neuromuscular mgmt week 1

cerebrovascular accident

blood vessel that carries oxygen and nutrients to the brain is either blocked or ruptures

ischemic

what type of stroke is more common?

ischemic/hemorrhagic/transient ischemic attack

what are the three types of strokes?

ischemic stroke

occlusion of a blood vessel in the brain

disability

ischemic strokes are associated with higher ________

mortality

hemorrhagic strokes are associated with higher ___________

thrombotic/embolic

what are the two types of ischemic strokes?

thrombotic

atherosclerotic plaques block an artery in the brain

embolic

atherosclerotic plaques form in arteries of another area, then travel to the brain

hemorrhagic stroke

rupture/bleeding of a blood vessel in the brain

hypertension/ruptured aneurysm/arteriovenous malformation

what are three main causes of hemorrhagic strokes?

cerebral aneurysm

weak area in a blood vessel that enlarges, may rupture and cause bleeding

size/shape/location/smoking/blood thinners/strenuous activity

what six things can change the likelihood of an aneurysm rupturing?

endovascular coiling/clipping

what are two surgical managements for cerebral aneurysms?

arteriovenous malformation

tangle of blood vessels in the brain, disrupts blood flow and oxygen circulation

YES

can arteriovenous malformations rupture?

CT/MRI

what two scans can detect arteriovenous malformations?

location

symptoms for arteriovenous malformations are based on WHAT?

avoid strenuous exercise/blood thinners/surgery

what are three treatments for arteriovenous malformations?

mini stroke

another name for transient ischemic attacks

transient ischemic attack

temporary blockage of blood flow to the brain, symptoms may last 24 hours

1/3

what fraction of people who have a TIA will have a more severe stroke within 1 year?

cryptogenic stroke

an ischemic stroke of unknown origin

1/3

what fraction of ischemic strokes are cryptogenic?

cardioembolism/large artery atherosclerosis/small artery disease

what three things is a cryptogenic stroke NOT attributable to?

physical exam/CT scan/MRI/cerebral angiogram

what are the four parts of a stroke diagnosis?

higher

higher scores on the NIH stroke scale indicate ________ severity

>25

what NIH stroke scale score indicates a VERY SEVERE stroke?

15-24

what NIH stroke scale score indicates a SEVERE stroke?

5-14

what NIH stroke scale score indicates a MILD-MODERATELY SEVERE stroke?

1-5

what NIH stroke scale score indicates a MILD stroke?

home (80%)

a patient with an NIH score of

acute inpatient rehab

a patient with an NIH score of 6-13 will be discharged where?

long term skilled care

a patient with an NIH score of >14 will be discharged where?

left neglect/deny problems/impulsive/impaired judgement/left hemiplegia

what are five symptoms of R brain damage?

right hemiplegia/aphasia/cautious/depression/impaired math skills/directional issues

what are six symptoms of L brain damage?

face/UE

what parts of the body are more affected by a middle cerebral artery stroke?

homonymous hemianopsia

what is a common visual deficit caused by a middle cerebral artery stroke?

agnosia/neglect/visuospatial loss/apraxia

what are four perceptual deficits caused by a middle cerebral artery stroke?

agnosia

the loss of ability to identify objects or people

anterior communicating artery maintains BF

why is an anterior cerebral artery more rare?

LE

what part of the body is more affected by an anterior cerebral artery stroke?

abulia/agitation/emotional change/incontinence

what are four behavioral changes caused by an anterior cerebral artery stroke?

abulia

a lack of will, drive, or initiation for action/speech/thoughts

contralateral hemianopsia/quadrantanopsia/cortical blindness

what visual deficits can occur from a posterior cerebral artery stroke?

cortical blindness

form of visual impairment caused by damage to the occipital lobe, rather than the eyes

visual agnosia/prosopagnosia/alexia/achromatopsia/thalamic pain

what are five symptoms of a posterior cerebral artery stroke?

visual agnosia

patient can't recognize visually presented objects

prosopagnosia

inability to recognize faces

alexia

inability to read written language

achromatopsia

absence of color vision

lacunar stroke

small ischemic strokes that occur in the deep structures of the brain, accounts for 25% of strokes

T

T/F: lacunar strokes are mostly small and asymptomatic

posterior limb of internal capsule

what part of the brain does a pure motor hemiparesis lacunar stroke affect?

contralateral hemiparesis of face/arm/legs

what is a symptom of a pure motor hemiparesis lacunar stroke?

internal capsule/pons

what two structures of the brain does an ataxia hemiparesis lacunar stroke affect?

unilateral limb ataxia/ipsilateral cerebellar signs

what are two symptoms of an ataxia hemiparesis lacunar stroke?

thalamus/corona radiata

what two structures of the brain may be affected in a pure sensory lacunar stroke?

unilateral numbness of face/arm/leg (NO MOTOR DEFICITS)

what is the main symptom of a pure sensory lacunar stroke?

thalamus/internal capsule/putamen/caudate

what four structures of the brain may be affected with a sensory motor lacunar stroke?

contralateral sensory/motor loss

what is the main symptom for a sensory motor lacunar stroke?

pons/internal capsule

what two structures of the brain may be affected by a dysarthria-clumsy hand lacunar stroke?

dysarthria/dysphagia/contralateral face paresis/contralateral paresis of UE/tongue weakness

what are five symptoms of the dysarthria-clumsy hand syndrome?

wallenberg syndrome/lateral medullary syndrome

what are two other names for a posterior inferior cerebellar artery stroke?

ipsilateral horner's syndrome/ipsilateral ataxia/pain and temperature loss

what is the wallenberg syndrome triad of symptoms?

contralateral/ipsilateral

wallenberg syndrome: what side of the body experiences pain and temperature loss in the limbs and trunk? what about the face?

miosis/ptosis/anhidrosis

what are three symptoms of horner's syndrome?

T

T/F: there is minimal to no weakness on the contralateral side with a posterior inferior cerebellar stroke

vertigo/nystagmus/diplopia/dysphonia/dysphagia/loss of gag reflex/loss of balance

what are seven other symptoms of wallenberg syndrome?

ipsilateral tinnitus/deafness/sensory loss to face

what are three symptoms of an anterior inferior cerebellar artery stroke?

coma/locked in syndrome/ipsilateral CN deficits/contralateral hemiparesis/dizziness

what are five symptoms of a basilar artery stroke?

locked in syndrome

complete paralysis of all voluntary muscles except those that control eye movements

hypertension/smoking/diabetes/high cholesterol/inactivity/obesity/sleep apnea/stress/atrial fibrillation

what are nine modifiable risk factors for strokes?

age/family history/female/prior stroke/race

what are five non modifiable risk factors for strokes?

2.5x

incidence of stroke increases by _________ with 3 or more social determinants of health

ischemic cascade

pathological mechanisms that are activated just a few minutes after blood vessel occlusion

excitotoxicity/cytotoxic edema/apoptosis

what are the three stages of the ischemic cascade?

excitotoxicity

pathological depolarization of neurons due to abnormal release of glutamate and calcium, results in cell damage

cytotoxic edema (cell swelling)

caused by passive water influx that follows the abnormal accumulation of calcium in the cell through osmosis

apoptosis

systematic cell death, related to disruption of mitochondria within the cell

increased intracranial pressure restricts blood flow

what is the mechanism of cerebral damage after a hemorrhagic stroke?

3 hours

within what time period should IV thrombolytics be given for a patient who had an ischemic stroke?

mechanical thrombectomy

what treatment is used for patients with a large vessel occlusion within 6 hours of stroke onset?

>18 years/ischemic stroke/neurologic deficits/onset

what are four rules of eligibility for IV thrombolytics?

intracranial hemorrhage/hypertension/head trauma/aneurysm

what are four contraindications for IV thrombolytics?

12-24 hours/hemorrhagic transformation

how long are patients who get IV thrombolytics monitored after treatment? for what precaution?

>185/>110

what BP is a contraindication for IV thrombolytics?

thrombectomy

mechanical interventional procedure where the clot is removed using endovascular devices

balance/eyesight/face drooping/arm weakness/speech difficulty/time

what does the BE FAST acronym stand for?

NIHHS >6/occlusion of MCA or ICA/>18 years

what are three indications for a thrombectomy?

core

area directly impacted by the stroke, non salvageable

penumbra

area surrounding the core, damaged but not destroyed

edema/reperfusion of penumbra/resolution of diaschisis/neuroplasticity

what are the four mechanisms of spontaneous neurological recovery after a stroke?

hemorrhagic

what type of stroke is associated with more edema, but may have a more dramatic post-stroke recovery after it subsides?

hyperacute

24 hours post stroke

acute

7 days post stroke

early sub acute

3 months post stroke

late sub acute

4-6 months post stroke

chronic

>6 months post stroke

3-6 months

where does stroke recovery often hit a plateau?