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Two types of Stroke:
______: arteries to the brain are blocked and blood flow is cut off. Accounts for 85% of strokes. (Thrombotic and Embolic).
______: blood vessel breaks and bleeds into the brain or compresses brain tissues. Less common but more fatal. (intracerebral and subarachnoid).
-Almost 75% of strokes happen in individuals older than ___.
- at younger ages, ____ are more likely to have a stroke, but older ages (85+) ______ are more likely.
When brain cells are deprived of oxygen for more than __ minutes, they begin to die. When the brain cells begin to die, the functions or body parts associated with that cell or group of cells are hindered. If the oxygen flow is not restored to the brain cells withing the next ___ to ___ hours, the cells will permanently die.
3 main causes of a CVA:
_____ of blood vessels.
_____ of blood vessels (thrombus or embolism)
_____ of a blood vessel (hemorrhage)
_____ Hemorrhage: blood vessel in the brain ruptures and deprives the brain of oxygen. Often caused by high blood pressure that creates an aneuryism.
________ Hemorrhage: cerebral or cerebellar artery ruptures and fills the subarachnoid space with blood. Very serious. If not treated immediately, pt can have extensive brain damage, coma, or death. Characterized by severe headache, nausea, vomiting, and stiff neck.
_____ ______ _____: a "warning sign" of an impending stroke. Caused by a temporary reduction of blood to the brain. Patient often recovers within 24 hours.
Transient Ischemic Attack
Once a stroke is suspected, the pt. undergoes a ___ scan or an _____ to distringuish an ischemic stroke from a hemorrhagic stroke.
-Thrombotic strokes are a treated with ____ ____ ____ (t-PA) to dissolve the clot. This must be administered within 3 hours.
- Hemorrhagic strokes- goal is to decrease intercranial pressure via medications such as intravenous ____ or ____.
- tissue plasminogen activator
- urea or mannitol
_____ ______ _____ therapy: functional limb is constrained while the patient is awake in order to facilitate function in the affected limb.
constraint induced movement therapy
LE spasticity with stroke victims presents as knee extension spasticity and PF, thus it is important to guard these patients during ______ and ______.
standing and ambulation.
________: inflammation of the protective membranes of the spinal cord and brain. Usually caused by an infection of the CSF.
2 subtypes of meningitis:
______: most severe, spread easily through exchange of mouth secretions.
______: often remains undiagnosed, not fatal, and spread through fecal contamination.
Age group most susceptible: under __ and over ___.
Clinical features of meningitis: headache, sensitivity to light, back pain, photophobia, stiff neck, vomiting, irritability, fever and chills.
-Resistance to leg extension when hip is flexed and patient is lying down ______ sign.
-When the neck is flexed, patient's hip and knee also flex ______ sign.
- kernig's sign
- brudzinski's sign
_______: infection (usually viral) of the parenchymal or connective tissue of the brain and spinal cord (particularly the basal ganglia. Death of tissue and inflammation develops in the tissue and leads to permanent brain damage.
The top three causes of TBI are ____ ____, ______, and _______.
car crashes, firearms, falls
____: involves fractures or penetration of the brain.
______ fractures: cracks in the bone
______ fractures: several fracture lines
______ fracture: where brain tissue is exposed.
______ _____ fracture: displacement of bone below the skull, thus compressing brain tissue.
______ fractures: occur at the base of the skull.
- depressed skull
____: skull is intact but brain tissue is damaged.
_____: reversible interference with brain functioning resulting ina loss of consciousness, headache, and or memory loss.
______: bruising of brain tissue, rupture of small blood vessels and edema. (two sub types)
____ ____ injuries: brain moves within the skull causing a shearing injury and results in disruption of axons.
- contusions (coup, and countercoup)
- diffuse axonal injuries
______: lack of oxygen flow to the brain due to heart attacks, respiratory failure or drops in blood pressure.
______: blocked blood flow due to cerebral vascular accident deprives the brain of important nutrients.
Three stages of recovery following TBI: name
- the time spent in each stage is variable and reflects severity of the injury.
coma, post traumatic amnesia (PTA), and a longer more variable recovery period
Levels of consciousness:
____: unresponsive but can be aroused briefly by a strong stim.
____: unconscious, unresponsive, unaware,and unarousable.
____ ____: unconscious and unaware but have a sleep-wake cycle and periods of alertness.
____-_-____: aware and awake but can't move.
_____ ____: absence of brain function.
- vegetative state
- brain death
loss/alteration of consciousness for
< 30 minutes, post traumatic amnesia for < 1 day, focal neurologic
deficits, and/or GCS of 13-15
loss of consciousness for > 30 minutes, post traumatic amnesia for > 1
day, and a GCS of 9-12
all criteria listed above plus a GCS of < 9
induced bymechanical force and occurs at the moment of injury. These include lacerations
of the neurons, glial cells, and blood vessels of the brain.
not mechanically induced and may be delayed from the moment of impact. They are caused by the
development of additional injurious factors (cerebral edema, hemorrhage,
hematoma, cerebral vasospasm, infection, and ischemia related to systemic
Mother's over ___ years, increased risk for children with down's syndrome.
In down syndrome, a person has ___ chromosomes with an extra chromosome in the __ position.
______ familial down syndrome: accounts for 4% of cases, 46 chromosomes, but a piece of chromosome 21 is moved to a part of the 14 chromosome.
Down syndrome is not progressive: true or false
In 1983, the average life span for a person with Down syndrome was 24, now it is __ or older. Death is usually secondary complications like CHD.
Screening for Down
___ ____ test: 11-13 wks of pregnancy. Uses US to measure the thickness of neck fold.
___ ____ Test: 15-20 wks. Blood sample from mother looking at AFP levels.
_______: 18-22 wks. uses sound waves to look for anatomical features such as: length of humerus/femur, length of nasal bridge, large gap between 1st and 2nd toe.
- nuchal translucency
- alpha-fetoprotein test
clinical features of down syndrome:
_______ spots: white spots on colored part of eye. hypotonic muscles, loose joints, small, head ears,and mouth, flat facial profile, large protruding tongue, one palmare crease in hands.
Most spinal cord injuries occur in the areas of the spine that are most mobile and have less ligamentous support c_-c_ and t__-l__.
-Approximately 50% result from _______>
Most common in (men or women).
- 1-7 and 12-2
- motor vehicle accidents
_____ does not occur in the nerves of the spinal cord. thus wen complete transection of the spinal cord occurs, there is an irreversible loss of all afferent and efferent functions at and below the level of the injury. However, recovery can occur if partial transection occurs.
SCI course: 2 stages
_____ ____: all neurologic activity ceases at, below, and even slightly above the level of injury. No reflexes are present. Loss of central control of autonomic fucntion can occur. May last days or weeks.
- recovery from ____ ____: indictated by gradual return of reflex activity below the level injury.
The higher the lesion, the ____ thelevel of function.
The lower the lesion, the ____ the level of function.
______: loss of extremities upper and lower, trunk (including the muscles of respiration) due to a cervical lesion.
______: paralysis of extremities: lower and all or part of the trunk due to a lesion in the thoracic, lumbar or cauda equina.
ASIA impairment scale
A =______: No motor or sensory function is preserved in the sacral segments S4-S5.
B =______: Sensory but not motor function is preserved below the neurological level and includes the sacral segments S4-S5.
C =Incomplete: Motor function is preserved below the neurological level, and more than half of key muscles below the neurological level have a
muscle grade less than 3.
D =_______: Motor function is preserved below the neurological level, and at least half of key muscles below the neurological level have a
muscle grade of 3 or more.
E =______: Motor and sensory function are normal.
_____ _____: paralysis of part of a body part affecting sensation and body movements. Involves a intracranial lesion. More common in pre-mature child births (ventilator greater than __ weeks), newborns who don't cry within the first __ minutes. Course is (progressive or non-progressive).
- cerebral palsy
Categories of CP:
_____: largest, caused by damgage to pyramidal tracts (diplegia), motor cortex (hemiparesis), and general cortical damage (quadriparesis). Characterized by hyperreflexia, incresed muscle tone, and abnormal movement due to stiff muscles.
______: damage to extrapyramidal tract, basal nuclei, and cranial nerves. Characterized by involuntary movements (athetoid-slow writhing and chreiform-jerky and irregular). Decreased coordination with fine movements.
_____: damage to cerebellum. characterized by loss of balance and coordination, hypotonia, tremors, and visual/auditory processing issues.
_____ _____: neural tube defect in which the posterior end fails to close around day 22-27 of development. most common permanently disabling birth defect in the USA.
Spina bifida _____: means hidden, sometimes never have health problems.
Spina bifida _____: involves the meninges if the meninges push through the hole in the vertebrae the sac is called a ______.
Spina bifida ______: most severe form; occurs when the meninges push through the hole in back, and the spinal cord also pushes through. Hydrocephalus is often a comorbidity.
- meningocele (2x)
Diagnosis of Spina Bifida: ____ ______ test: measures the levels of alpha-fetoprotein. If abundant, could indicate the fetus has a neural tube defect.
In spina bifida, how are the subtypes determined:
presence or absence of nerves, presences of CSF, whether or not meninges are included in the deformity
_____ _____ ischemia: may develop secondaty to severe shock or cardiac arrest; occurs when impaired perfusion of the entire brain results in loss of function and generalazed cerebral edema.
global cerebral ischemia
______: infarction of brain tissue that results
from lack of blood. Tissue necrosis may be an outcome of total occlusion of cerebral blood vessels by atheroma or embolus, which causes ischemia, or may be the consequence of ruptured cerebral vessel, which causes hemorrhage and increased intracranial pressure. ___ minutes of ischemia cause irreversible nerve cell damage.
-Occlusion of artery by ______ is most common
cause of CVA: often in large arteries such as carotid artery.
-Sudden obstruction caused by an ______ lodging
in a cerebral artery is the second type of stroke.
-________ hemorrhage usually caused by
rupture of a cerebral artery in a patient with severe hypertension is the third class of strokes. Frequently more severe and destructive than other CVA’s because they affect large portions of the brain.
Signs and symptoms of _____: sudden transient weakness, numbness, or tingling in the face, and arm or leg, or on one side of the body. Temporary loss of speech, failure to comprehend, or confusion. Sudden loss of vision, sudden severe headache. Unusual dizziness or unsteadiness.
Treatment: rapid treatment with “____-busting
agents”, glucocorticoids may reduce cerebral edema. Approximately __% of stroke patients die within the first few days. Complete recovery is rare.
_______ Hematoma: bleeding between the dura and
the skull caused by the tearing of the middle meningeal artery in the temporal
______ hematoma: develops between the dura and
________ hemorrhage: space between the
arachnoid and pia
________ hematoma: contusions or shearing
injuries and may develop several days later
When injury occurs in the cervical regions, the
inflammation may extend upward to the level of C_ to C_, interfering with phrenic nerve innervations to the diaphragm and affects respiration.
_______ ______: serious complication caused
by a sensory stimulus that triggers a massive sympathetic reflex response that
can’t be controlled from the brain.
______ ______: Group of disorders marked by some degree of motor impairment, caused by genetic mutations, abnormal fetal formation brain areas, infection, or brain damage in the perinatal period. Brain tissue is altered by malformation, mechanical trauma, hypoxia, hemorrhage, hypoglycemia, hyperbilirubinemea, infection, or some other factor.
_______: accumulated bilirubin crosses the
BBB and damages the neurons, often a cause of CP.
____ ____: multifactorial, with genetic and environmental factors. High familial contribution with _______ (absence of the cerebral hemispheres and superior cranial vault). Factors include: radiation, gestational diabetes, deficits of vitamin A or _____ ____.
- spina bifida
- folic acid