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SEMESTER 4 - REHAB > STROKE > Flashcards

Flashcards in STROKE Deck (29):
1

Objectives (lecture and lab)

Syllabus objectives 14, 15 & 16

FYI

2

Stroke/CVA

2 TYPES

Ischemic

Hemorrhagic stroke

3

Most common
80% of individuals
Due to clot or impairment of blood flow

What type of stroke?

Ischemic

4

Blood vessel ruptures

what type of stroke?

Hemorrhagic stroke

5

  • Change in level of consciousness
  • Impairment of sensory, motor , cognitive, perceptual and language functions
  • By definition must persist > 24 hours (otherwise TIA)

Stroke

6

Motor deficits that can happen due to a stoke

  • Hemiplegia
  • Hemiparesis

7

paralysis -Motor deficit

 

Hemiplegia

8

weakness - motor deficit

and what side of body

Hemiparesis

opposite

 

9

  • Frontal and parietal lobes
  • BG, corpus callosum
  • contralateral hemiparesis worse in LE
  • dr c says to know these

what type of syndrome?

Anterior cerebral artery syndrome

10

Left homonymous hemianopsia

what does their vision look like?

Only see 1/2 the picture in vision

11

  • Area is large; IC supplies ant carotid A and MCA
  • Damage can be very extensive
  • Can cause large amounts of edema and even death

What syndrome is this?

Internal carotid artery syndrome

12

  • Can cause vision issues (hemianopsia, visual agnosia, cortical blindness)
  • Memory loss

What syndrome?

Posterior Cerebral Artery Syndrome

13

  • Very small vessels affected in white matter
  • Can be either hypertensive issues or diabetic microvascular disease
  • Can have several issues: : dysarthira, clumsy hand syndrome, atacia, dystonia, sensory/motor stroke
  • Higher cortical levels are preserved

what type of syndrome?

  • Lacunar syndromes


14

Medical management of a stroke

  • Oxygen
  • Blood pressure
  • Manage cardiac output
  • Electrolyte balance
  • Blood glucose levels
  • Seizures
  • Intracranial pressure
  • Bladder function
  • Integrity of skin and joints

15

Primary Impairments

of a stroke

  • sensation loss
  • Pain
  • vision changes
  • motor functions
  • weakness
  • alterations in tone
  • abnormal reflexes
  • alterted coordination
  • apraxia
  • postural and control balance

 

16

In a stroke what can happen to sensation?

 

  • Can lose superficial or deep or can have issues with combined cortical sensation ( steriognosis, 2 pt discrim., barognosis, graphesthesia, dble simultaneous stim. Etc)
  • Usually see face, UE,LE loss
  • Can be face/UE or UE/LE
  • Proprioceptive loss is common (motor control/posture/balance)

17

describe pain associated with a stroke.

Can have severe head/neck /face pain

Post stroke (thalamic) pain (resulting typically from PCA stroke)

  • Constant, severe, burning, intermittent sharp pain
  • Trigger by stroking of skin, pinprick, temp change
  • Loud noise, other mild irritants
  • spontaneous recovery is rare

18

what type of vision changes happen from a stroke?

  • Hemianopsia
  • Visual neglect-No attention to what happens on one side of them
    • Compensate with turning of head
  • Forced gaze deviation
    • Eyes will deviate in the direction of the intact muscluture

19

pg 719

stages of revovery

for motor functions from a stroke.

  • UE and LE may be at different levels
  • May have more complete recovery of LE and very little of UE
  • Degree of recovery will vary
  • Will see general patterns
  • Variation will depend on location of insult, severity of lesion and capacity for adaptation

20

what weakness impairments happen with a stroke?

  • Found in large percentage of patients, major factor in disability
    • Relates to location of insult and size of area affected
  • Many times UE more involved
    • Corticospinal system facilitates distal musculature
    • May see mild weakness on “good side”

21

Motor Deficits

Anything > how many weeks  may lead to permanent disability with a stoke pt?

3 weeks: 

22

Strokes are classified by what 3 etiologies?

  • Thrombosis
  • Embolus
  • hemorrhage

23

What can stokes be due to?

  • Plaques
  • Ischemic stroke
  • Hemorrhagic stroke

24

what can cause an Ischemic stroke?

  • Thrombus
    • Cerebral thrombus: tissue death
  • Embolism: comes from somewhere else, breaks off and lodges
  • Conditions with low systemic perfusion pressures (lack cerebral blood flow)

25

what causes a Hemorrhagic stroke?

  • Intracerebral hemorrhage
    • Primary cerebral hemorrhage (small vessels)
    • Subarachnoid hemorrhage (large vessels)

26


Risk factors for a stroke?

  • Hypertension
  • Coronary artery disease
  • Congestive heart failure
  • Peripheral arterial disease
  • diabetes

27

Early warning signs of a stroke?

  • Sudden numbness or weakness of face, arm, or leg, especially on one side of body
  • Sudden confusion, trouble speaking/understanding
  • Sudden trouble seeing (this could be several things, most of which are dangerous!)
  • Sudden trouble walking, dizziness, loss of balance, or coordination
  • Sudden SEVERE headache (worst headache of my life)
  • Sudden nausea/fever/vomiting
  • Brief LOC or decreased consciousness

28

what is the The Golden “hour”?

  • Or, actually 3 hrs!
  • If it is a thrombotic event, must use t-PA (clot dissolving enzyme) within 3 hours of symptom onset
  • t-PA cannot be given for: _____________________
  • More likely to fully recover or have limited disability if t-PA is given in time

29

  • Damage over 3-4 hours
  • Cerebral edema:  reaches maximal level at 3-4 days: should dissipate in 2-3 weeks

what Pathophysiology?

Ischemic cascade