Cva Report

8/9/2019 Cva Report

1/34

8/9/2019 Cva Report

2/34

Is the sudden loss of neurological function

caused by an interruption of the blood flow to

the brain

Variety of focal deficits are possible, including

changes in the level of consciousness andimpairments of sensory, motor, cognitive,

perceptual and language functions.

8/9/2019 Cva Report

3/34

ISCHEMIC STROKE is the most common type,affecting about 80% of individuals with stroke,

and results when a clot blocks or impairs blood

flow, depriving the brain of essential oxygen and

nutrients.x CEREBRAL THROMBOSIS- refers to the formation or

development of an atherosclerotic plaque within the

cerebral arteries or their branches.

x CEREBRAL EMBOLUS- are travelling bits of matterformed elsewhere that are released into the

bloodstream and travel to a cerebral artery, where they

lodge in a vessel, producing occlusion and infarction.

8/9/2019 Cva Report

4/34

Atherosclerosis

Hardening or loss of elasticity of vessel

Plaques which can lead to thrombus .

8/9/2019 Cva Report

5/34

8/9/2019 Cva Report

6/34

HEMORRHAGIC STROKE- occurs when blood

vessels rupture, causing leakage of blood in or

around the brain.

x INTRACEREBRAL HEMORRHAGE- rupture of bloodvessel with a subsequent bleeding into the brain.

x SUBARACHNOID HEMORRHAGE- occurs from

bleeding into the subarachnoid space typically from a

saccular or berry aneurysm.

x ARTERIOVENOUS MALFORMATION- a tortorous

tangle of arteries and veins with an agenesis of an

interposing capillary system.

8/9/2019 Cva Report

7/34

Hypertension

Heart disease

Diabetes

8/9/2019 Cva Report

8/34

COMPLETE STROKE

STROKE IN EVOLUTION

TRANSCIENT ISCHEMIC ATTACK (TIA)

REVERSIBLE ISCHEMIC NEUROLOGIC

DEFICIT (RIND)

8/9/2019 Cva Report

9/34

8/9/2019 Cva Report

10/34

8/9/2019 Cva Report

11/34

8/9/2019 Cva Report

12/34

It supplies orbital and medial surfaces of frontal

and parietal lobes.

INTERRUPTION CAUSES: Cortical arteries

Paralysis of legs and feet

Difficulty in prefrontal lobe functions of cognitivethinking, judgement, motor initiation and self

monitoring.

8/9/2019 Cva Report

13/34

SIGNS AND SYMPTOMS:

x Paresis of opposite foot and leg more affected than the

armx Mental impairment (perseveration, confusion and

amnesia)

x Sensory impairment primarily on LE

x Urinary incontinencex Problems with imitation of bilateral tasks, apraxia,

slowness, delay, lack of spontaneity, motor inaction.

8/9/2019 Cva Report

14/34

Primary motor area, medial aspect of cortex,

internal capsule

Primary sensory area, medial aspect of cortex

Posteromedial aspect of superior frontal gyrus

Corpus callosum

8/9/2019 Cva Report

15/34

Supplies blood to entire lateral surface of brain.Somatosensory cortex

x Motor cortexx Brocas area

x Heschls gyrus

x Wernickes area

INTERRUPTION CAUSES:Contralateral hemiplegia

Impaired sensory systems

Touch

8/9/2019 Cva Report

16/34

SIGNS AND SYMPTOMS:

x Paresis of contralateral face, arm and leg is least affected

x Sensory impairment of contralateral sidex Expressive aphasia and receptive aphasia

x Perceptual deficits

x Homonymous hemianopsia

x Loss of conjugate gaze to the opposite side

x Ataxia or contralateral limb.

8/9/2019 Cva Report

17/34

Supplies blood to anterior and inferior temporal

lobes, uncus, inferior temporal gyri, inferior and

medial occipital lobe. Watersheds with middle cerebral artery

Interruption causes:

xHomonymous hemianopsia

x Possible total blindness

x Cerebellar symptoms

8/9/2019 Cva Report

18/34

SIGNS AND SYMPTOMS:

Contralateral homonymous hemianopsia

Contralateral sensory loss

Thalamic syndrome

Involuntary movements (choreoathetosis, intention,

tremor, hemiballismus)

Webers syndrome

Dyslexia, prosopagnosia, agraphia, anomia

8/9/2019 Cva Report

19/34

HEMIPLEGIA (LEFT HEMISPHERE)

Visuomotor perception and memory intact

Visual learning

Learning is step by step, encourage imitation

Unable to communicate effectively vocabulary andauditory span reduced.

Able to pick up ideas through body language and facial

expression. Cautious and unorganized when approaching an unfamiliar

situation.

Learns from mistakes able to synthesize

8/9/2019 Cva Report

20/34

1. Visuomotor perceptual impairment

2. Loss of visual memory

3. Left sided neglect; impulsive or unorganized activitiesof daily living

4. Safety problem with many falls inability to followthrough.

5. Does not learn from mistakes or observing others.6. Learning is impaired ; persons performance may not

improve.

7. Often battles with staff or premature discharge.

8/9/2019 Cva Report

21/34

8/9/2019 Cva Report

22/34

SYNDROME LOCATION STRUCTURAL INJURYCHARACTERISTICS

WEBER MEDIAL BASAL

MIDBRAIN

3RD CRANIAL NERVE PALSY

CORTICOSPINAL TRACT

IPSILATERAL 3RD NERVE

PALSY

CONTRALATERAL

HEMIPLEGIA

BENEDIKT TEGMENTUM OF

MIDBRAIN

3RD CRANIAL NERVE PALSY

SPINOTHALAMIC TRACT

MEDIAL LEMNISCUS

SUP.CEREBELLAR PEDUNCLE

RED NUCLEUS

IPSILATERAL 3RD NERVE PALSY

CONTRALATERAL LOSS OF

PAIN AND TEMPERATURE

SENSATION, LOSS OF JOINT

POSITION, ATAXIA AND

CHOREA.

LOCKED IN BILAT. PONS CORTICOSPINAL TRACTCORTICOBULBAR TRACT

BILAT, HEMIPLEGIA

BILAT. CRANIAL NERVE PALSY

(UPWARD GAZE SPARED )

MILLARD

GUBLER

LATERAL PONS 6TH CRANIAL NERVE PALSY

7TH CRANIAL NERVE PALSY

CORTICOSPINAL TRACT

IPSILATERAL 6TH NERVE PALSY

AND FACIAL WEAKNESS

CONTRALATERAL

HEMIPLEGIA

WALLENBERG LAT. MEDULLA SPINOCEREBELLAR TRACT5TH CRANIAL NERVE PALSY

NUCLEUS AMBIGUUS

SPINOTHALAMIC TRACT

VESTIBULAR NUCLEI

SYMPATHETIC TRACT

IPSILATERAL HEMIATAXIA

IPSILATERAL LOSS OF FACIAL

PAIN AND TEMP. SENSATION

CONTRALATERAL LOSS OF

BODY PAIN AND TEMP.

SENSATION.

NYSTAGMUS

IPSILATERAL HORNERS

SYNDROME

DYSPHONIA & DYSPHAGIA

8/9/2019 Cva Report

23/34

BRAYDYKINESIA

RIGIDITY: (Lead pipe & Cogwheel rigidity)

TREMOR (Resting tremor)

AKINESIA

CHOREA ATHETOSIS

CHOREOATHEROSIS

HEMIBALLISMUS

DYSTONIA

8/9/2019 Cva Report

24/34

HYPOTONIA

DYSMETRIA

DYSDIADOCHOKINESIA

TREMOR; Intention tremor & Postural Tremor

DYSSENERGIA (Movement decomposition)

DISORDERS OF GAIT DYSARTHRIA(SCANNING SPEECH)

NYSTAGMUS

REBOUND PHENOMENON

ASTHENIA

TRUNKAL AND LIMB ATAXIA

FATIGABILITY

8/9/2019 Cva Report

25/34

8/9/2019 Cva Report

26/34

Paralysis/Paresis- inability to generate normal levels of force required inthe muscles for the purposes of posture and movement ; Hemiplegia, Paraplegia,

Tetraplegia, Quadriplegia, Monoplegia

Dystonia- sustained muscle contraction frequently causing twisting, repetitivemovement and abnormal postures ;co-contraction of agonist and antagonist.

x focal dystonia single body region

x segmental dystonia two or more adjoining areas

xhemidystonia one side

x multifocal dystonia 2 or more nonadjoining areas

x generalized dystonia involves whole body

8/9/2019 Cva Report

27/34

Tremor rhythmical involuntary oscillatory movement ofa body part on a fixed point

x resting tremor on the part that is not voluntarily

activated, supported against gravity

x intention tremor when part is asked to perform

a specific movement

x postural tremor unsupported against gravity

Involuntary Movementsx chorea rapid, random, irregular, jerky

x athetosis slow, writhing, twisting

x Hemiballismus- Exaggerated sudden jerky

movements

x upper ex more than lower ex; also on neck, face,

tongue

8/9/2019 Cva Report

28/34

Superficial- Pain, Temperature and Light touch

Deep Sensation- Kinesthesia, Proprioception, Vibration,Tactile Discrimination, Stereognosis, Bargognosis

Visual Deficits- Homonymous Hemianopsia, CorticalBlindness, Myopia(impaired far vision), Presbiopia(impaired near vision)

Vestibular Deficit- blurred vision, nystagmus,oscillopsia (oscillating vision), problems with posture

and balance, vertigo or dizziness

8/9/2019 Cva Report

29/34

Attention- ability to focus on a specific stimuluswithout being distracted

x focused attention ability to respond to a specific stimulus

x sustained stimulus ability to maintain attention over time

x selective attention ability to focus attention in the presence ofdistracting stimulus

x alternating attention ability to shift focus from one task to another

x divided attention ability to respond simultaneously to multiple tasks

8/9/2019 Cva Report

30/34

Memory-ability to process, store and retrieve information

Kinds of memory

Immediate RecallRecent Memory

Remote Memory

Multi-Infarct Dementia- a generalized decline in higherbrain functions with faulty judgement, impairedconsciousness, poor memory, diminished communication,and behavioral or mood alterations.

Confabulation- Memory gaps with inappropriate words orfabricated stories

Perseveration- is the continued repetition of words,thoughts, or acts not related to current context

8/9/2019 Cva Report

31/34

Agnosia-inability to recognize information despite intactsensory capacities; visual agnosia, tactile agnosia,auditory agnosia,

Prosopagnosia- Inability to recognize faces

Dyslexia- inability to read

Anomia- inability to name objectsAgraphia- inability to write

Acalculia- Inability to perform simple arithmeticoperations

Atopognosia- Inability to localize a sensationAstereognosis- Inability to recognize shape and form of

objects

8/9/2019 Cva Report

32/34

Body Image and Scheme Disorder

Somatagnosia lack of awareness of body structure

and the relationship of body of parts to one another Anosognosia denial of the presence or severity of

ones paralysis

Unilateral neglect inability to perceive andintegrate stimuli on one side of the body

Spatial Relation Disorder topographical disorientation inability to remember the

relationship of one place to another

figure ground perception problems inability to

distinguish foreground from background Form discrimination- Inability to distinguish form of objects

Pusher Syndrome- an unusual motor behavior characterizedby the patients strong lean toward the hemiplegic side on allpositions

8/9/2019 Cva Report

33/34

Apraxia- inability to carry out purposefulmovement in the presence of intactsensation, movement and coordination

Five types of apraxia:

Verbal

Buccofacial

Limb Constructional

Dressing

Two types of limb apraxia

x ideomotor can perform movement automatically butnot on command

x ideational purposeful movement is not possibleeither upon command or automatically

8/9/2019 Cva Report

34/34

Aphasia- is the general term used to describe an

acquired communication disorder caused by

brain damage Fluent Aphasia(Wernickes)- demonstrates

difficulty in comprehending spoken language

Nonfluent Aphasia (B

rocas)- vocabulary islimited, syntax is impaired

Global Aphasia- marked impairments of both

aphasias