Stroke
FAST is a checklist by the NSA which stands for:
Face, Arms, Speech, Time
-Hemorrhagic strokes are preceded by ___ and an aneurysm, which is a ___.
-Aneurysms worsen due to __(3)__.
-Hemorrhagic strokes can occur within the ___ or ____.
-HTN, a weak spot in the wall.
-mechanical stress, diabetes, nicotine
-Brain, arachnoid or pia mater
A frontal lobe-specific stroke deficit may result in:
Preservation? Decreased awareness, slowed execution, lack of goal directed behavior, social disinhibition, poor judgement, aggression.
-What things to review in your patient's chart? (6)
-What 3 things should you include in your face to face assessment first?
-type of stroke, artery affected, side, stable or in evolution , OT/SLP eval, home and family situation
-vision, speech, cognition
This scale is a 3-4 point scale measuring consciousness, vision, eye movements, facial palsy, limb strength, ataxia, sensation, speech and language. (Olivia does this q1hour for her stroke pts)
NIH Stroke Scale
-Ischemic strokes are caused by occlusions that block bloodflow to the brain, resulting in a metabolically depressed region called ___
-Hemorrhagic strokes are caused by bleeds from blood vessels, typically ___, resulting in frank bleeding. Why?
-penumbra
-arterial
Ischemic strokes are embolic or thrombotic; explain the differences. What % of strokes are ischemic?
Embolic: blood clot forms elsewhere, dislodges, and travels to the brain. Thrombotic: occur due to buildup in the arterial walls in arteries surrounding the brain; 80%
Deficits associated with cerebellar stroke include:
balance and coordination, head and body reactions / reflexes, dizziness, N/V
What types of movements will you assess on your patient? What 2 qualities will you pay most attention to?
ROM, strength and tone, transfers, FMC, balance and coordination, gait; quality of movements and movement planning
-This scale is a 5 point scale measuring strength, memory, affect, mobility, daily activities; subjective test.
-Barthel Index
Stroke Impact Scale
Symptoms of a stroke are scary. Name 2 most common + other less common
What is: numbness and weakness + confusion, aphasia, vision changes, poor coordination, changes in musc. tone, headache
-A stroke is "completed" when max. deficit has been produced, typically within ___ hours after it begins.
-Sometimes a stroke continues to evolve beyond this point, esp. in patients with ___
-24-36
-diabetes
Deficits associated with left hemisphere stroke include: (3)
-speech and language: expressive or receptive aphasia
-slow and cautious movements when performing tasks
-memory deficits: short attention span, trouble learning new info
-Assessment of strength and spasticity is controversial due to our understanding of ____
-the underlying cause of these deficits
-This is a 5 point scale measuring spasticity
-This scale has 2 sections for gait and balance to measure fall risk; good interrater reliability
-Modified Ashworth scale
-Tinetti Assessment Tool
Strokes have many risk factors. What are 5 of them?
What is: old age, HTN, Afr. Amer, male, T2D, obesity, high chol, smoking, a-fib
-Intracerebral hemorrhage most often occurs in which 4 places?
-Sx of hemorragic stroke include ___ due to ____
-More or less likely to evolve than ischemic stroke?
-basal ganglia, cerebellum, brain stem, cortex
-severe HA, LOC, vomiting; increased ICP.
-more
Deficits associated with right hemisphere stroke include: (5)
control of analytical and perceptual tasks, spatial and perceptual abilities, impulsivity / reduced awareness of impairments, L side neglect, short term memory.
Initial presentation would include ___ posture in UE and ___ posture in LE as a result of spasticity
flexion, extension
-This is a 4 point scale assessing sitting, standing, transfers, mobility.
-This is a point scale assessing orientation, mental ability, language, ability
-This is a 6 item scale measuring ADLs as I, A, D.
-Berg Balance Scale
-Mini Mental State Exam
-Katz Index of ADLs
-If stroke affects brainstem, the sx will affect ____ fct and / or localized to ___ and ___.
-If stroke affects the cerebral cortex, the sx will be ___ in nature.
-If stroke affects the cerebellum, ___ will be affected
-involuntary systemic fct; face and neck
-cognitive
-coordination
-A silent stroke is AKA ___
-Duration of a TIA is about ___ mins with sx resolving in ___. Also increased risk for ___ in the future.
-RIND is similar to a more involved ___, resolves after ___, regarded as a ___ in medical record.
-Asymptomatic Cerebral Infarct
-2-15 mins; 24 hours; early onset dementia.
-TIA; 2 weeks; full stroke
A circle of willis specific stroke deficit in this artery may result in which symptoms? 1. internal carotid artery 2. anterior cerebral artery? 3. Middle cerebral artery? 4. post. cerebral artery? 5. vetebral-basilar artery?
1. Asymp. or MCA 2. unilat. UE or LE weakness, impaired judgement, perseveration. 3. Unilat. face, UE or LE weakness, hemisensory loss of sensation, visual-perceptual problems, lang. disturbance. 4. homonymous hemianopsia, aphasia. 5. sensory loss, dysarthria, dysphagia, vertigo, ataxia, nystagmus.
-At onset of a stroke, the __ extremities are more involved than ___ extremities. Which usually recovers less fully?
-Poor prognosis if complete flaccidity at onset or grip strength immeasurable at ___ weeks. Almost all spontaneous recovery occurs in ___ months.
-UE, LE. UE less fully
-4 weeks; 6. months
This person is the smartest, most determined, most considerate, most selfless and most beautiful and amazing woman who is studying so hard for her exams. Who is this?
YOU!! (Chloe)