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Flashcards in Cerebrovascular Accident Deck (29)
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What is a cerebrovascular accident (CVA)?

Specific event that results in a lack of oxygen supply to a specific area of the brain secondary to either ischemia or hemorrhage


What are the primary risk factors that can lead to CVA?

- Hypertension
-Cardiac Disease or arrhythmias
- Diabetes mellitus
-Cigarette smoking
-Transient ischemic attacks


What are secondary risk factors of the development of a CVA?

1. Obesity
2. High Cholesterol
3. Behaviors related to hypertension (i.e. stress, excessive salt intake)
4. Physical inactivity
5. Increased Alcohol consumption


What are the types of CVA’s?

1. Transient Ischemic Attack (TIA)
2. Completed Stroke
3. Stroke Evolution
4. Ischemic Stroke
5. Hemorrhage


Describe a TIA CVA?

-usually linked to an atherosclerotic thrombosis which causes a temporary interruption of blood upply to an area of the brain

-symptoms resolve quickly, typically within 24-48 hours


Where does a TIA often occur?

Vertebrobasilar arteries and may incite future CVA


What is a completed stroke?

A CVA that presents with total neurological deficits at onset


What is a stroke in evolution?

CVA usually caused by a thrombus that gradually progresses

Total neurological deficits are not seen for one to tow days after onset


Name the type of Ischemic Strokes.

Embolus (20% of Ischemic CVAs)



What is an Embouls Ischemic Stroke associated with?

CVD, the embolus may be solid, liquid or gas, and can originate in any part of the body.


Explain what happens with an Ischemic CVA caused by an embolus

Embolus travels through the bloodstream to the cerebral arteries causing occlusion of a blood vessel and a resultant infarct

-occurs rapidly with no warning; often presents with a headache

-tissues nearest the occlusion sustain higher permanent damage


What artery is most commonly affected in regards to an embolic CVA?

Middle cerebral artery (MCA) from the internal carotid artery most commonly affected


what are common cardiac disorders that can lead to embolism?

- valvular disease (i.e. rheumatic mitral stenosis)
- Ischemic heart disease
-acute myocardial infarction
-arrhytmias (i.e. atrial fibrillation)
-patent foramen ovale
- cardiac tumors
-post cardiac cathertizationd


What is a thrombus CVA?

- atherosclerotic plaque develops in an artery and eventually occluded the artery or a branching artery causing an infarct.


T or F: A thrombus CVA is extremely variable in onset where symptoms can appear in minutes or over several days AND typically occurs during sleep or upon awakening after a MI or p/o



What are the characteristics of a Left CVA?

- Weakness, paralysis of the Right Side
- increased frustration
-decreased processing
-possible aphasia (expressive, receptive, global)
- possible dysphasia
-possible motor apraxia (ideomotor and ideational)
-decreased discrimination b/t left and right
-Right hemianopsia


What are characteristics of a Right Hemisphere CVA?

-Weakness, paralysis of the left side
-decreased attention span
-Left hemianopsia
-decreased awareness and judgement
-memory deficits
- Left inattention
-decreased abstract reasoning
-Emotional lability
-Impulsive behaviors
-decreased station orientation


What are the charateristics of a brainstem CVA?

-Unstable vital signs
-decreased consciousness
-decreased ability to swallow
-weakness on both sides of the body
-paralysis on both sides of the body


What are the characteristics of a cerebellum CVA?

-decreased balance
-decreased coordination
-Decreased ability for posture adjustment


What are synergies?

Synergy patterns result when the higher centers of the brain lose control and the uncontrolled or partially controlled stereotyped patterns of the middle and lower centers emerge


What is a Flexor synergy of the UE?

*Flexor synergy is seen when the patient attempts to lift up their arm or reach for an object
Scapula: Elevation and retraction
Shoulder: abduction and ER
Elbow: Flexion
Forearm: supination
Wrist: Flexion
Fingers: flexion with adduction
Thumb: Flexion and adduction


Describe an Extensor Synergy of the UE.

Scapula: Depression and protraction
Shoulder: IR and Adduction
Elbow: Extension
Forearm: Pronation
Wrist: Extension
Fingers: Flexion with adduction
Thumb: Flexion and adduction


Describe a flexor synergy of the LE?

Hip: Abduction and ER
Knee: Flexion
Ankle: DF with supination
Toes: Extension

*flexor synergy is characterized by great toe extension and flexion of the remaining toes secondary to spasticity


Describe an Extensor Synergy of the LE.

Hip: Extension, IR, and adduction
Knee: Flexion
Ankle: PF with Inversion
Toes: Flexion and adduction


What are some CVA tests and outcome measures?

1. National Institute of Health (NIH) stroke scale
2. Functional Independence Measure (FIM)
3. Stroke Impact Scale
4. Fugl-Meyer Assessment of Physical Performance


Describe the NIH.

Assessment of an acute CVA relative to impairment


Describe FIM.

Provides a level of burden through assessment of mobility and ADL management


Describe the Stroke Impact Scale.

Assessment of physical and social disability or levle of impairment secondary to CVA


Describe the Fugl-Meyer Assessment of Physical Performance.

Motor, sensory, and balance impairment; also assesses pain and ROM