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Stroke Flashcards

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1
Q

what does ACA supply

A

Anterior 2/3 of medial cerebral cortex (frontal & parietal lobes) + subcortical structures (such as basal ganglia

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2
Q

ACA characteristics

A

contralateral hemisensory loss
Contralateral hemiplegia
LE > UE
broca or non fluent aphasia
Apraxia
Abulia
Akinetic mutism
Slow, lack of spontaneity
Contralateral grasp reflex
Urinary incontinence

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3
Q

MCA supply

A

Lateral cerebral cortex (frontal temporal and parietal), basal ganglia, large portions of the internal capsule

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4
Q

MCA characteristics

A
  • Contralateral hemiparesis
  • Contralateral hemisensory loss
  • UE & face > LE
  • Broca (non fluent aphasia) > frontal
  • Wernicke’s (fluent) > temporal
  • Global aphasia
  • Perceptual deficits (unilateral neglect, apraxia, agnosia, spatial disorganization) > non dominant hemisphere
  • contralateral homo. Hemianopsia
  • loss of conjugate gaze
  • sensory ataxia & pure motor hemiplegia (lacunar stroke)
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5
Q

PCA supply

A

Occipital lobe, medial & inferior temporal lobe, midbrain, upper brainstem, most of thalamus

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6
Q

PCA characteristics

A
  • visual agnosia
  • homo. Hemianopsia
  • prosopagnosia
  • dyslexia
  • agraphia
  • amnesia & memory deficits
  • anomia (color discrimination)
  • central post stroke thalamic pain
  • contra sensory loss
  • webers syndrome
  • Involuntary movements (such as choeroathestosis, tremor, hemiballismus)
  • contra hemiplegia
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7
Q

Webers syndrome ?

A

Oculomotor palsy & contralateral hemiplegia

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8
Q

Wallenberg syndrome is also known as

A

Lateral medullary syndrome & posterior inferior cerebellar artery syndrome

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9
Q

Symptoms of Wallenberg syndrome:

A

Ipsilateral ataxia
Ipsilateral impaired sensation (face)
Contralateral impaired pain & thermal in UE & LE
Vertigo, nausea, vomiting, nystag.
Dysarthria, dysphonia, dysphagia (paralysis of laryngeal & palatal muscles + diminished gag reflex) Horners syndrome
Ipsilateral sensory loss of trunk & limb
Contralateral pain & temp loss

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10
Q

Horners syndrome symptoms

A

Miosis, ptosis, anhidrosis

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11
Q

Occlusion of small vessels in cerebral white matter, strongly associated with hypertensive hemorrhage and diabetic microvascular disease, what is this

A

Lacunar Stroke

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12
Q

Characteristics of lacunar stroke

A
  • pure motor stroke (contra hemi)
  • purse sensory stroke (one side)
  • ataxic hemiparesis (ipsi, LE > UE)
  • dysarthria / clumsy hand syndrome
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13
Q

Patients with lesions involving the cortex of the __________ hemisphere typically the _______ hemisphere demonstrate speech and language impairments (aphasia)

A

Dominant, Left

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14
Q

Patients with stroke in the _____ lobe commonly present with dysarthria, due to affection of the muscles that produce speech

A

frontal

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15
Q

Cognitive dysfunction are typically due to lesions affecting the______

A

Prefrontal cortex

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16
Q

Short term memory may be affected but long term memory is unaffected in stroke patients true or false

A

True

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17
Q

______ is known as an acute confusional state seen more commonly in acute care setting and results from several factors following an acute stroke (clouding consciousness or dulling of cognitive process and impaired alertness)

A

Delirium

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18
Q

Lesions of the brain affecting _____ and ______ and _____ can produce several emotional changes such as depression, apathy, euphoria, etc

A

Frontal lobe, hypothalamus, limbic system

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19
Q

Pseudobulbar affect (emotional incontinence)

A

Episodes of sudden uncontrollable laughing crying anger or other emotional displays

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20
Q

Difficulties in communication and processing information in a linear order + slow cautious anxious disorganized + more hesitant when trying next tasks (increased need for feedback and support) this are behavioral differences seen in

A

Left hemisphere lesions

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21
Q

Aware of their deficits and more realistic in their appraisal of their existing problems + difficulty processing verbal commands are behavioral differences seen in ?

A

Left hemisphere lesion

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22
Q

Demonstrate difficulty in spatial-perceptual tasks (grasping the idea of the task or activity) + described as quick and impulsive with poor judgement + tend to overestimate their abilities (acting unaware of their deficits) these are all behavioral changes seen in

A

Right hemisphere lesion

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23
Q

Safety is an issue for them + difficulty processing visual commands are signs seen in

A

Right hemisphere lesions

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24
Q

Flexion synergy components
1. Scapular >
2. Shoulder >
3. Elbow >
4. Forearm >
5. Wrist & fingers >
6. Hip >
7. Knee >
8. Ankle & toes >

A
  1. Retraction / Elevation or hyperextension
  2. Abduction & ER
  3. Flex
  4. Supination
  5. Flex
  6. Flex, abduct, ER
  7. Flex
  8. DF + inversion
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25
Extension synergy components 1. Scapular > 2. Shoulder > 3. Elbow > 4. Forearm > 5. Wrist & fingers > 6. Hip > 7. Knee > 8. Ankle & toes >
1. Protraction 2. Adduction & IR 3. Extend 4. Pronation 5. Flex 6. Extend, adduct, IR 7. Extend 8. PF + inversion
26
UE spasticity pattern
Scapular retractor, shoulder adductor, depressor, IR, elbow flexor, forearm pronator, wrist and finger flexors
27
LE spasticity pattern
Pelvic retractors, hip adductors extensors and IR, knee extensor, ankle PF and supination, toe flexion
28
Neck and trunk spasticity pattern
Lateral flexion to hemiplegia side (pusher syndrome)
29
Perceptual dysfunctions typically result from a lesion in _____
Right parietal cortex
30
Understanding one’s body parts and their relative positions in space for example individuals inability to recognize their right from their left, what is this called
Body scheme
31
What is it called when a person denies having difficulties even when it is evident they do (ex: denying mobility problems when requiring a wheelchair)
Anosognosia
32
Inability to recognize familiar faces
Prosopagnosia
33
Unilateral neglect is the inability to recognize or respond to stimuli on the ________ side of the body to the brain injury. It is almost always seen in _____ sided hemisphere lesion.
Opposite side, right hemisphere
34
Initial flaccidity and no voluntary movement, which stage of twitchell and brunnstrom is this
Stage 1
35
Emergence of spasticity, hyperreflexia, synergy, which stage of twitchell and brunnstrom is this
Stage 2
36
Voluntary movement possible but only in synergy, spasticity is strong which stage of twitchell and brunnstrom is this
Stage 3
37
Voluntary control in isolated joint movements emerging due to corresponding decline of spasticity and synergy which stage of twitchell and brunnstrom is this
Stage 4
38
Increasing voluntary control out of synergy and coordination deficits are present which stage of twitchell and brunnstrom is this
Stage 5
39
Control and coordination near normal which stage of twitchell and brunnstrom is this
Stage 6
40
Lesion of the thalamus causes deficit in which CN
CN2
41
Midbrain lesion causes deficit in which CN
CN3 & 4
42
Brainstem lesion causes deficits in which CN
CN3 4 5 6 9 10 11 12
43
What regulates the cardiovascular and pulmonary systems
Medulla oblangata
44
The midbrain houses the nuclei of which cranial nerves
CN3 & CN4
45
The medulla houses which cranial nerves
CN9,10,11,12
46
Unilateral neglect is a function of which lobe
Parietal
47
Motor function, problem solving, spontaneity, memory, language, these are all the functions of which lobe
Frontal
48
The primary visual cortex area is which lobe
Occipital
49
Extra cranial blood supple to the brain is provided by _____
Right & left internal carotid + right & left vertebral arteries
50
UE flexor synergy components
Scapular retraction / elevation Shoulder abduction / ER elbow flexion / supination Wrist & finger flexion
51
UE extensor synergy components
Scapular protraction Shoulder adduction / IR elbow extension / pronation Wrist & finger flexion
52
LE flexor synergy components
hip flexion / abduction / ER knee flexion Ankle DF & inversion
53
LE extensor synergy components
Hip extension / adduction / IR KNEE EXTENSION ankle PF & inversion
54
Regarding chemical regulation in CBF (cerebral blood flow) what causes vasodilation
PaCO2 increased Decreased PaO2 Acidosis
55
Can ACA be asymptomatic if circle of Willis is competent and intact ? Yes or No
Yes
56
Vertebrobasilar Artery syndrome blood supply
Cerebellum Brainstem (Posterior circulation)
57
What is vertebrobasilar artery syndrome divided to
Medial Medullary syndrome & Lateral (Wallenberg) medullary syndrome
58
Medial medullary syndrome signs & symptoms
Ipsi tongue paralysis (tongue deviates to affected side) Contra UE & LE paralysis Impaired tactile & proprioception sensations
59
Complete basilar artery syndrome results in and is also known as
Locked in syndrome - tetraplegia - bilateral cranial nerve palsy - Consciousness & up gaze preserved - coma
60
Occlusion of the internal carotid artery will produce a massive infarction in the region of the brain supplied by ________. The ICA supplied both the ____ & _____ if the _______ is absent from the circle of Willis then extensive cerebral infarction will occur in both the _____ & ____. Significant edema with possible herniation, coma, & death is possible.
MCA / MCA & ACA / ACA / ACA & MCA
61
Impairment of comprehension, formulation, and use of language is known as
Aphasia
62
Fluent speech, poor comprehension (receptive type) what aphasia is this
Wernicks
63
Nonfluent, effortful speech, good comprehension (expressive type) what type of aphasia is this
Broca’s aphasia
64
Severe impairment in both comprehension & fluency, what type of aphasia is this
Global aphasia
65
Is aphasia seen most commonly in right or left hemisphere lesions
Left
66
Perceptual dysfunction such as body scheme disorders, agnosia, spatial relation deficits, these are commonly seen in lesions at the _____
Right parietal lesions
67
Bilateral signs of stroke are suggestive of a _____ lesion
Brainstem lesion (or massive cerebral involvement)
68
Valuable screening tool for initial examination following stroke
NIHSS (national institute of health stroke scale)
PCE
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