to allow movement synergies during training with enough repetitions of practice, neuroplasticity and motor learning principles will drive improvements in movement quality
64
Traditional PT
focuses on movement quality as primary focus patients should only practice with movements out of synergistic patterns
65
UE Flexor Synergy
Scapula = elevation and retraction Shoulder = abduction/ER or adduction/IR Elbow = flexion Forearm = supination Wrist/Digits = flexion
66
LE Flexion Synergy
Pelvic = Elevation Hip = Flexion Knee = Flexion Ankle = DF Forefoot = Eversion unusual pattern to observe after stroke
67
UE Extension Synergy
Scapula = downward rotation and protraction Shoulder = IR and adduction Elbow = extension Forearm = pronation Wrist/hand/digits = position varies occurs with intentional elevation of arm
68
LE Extension Synergy
Pelvic = elevation and. retraction Hip = adduction and extension Knee = extension Ankle = PF Forefoot = inversion occurs in late swing with extension
69
Are synergies good or bad?
it depends some people use their synergies to be able to perform functional tasks but synergies impede ability to perform necessary mobility tasks or ADLs

6 Neurological Dysfunction (16 decks)

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