Cerebrovascular Accident (Stroke)

Flashcards on Cerebrovascular Accident (Stroke)

Cerebrovascular disease

Any disorder involving the blood supply to the brain

Stroke Classification

Neurological deficits must persist for at least 24 hours

Epidemiology of CVA

Fifth leading cause of death in the United States and the leading cause of serious long-term disability.

Types of Strokes

ischemic and hemorrhagic

Ischemic Strokes

Caused by ischemia (87% of all strokes)

Hemorrhagic Strokes

Caused by hemorrhage (13% of all strokes but account for 30% of stroke deaths)

Ischemia

Hypoxia or decreased oxygenation to tissue resulting from poor blood supply

Mechanism to store metabolic reserves in the brain

Brain lacks this so adequate blood supply is required to provide all the glucose, oxygen, and nutrients used by these tissues

Two major categories of Ischemic Strokes

Result from thrombosis and those that result from an embolus

Thrombotic Strokes

Most frequently a consequence of atherosclerosis

Cerebral thrombosis

Formation or development of a blood clot within the cerebral arteries or their branches

Atherosclerosis

Major contributory factor in cerebrovascular disease characterized by plaque formation.

Embolic Stroke

Blood clot that breaks away from the intima and is carried to the brain

Ischemic penumbra

Area surrounding the infarcted cerebral tissue where cells may be damaged but preserved

Hemorrhagic strokes

Abnormal bleeding from rupture of a cerebral vessel

Intracerebral hemorrhage (ICH)

Low among persons less than 45 years old and increases after age 65, major cause of morbidity and death accounting for 30% of all stroke deaths

Subarachnoid hemorrhages

Bleeding into the subarachnoid space

Aneurysms

Ballooning or outpouching of a vessel wall

Arteriovenous malformation (AVMs)

Congenital anomalies that affect the circulation in the brain

Transient ischemic attacks (TIAs)

Frequently called mini strokes, resemble a stroke in many ways

Major Risk Factors for Stroke

Hypertension, diabetes mellitus (DM), disorders of heart rhythm, high blood cholesterol and other lipids, smoking/tobacco use, and heart disease (HD)

Risk Factors for Stroke

Medical and lifestyle related factors.

F.A.S.T.

Early warning signs of a stroke

Medical Intervention for Stroke

Hospitalization to determine the etiology of the infarct

Thrombolytic agents

Recombinant tissue plasminogen activator (rt-PA) - dissolve blood clots, improve blood flow, and minimize tissue damage

Surgical intervention for Stroke

Endovascular thromboaspiration, carotid endarterectomy, sonothrombolysis, angioplasty, or stent placement

Anterior cerebral artery

Supplies the superior border of the frontal and parietal lobes

Middle cerebral artery

Supplies the surface of the cerebral hemispheres and the deep frontal and parietal lobes

Vertebrobasilar Artery

Supplies the brainstem and cerebellum

Posterior cerebral artery

Supplies the occipital and temporal lobes, thalamus, and upper brainstem

Middle Cerebral Artery Syndrome

Most common type of stroke

Locked-in Syndrome

Patient is alert and oriented; unable to move or speak because of weakness in all muscle groups

Visual agnosia

A neurological condition where an individual can see objects clearly but is unable to recognize or name them

Prosopagnosia

Neurological disorder characterized by the inability to recognize faces, even familiar ones like family members or friends

Thalamic pain syndrome

Experience a mismatch between their perception of vertical and the body’s orientation to the environment and gravity, they demonstrate pusher syndrome

Lacunar Strokes

Deep regions of the brain, including the internal capsule, thalamus, basal ganglia, and pons; named for their crescent-shaped appearance

Motor impairments post stroke

Spectrum of motor problems resulting from damage to the motor cortex

Spasticity

Motor disorder characterized by exaggerated deep tendon reflexes (DTRs) and velocity-dependent increased muscle tone

Modified Ashworth Scale

Tool used to assess spasticity

Brunnstrom Stages of Recovery

Stages of motor recovery following a stroke

Apraxia

Difficulty in performing purposeful movements, although no sensory or motor impairments are noted

Body scheme

Postural model of the body, including the relationship of the body parts to each other and the relationship of the body to the environment

Body image

Visual and mental image of one’s body that includes feelings about one’s body

Agnosia

Inability to recognize incoming information despite intact sensory capacities

Aphasia

Acquired communication disorder caused by brain damage; characterized by impairment of language comprehension, oral expression, and use of symbols to communicate ideas

Dysarthria

Difficulty articulating words due to weakness and inability to control the muscles associated with speech production

Dysphagia

Difficulty or inability to swallow foods and liquids

Aspiration

Penetration of food, liquid, saliva, or gastric reflux into the airway

Associated reactions

Automatic movements that occur as a result of active or resisted movement in another part of the body

Cognitive Deficits post stroke

Impairments in alertness, attention, orientation, memory, or executive functions

Abnormal posturing and positioning post stroke

Spasticity in specific muscle groups and can lead to the development of contractures and deformities

Complex regional pain syndrome

Result of autonomic nervous system dysfunction and signs and symptoms include, pain, edema, movement disorders, weakness, and atrophy

Core Set of Outcome Measures for Adults with Neurologic Conditions

Published 2018 and endorsed by the Academy of Neurologic Physical Therapy

Cardiopulmonary retraining post stroke

Diaphragmatic strengthening, deep-breathing exercises, and use of incentive spirometers

Benefits of positioning post stroke

Assists in stimulating motor function, increases sensory awareness, improves respiratory and oromotor functions, and assists in maintaining normal range of motion in the neck, trunk, and extremities

Cerebrovascular Accident (CVA)

Sudden loss of neurological function caused by an interruption of blood flow to the brain

Transient ischemic attacks (TIAs)

Frequently called mini strokes, resemble a stroke in many ways

Anterior cerebral artery

Supplies the superior border of the frontal and parietal lobes

Middle cerebral artery

Supplies the surface of the cerebral hemispheres and the deep frontal and parietal lobes

Vertebrobasilar Artery

Supplies the brainstem and cerebellum

Posterior cerebral artery

Supplies the occipital and temporal lobes, thalamus, and upper brainstem

Middle Cerebral Artery Syndrome

Most common type of stroke

Anterior Cerebral Artery Syndrome

Supplies motor and sensory to the contralateral lower extremity

Rehabilitation Approach for Stroke

Utilizing task-oriented training, compensatory strategies, and motor learning principles

Homunculus

Cortical representation of the body, illustrating the concentration of sensory and motor functions in specific brain areas

Why more UE or LE weakness?

MCA strokes tend to affect the UE more due to the lateral location/supply of the MCA; ACA strokes tend to affect the LE more due to the anterior/medial location/supply of the ACA