NeuroPT - 16 - CVA

vascular

strokes are a ________ issue affecting the brain and other areas

FALSE - ALL SYSTEMS

T/F: atherosclerosis across the body affects just the cardiovascular system

disability

strokes are the number one cause of long-term __________

females

more deaths from strokes occure in (males/females)

• balance

• eyes

• face

• arm

• speech

• TIME to call 911

BE FAST stands for

pools, clots

a-fib is a risk factor for stroke because blood _______ in the atria, causing ______ to form

ischemic, hemorrhagic

the two categories of strokes are _______ and _______

ischemic (87%)

the majority of strokes are (ischemic/hemorrhagic)

ischemic

with (ischemic/hemorrhagic) strokes, the pipe is clogged

hemorrhagic

with (ischemic/hemorrhagic) strokes, the pipe leaks or bursts

interruption, damage

an ischemic CVA is a sudden _________ in cerebral blood flow that causes ______ to neuronal tissues

24 hours

with an ischemic CVA, symptoms need to last for at least _______

transient ischemic attacks

_______________ are essentially “warning sign” blockages that resolve and have symptoms lasting less than 24 hours

TRUE

T/F: imaging appears normal after a TIA

5 minutes

most TIAs last less than __________

• intravenous thrombolysis IVT

• endovascular thrombectomy EVT

acute ischemic stroke revascularization treatments include _______________ and ______________

tissue plasminogen activator tPA

a common thrombolytic used to dissolve clots for ischemic CVAs is called __________________

3 hours

tPA MUST be administered within _________ and monitored closely following administration

hemorrhagic stroke

tPA decreases clotting to help ischemic stroke, but elevates the risk for ______________

IVT

medications for stroke revascularization are considered (EVT/IVT)

EVT

procedures to physically remove a clot with an ischemic CVA are considered (EVT/IVT)

endovascular thrombectomy

EVT stands for _________

6-12

EVT can be done up to ____-____ hours after the onset of stroke symptoms

FALSE FALSE FALSE do not use either!!! ischemic only for those

T/F: if there is an acute hemorrhage, IVT treatment can be used but EVT treatment cannot

decr

hemorrhagic strokes have (decr/incr) survival compared to ischemic strokes

incr

hemorrhagic strokes have (decr/incr) recovery potential compared to ischemic strokes

• brain aneurysm

• arteriovenous malformation AVM

• trauma

the three main causes of hemorrhagic strokes are:

• nausea and vomiting

• sudden onset and severe headache

• loss of consciousness

• unequal pupil size

• lethargy

symptoms of bleeding within the skull/hemorrhagic stroke: (5)

aneurysm

a brain _______ is the ballooning of a weakened area of a blood vessel, often associated with hardening of the arteries, high BP, hereditary, or head injury

• endovascular coiling

• aneurysm clip

• flow diverters (stent)

the three management options for hemorrhagic CVA that are NOT ruptured are:

catheter

endovascular coiling for hemorrhagic CVA is done with a (catheter/craniotomy)

craniotomy

an aneurysm clip for hemorrhagic CVA is done with a (catheter/craniotomy)

pharmacological

the management options for hemorrhagic CVA that have ruptured are ___________ management

arteriovenous malformations AVMs

____________ are a collection of abnormally formed blood vessels that disrupts the normal function of the capillaries transitioning from high to low pressure systems

are

AVMs typically (are/are not) present at birth

surveilance and imaging

AVMs are managed through __________ long-term and potentially microsurgical resection or stereotactic radiosurgery to remove

higher

a (lower/higher) score on the NIH stroke scale indicates a more severe stroke with a worse prognosis

MCA

the _______ artery is most affected by ischemic stroke bc of its twisty turny curvys

• contralateral loss

• hemiplegia/paresis

• hemisensory loss

• hemianopsia (visual cuts)

a MCA stem occlusion would cause these 4 things:

aphasia

left hemisphere involvement of the MCA could cause _______

left unilateral neglect

right hemisphere involvement of the MCA could cause _______

L (usually L, may also be R)

apraxia is usually caused by MCA involvement of the (R/L) hemisphere

distal

a more _______ blockage affects less cortical tissue and would therefore be less severe

• visual deficits

• contralateral homonymous hemianopsia

• visual agnosia

• memory deficit

• prosopagnosia (naming people by sight)

a PCA occlusion would cause these 5 things:

TRUE

T/F: recovery of visual field deficits is typically very limited

• contralateral weakness (LE>UE)

• cognitive deficits, aphasia

• minimal sensory deficits (not common)

an ACA occlusion would cause these 3 things:

locked in syndrome

a basal artery occlusion could cause _________

CONTRALATERAL

strokes affecting the cortex affect the (ipsilateral/contralateral) side

IPSILATERAL

strokes affecting the cerebellum affect the (ipsilateral/contralateral) side

• dysdiadochokinesia

• dysmetria (hypermetria)

• ataxia

• intention tremor

• visual tracking issues

occlusions of posterior circulation, often affecting the cerebellum, cause these 5 issues:

uninvolved

motor output impairments/paresis make it harder to roll toward the (involved/uninvolved) side for bed mobility

• shoulder abd

• elbow F

• pinch grip on cube

to test motor output of the UE, test these three:

• hip F

• knee E

• DF

to test motor output of the LE, test these three:

TRUE

T/F: with motor output paresis from stroke, muscles are impacted similarly throughout the limb

fractionated

a motor output impairment in addition to paresis is the loss of _____________ movement that involves hypertonicity

modified ashworth

fractionated movement hypertonicity is tested with the _____________

paresis

hypertonicity is accompanied by _______!!!

TRUE

T/F: if you can’t feel, you can likely move just not as well

hemiparesis

(hemiparesis/hemisensory loss) is more impactful to function

one, three

bottom line for sensation: pick _____ modality/ies and test _____ places on each limb

parietal

perceptual deficits following stroke are related to issues in the _______ lobe

• apraxia

• unilateral neglect

• lateropulsion

examples of perceptual deficits following stroke: (3)

ideomotor, ideational

the two main types of apraxia are ________ and __________

ideomotor

(ideomotor/ideational) apraxia is when a patient is unable to produce a movement on command or imitate gestures but CAN perform it automatically

ideational

(ideomotor/ideational) apraxia is when a patient is inable to produce movement on command or automatically

left

unilateral neglect most commonly affects the ____ side of the body

right parietal

unilateral neglect is most commonly associated with the ____ ______ lobe/area

cognitie, behavioral

family education on unilateral neglect is important because neglect is NOT a ________ or _________ impairment

prism lenses

__________ can be a beneficial compensatory item used to help unilateral neglect

TOWARDS

lateropulsion involves a deficit in verticality where the patient pushes (away from/toward) the involved side

6

lateropulsion is rarely present after ___ months

receptive, word soup

wernicke’s aphasia is ________ aphasia and sounds like ________

expressive, not words

broca’s aphasia is _________ aphasia and sounds like _________

wenicke’s

with (wernicke’s/broca’s) aphasia, auditory comprehension IS impaired

broca’s

with (wernicke’s/broca’s) aphasia, auditory comprehension is NOT impaired

dysarthria

________ is a motor speech disorder that occurs in about half of people following a stroke

FALSE - nothing to do with language - it’s swallowing issues

T/F: dysphagia has to do with the production of language

left

a person with a lesion in the (right/left) hemisphere is more aware of their deficits

right

a person with a lesion in the (right/left) hemisphere is less aware of their deficits

• quick/impulsive

• poor judgement

common behavioral deficits with right hemispheric lesions are: (2)

• slow

• cautious

common behavioral deficits with left hemispheric lesions are: (2)

vision

changes in ______ after stroke affect prognosis the most (negatively)

**write out the prognostic chart for clinical practice

**write out the prognostic chart for clinical practice

• shoulder dysfunctions/sublux

• mood changes

• contractures

• DVT

• pneumonia (bc of dysphagia)

• deconditioning

possible secondary impairments after stroke:

acute

the highest rate of recovery after stroke is in the _______ phase

early

spontaneous neurological recovery occurs _______ in the recovery process and is what would occur even if PT wasn’t involved :(

INTENSITY

_________ matters a lot when designing interventions post-stroke, especially for recovery interventions. read the action statements!!