EHR525: Exercise for Neurological and Neuromuscular Conditions - Stroke and Exercise

Vocabulary practice flashcards covering the pathophysiology, neurovascular territories, acute medical and surgical management, functional recovery trajectory, and clinical exercise testing and prescription principles for stroke patients.

Acquired Brain Injury (ABI)

Any type of brain damage that occurs after birth that is not attributable to genetic or degenerative diseases.

Non-Traumatic Brain Injury (NTBI)

A form of acquired brain injury caused by an internal mechanism of injury, such as a stroke, tumour, poison, hypoxia, or infection.

Traumatic Brain Injury (TBI)

A form of acquired brain injury caused by an external mechanism of injury, including head impacts, violent head movements, falls, motor vehicle accidents (MVA), or sports collisions.

Stroke

A group of disorders involving a sudden, focal interruption of cerebral blood flow that produces a neurological deficit lasting longer than 24 hours.

Ischemic Stroke

A classification of stroke accounting for approximately $85\%$ of all cases, occurring when a blood clot occludes a narrowing cerebral artery.

Embolic Stroke

A subtype of ischemic stroke where an arterial vessel is blocked by a clot that formed elsewhere in the body (such as the heart) and travelled through the circulation to the brain.

Thrombotic Stroke

A subtype of ischemic stroke in which the occluding blood clot forms directly within a cerebral blood vessel inside the brain.

Haemorrhagic Stroke

A stroke classification accounting for approximately $15\%$ of cases, characterized by excessive bleeding from a ruptured cerebral vessel, which deprives downstream tissues of blood flow and elevates tissue pressure at the site of rupture.

Ischemic Core

The central zone of infarction where severe ischemia (a $75\text{--}90\%$ reduction in baseline cerebral blood flow) leads to rapid depletion of energy stores and irreversible tissue necrosis.

Ischemic Penumbra

The rim of salvageable brain tissue surrounding the ischemic core where cells remain viable initially, but will progress to necrosis if cerebral reperfusion is not quickly re-established.

Subarachnoid Haemorrhage

A haemorrhagic stroke subtype where bleeding occurs in the subarachnoid space, primarily affecting the cerebral cortex.

Intracerebral Haemorrhage

A haemorrhagic stroke subtype involving bleeding inside deeper subcortical structures of the brain, including the basal ganglia, cerebellum, and brainstem.

Transient Ischemic Attack (TIA)

A brief ischemic episode where cerebral perfusion is temporarily interrupted, producing stroke symptoms lasting up to 30 minutes before rapid spontaneous resolution; serves as a major warning sign associated with a 10-fold increase in future stroke risk.

Circle of Willis

An arterial vascular ring located at the base of the brain that connects the internal carotid and vertebrobasilar systems, providing redundant blood supply and collateral circulation between major cerebral arteries.

Cortical Vascular Territories

The distinct anatomical zones of the cerebral cortex supplied by the anterior cerebral artery (ACA), middle cerebral artery (MCA), and posterior cerebral artery (PCA).

Left Middle Cerebral Artery (MCA) Syndrome

A clinical syndrome resulting from left MCA occlusion, presenting with aphasia, a right visual field cut, left gaze preference, and right-sided motor/sensory deficits predominantly affecting the face and upper extremity ($\text{face} > \text{arm} > \text{leg}$).

Right Middle Cerebral Artery (MCA) Syndrome

A clinical syndrome caused by right MCA infarction, typically characterized by contralateral neglect syndrome, agnosia, apraxia, right gaze preference, visual field deficits, and left-sided motor and sensory loss.

Anterior Cerebral Artery (ACA) Syndrome

A stroke syndrome involving the frontal and parasagittal cortical areas, marked by behavioral changes and contralateral motor deficits that affect the lower extremity more severely than the upper extremity ($\text{leg} > \text{arm}$).

Posterior Cerebral Artery (PCA) Syndrome

A stroke syndrome affecting the occipital cortex, subcortex, thalamus, and medial temporal lobes, producing homonymous visual field cuts, motor/sensory deficits, cranial nerve III (3rd nerve) palsies, and seizures.

Basilar Artery (Brainstem) Syndrome

A life-threatening vascular syndrome involving the pons, midbrain, medulla, and cerebellum, presenting with ophthalmoplegia, bilateral motor deficits, ataxia, dysmetria, vertigo, and coma or altered mental status.

Recombinant Tissue-Type Plasminogen Activator (rt-PA)

An intravenous thrombolytic medication ('clot buster') administered in acute ischemic stroke to recanalize occluded vessels, which must be given within $3\text{--}4.5\,\text{hrs}$ of symptom onset.

Thrombectomy

A mechanical endovascular surgical procedure where a catheter and stent retriever are navigated into an occluded cerebral artery to engage and extract a blood clot.

Carotid Endarterectomy

A surgical intervention to incise the carotid artery wall and excise atherosclerotic plaque, providing an $80\%$ risk reduction in stroke for patients with $>70\%$ arterial stenosis.

Spontaneous Neurological Recovery

The intrinsic neurological recovery process that occurs most rapidly within the first month post-stroke, plateaus between 3 and 6 months, and requires physical exercise and conditioning to sustain beyond 6 months.

Independent Living Threshold ($\text{VO}_2\text{max}$)

The minimum aerobic capacity value ($20\,\text{mL/kg/min}$) required to sustain independent activities of daily living; stroke patients typically present with an average $\text{VO}_2\text{max}$ of approximately $14.5\,\text{mL/kg/min}$.

Hemiparetic Gait

The primary gait deficit observed following stroke resulting from unilateral weakness or paralysis, characterized by circumduction, foot drop, hip hiking, reduced knee/hip flexion, lateral trunk lean away from the affected side, and prolonged double support time.

Absolute Red Flags for Exercise

Contraindications requiring immediate cessation or avoidance of exercise post-stroke, including unstable angina, resting blood pressure $>200/>110\,\text{mmHg}$, isometric actions, high-intensity exercise, high fall risk movements, and impact activities for 3 months.