Flashcards in Cerebrovascular Accident Deck (29)
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?
-Cardiac Disease or arrhythmias
- Diabetes mellitus
-Transient ischemic attacks
What are secondary risk factors of the development of a CVA?
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
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
-possible aphasia (expressive, receptive, global)
- possible dysphasia
-possible motor apraxia (ideomotor and ideational)
-decreased discrimination b/t left and right
What are characteristics of a Right Hemisphere CVA?
-Weakness, paralysis of the left side
-decreased attention span
-decreased awareness and judgement
- Left inattention
-decreased abstract reasoning
-decreased station orientation
What are the charateristics of a brainstem CVA?
-Unstable vital signs
-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 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
Fingers: flexion with adduction
Thumb: Flexion and adduction
Describe an Extensor Synergy of the UE.
Scapula: Depression and protraction
Shoulder: IR and Adduction
Fingers: Flexion with adduction
Thumb: Flexion and adduction
Describe a flexor synergy of the LE?
Hip: Abduction and ER
Ankle: DF with supination
*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
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
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