The Ben Shahabi Category
Attending Dr. Collier's ZL Service
Charles Taylor's Candy Bag
I Hope You Paid Attention to Lesley's Jeopardy Game
Committee to Rename the Derek Davidson STAR award the Avers Award of Accomplishment (AAA)
100
58yo M with PMH of T2DM, AFib on Warfarin, HTN, medication noncompliance presents with complete right sided weakness, unable to speak, difficulty swallowing, unable to follow directions. Exam reveals flaccid 0/5 MMT to RUE and RLE.
What artery is affected.
Left MCA
100
This person was credited as the first person to describe the pattern of motor recovery after stroke.
Thomas Twitchell in 1950
Hemiplegia/decrease DTRs--> increase in DTRs at 48hrs-> increase tone Flex/Add UE, Ext/Add LE -> as tone increases, clonus can appear at 1-38d -> movement recovery (6-33d) first intentional movements appear ShFlex UE (followed by flexor synergy), HF in LE (followed by extensor synergy)
100
Strokes are the ____ (number) leading cause of death in United States.
Per Cuccurullo in 2013 = 3rd behind Heart Disease and Cancer.
CDC 2016 - 5th behind accidents (3) and chronic Respiratory Illness (4)
Globally in 2016 - 2nd, behind Heart Disease
100
What are the two most common areas of focal contusions damaged in a TBI?
Inferior Frontal Lobe
Anterior Temporal Lobe
100
"I am not a crook" - this (in)famous U.S. President with AFib died of an embolic stroke April 18, 1994 at the age of 81.
Richard Nixon
200
58yo F with PMH of HTN, HLD, T2DM presents with worsening weakness and sensory changes on left side of body. PE reveals decreased sensation to PP and LT on left side, MMT shows 1/5 DF/PF/KE/KF 2/5 HF/HE, LUE 4+/5. Eyes are deviating to the right. Has full involuntary resistance to passive movements with both flex and extension to LLE.
Where is the lesion? And what is the German word for the last portion?
Right ACA Stroke
Gegenhalten -paratonic rigidity. Different than spasticity as there is no increase in DTRs and if repeated, spasticity resistance decreases while paratonic rigidity increases
200
If a patient has some motor recovery in hand by ___ weeks, there is a 70% change of full/good recovery
4 weeks
200
The most important modifiable and non-modifiable risk factor for stroke.
HTN = also TIA (5% within 1 mo, 14% within 1 year), Heart Disease, Afib, DM, Cigarettes, Carotid Stenosis (>70% beneficial for CEA), ETOH/Drug ABuse, OCPs (high estrogens), hypercoag states, HLD, Migraines, OSA, PFOs, Obesity/Sedentary lifestyle, living in SE USA, low SEC.
Age >55 = also M>F, AA>Cauc>Asian, FHx+
200
Give two ways to lower ICP
*Elevate HOB to 30 *Hyperventilate (inc RR -> dec CO2 ->vasodilation) *Hyperosmolar (mannitol) *Chill *Maintain Euvolemia *Burr Hole/Crani
200
Nyuk, Nyuk, Nyuk - Jerome Lester Horowitz, Pseudonym Curly Howard, suffered multiple strokes throughout his career affecting his slap comedy style- eventually being replaced by his brother Shemp. What comedy group is this?
Three Stooges
300
40yo F with PMH of cocaine use, morbid obesity, uncontrolled hypertension presents with acute onset of right arm and leg weakness. On exam patient cannot look to the left, and has 1/5 MMT to RUE and RLE.
What is the Syndrome? What are of the brain is affected?
Weber Syndrome
Median Midbrain - affects CN III (Ipsi effect) and Corticospinal tracts (Contra effect)
300
The greatest predictor of community ambulation after stroke is ...
Walking Speed.
Sitting balance at stroke onset based on some studies.
300
How do you calculate Cerebral Perfusion Pressure and what are the goal numbers for CPP and ICP?
CPP = MAP - ICP
CPP > 60mmHg
ICP < 20mmHg
300
What are the 3 categories of DAI?
Grade 1 - widespread white matter changes
Grade 2- white matter changes + focal changes (most commonly CC)
Grade 3- white matter changes involving brainstem
300
This All Pro Linebacker, now NFL analyst, had a big year in 2005: On Feb 8 he won his 3rd Super Bowl Title. Feb 16 he played in his only Pro Bowl. Feb 18th he suffered an embolic CVA (had a PFO). After an extended stay at Spaulding IPR, he returned to play Oct 30th was awarded NFL Comeback Player of the Year, and continued to play another 3 years in the NFL.
Tedy Bruschi
400
65yo M with PMH of HTN, AFib presents with N/V, vertigo, difficulty swallowing food. PE reveals that the Pain and Temp sensation is decreased on left face and right arm, when ambulating falls towards the left, nystagmus with right gaze. Also notice constricted pupil on left with droopy eyelid.
Location of stroke and what is the syndrome called.
Lateral Medullary Syndrome aka Wallenburg Syndrome.
Can occur with occlusion of Vert , PICA, Superior/Middle/Inferior Lateral Medullary branch.
Ipsilateral side: Horners (MAP), Cerebellar Signs, Spinothalamic tract decrease in face.
Contralateral side: Spinothalamic decrease in body, dysphagia, N/V, Nystagmus and Vertigo.
400
Name 4 risk factors for disability after stroke -
*minimal motor recovery at 4 weeks *delay in rehabilitation *bilateral lesions *Poor sitting balance *Global Aphasia *Severe Neglect *Incontinence persisting >1-2 weeks *old age *DM *impaired cognition *previous stroke *previous functional disability
400
What are the four phases of swallowing?
Which phase is where aspiration occurs most commonly?
Which phase would you see problems with pocketing/drooling?
Oral Preparatory -> Oral Phase -> Pharyngeal Phase -> Esophageal Phase
Pharyngeal Phase
Oral Preparatory Phase
400
Aphasic patient with impaired fluency, intact comprehension, and intact repetition is which type of aphasia?
Transcortical Motor = frontal lobe location
400
This famous politician was known for many things including suffering, and eventually dying, from 11 known strokes, on average smoking 900 cigars every 3 months, drank from 8am until his nightcap at 10pm, and would notoriously put a paperclip in his cigars to hold the ash in place to distract/intimidate foreign leaders he was meeting with. Who is this?
Winston Churchill
500
This stroke syndrome characteristics is a constellation of these four findings:
- Acalculia * Finger Agnosia *Agraphia *Left/Right Disorientation
What is the stroke syndrome?
Gerstmann Syndrome
Damage to the dominant hemisphere at the temporal/parietal junction - Angular Gyrus
500
Describe the Brunnstrom vs. Bobath approach to Motor Recovery Therapy
Bobath is to normalize tone, to inhibit primitive patterns of movement, and to facilitate automatic, voluntary reaction. BREAKs the syngergies. Most common.
Brunnstrom uses synergistic patterns in training in an attempt to improve motor control. KEEPS the synergies.
500
Recruiting Right Hemisphere to assist in communication using melodies or rhythms helps assist in what type of Aphasia?
What is this technique called?
Broca's Aphasia
Melodic Intonation
500
Neuroplasticity occurs by what two mechanisms?
Neuronal (Collateral) Sprouting - intact axons sprout to areas where damage has occurred
Unmasking Neural Reorganization - Healthy structures are reassigned to do functions that the damage part was supposed to do.
500
This Hollywood female icon almost died when suffering from a cerebral hemorrhage in 2001 at the age of 39. Her basic instinct was to seek medical attention and so she survived. With luck like that, she should go to the Casino.
Sharon Stone
