Case Study: Cerebrovascular Accident

Click on the correct answer



1 Mrs. Beulah Jacobson, a 69 year old African American, is brought to your emergency room via ambulance. Her daughter found Mrs. Jacobson at home lying in the floor, unable to speak and or move her left extremities. She is unsure of how long Mrs. Jacobson has been in this condition. She last spoke with her 3 days ago. Mrs. Jacobson has a history of hypertension for which she has been non-compliant with her medication, but otherwise is in good health. Sh is retired, but is active in her garden and around the house. Her husband died several years ago. What predisposing factors for cerebrovascular disease does Mrs. Jacobson have?
Age & race
Age, race, & sex
Age, race, sex, & history of hypertension
Age, race, sex, history of hypertension, & prior activity level
2 There are several different causes of a cerebrovascular accident or brain attack. What are these causes?
Thrombotic, Embolic
Lacunar
Hemorrhagic
All the above
3 What are the risk factors for developing a thrombotic stroke?
Arteriosclerosis, Hyperthyroidism, & Sickle Cell Disease
Chronic hypoxia, use of oral contraceptives, & hypertension
Coagulation disorders, global hyperperfusion, & polycythemia vera
Cigarette smoking, decreased blood cholesterol, malignant hypertension
4 Based upon Mrs. Jacobson's history what type of stroke would you suspect she has had?
Hemorrhagic
Thrombotic
Embolic
Lacunar
5 If her history had included a history of myocardial infarction, atrial fibrillation or rheumatic heart disease, what type of stroke might you suspect?
Lacunar
Hemorrhagic
Embolic
Throbolic
6 Why?
These conditions are congruent with the development of small microbleeds that can lead to hemorrhage within the cranial vault.
These conditions may cause changes within the vascular tree that cause strictly motor deficits in the subcortical areas.
These conditions are precursors for the narrowing and inflammation of the cerebral arterial vessel walls.
These conditions are known to allow small emboli to develop within the cardiovascular system which then lodge within the cerebral arteries and narrow/occlude blood flow.
7 On exam, Mrs. Jacobson appears awake but unable to speak or follow commands. Mrs. Jacobson's vitals are: T 99, P 82, R 18, & BP 168/104. She moves her left side spontaneously, but has no movement of the right arm; very little movement of the right leg. Her daughter reports that she is right-handed. Xrays reveal no cranial/hip/pelvic fractures; CSF is clear with no erythrocytes. What blood vessel do you suspect is involved?
Middle cerebral in the left hemisphere
Middle cerebral in the right hemisphere
Posterior cerbral in the parietal lobe
Basilarl in the temporal lobe
8 Based upon her history/symptoms, is there a possiblity that there is some collateral circulation in the area involved?
No, due to the nature of the stroke, the ischemia/infarct has develped suddenly not allowing collateral vessel development.
No, collateral circulation is not feasible in the circle of Willis.
Yes, based upon her age, history, and probable cause of the stroke, there could be some collateral circulation.
Yes, collateral circulation is always available in the brain tissues to prevent massive neurological deficits.
9 Over the next few days, Mrs. Jacobson's condition improves. She begins to have more strength in her right leg and has spoken a few words. It is thought that with rehabilitation and medication, she will continue to improve.

While in the hospital, Mrs Jacobson has a roommate who has also had a stroke. Her name is Myra Flemming. Her stroke involved the basilar artery. What symptoms would you expect Ms. Flemming to have?
Upper motor neuron type weakness, paralysis of tongue & throat.
Mild contralateral hemiparesis in leg
Cheyne-Stokes respirations, dysarthria
Mild upper body extremity weakness, loss of position sense
10 Ms. Flemming is a 57 year old school teacher who has a history of rheumatic heart disease. She was driving to work when she suddenly lost control of the car. Based upon the vessel involved and her history, what type of stroke would your suspect?
Hemorhagic
Lacunar
Embolic
Intracranial aneurysm
11 Based upon Ms. Flemming's symptoms, what other body system could be at high risk for lethal complications?
Integument
Respiratory
Genitourinary
Gastrointestinal
12 A 42 year old male is brought from work via ambulance to the emergency room. Co-workers reported that the office worker was working at his desk when he suddenly grabbed his head, vomited, and then collapsed. He had complained of a headache earlier in the morning. He appears healthy and co-workers report that he has no known medical problems other than mild hypertension. No family can be found. He is now unconscious and shows signs of increasing intracranial pressure. What signs might he be displaying?
Cheyne-Stokes respirations
Pupils sluggish and dilated
Widened pulse pressure & bradycardia
All the above
13 A spinal tap reveals bloody CSF. What might be your hypothesis?
Embolic stroke
Hemorrhagic stroke
Bleeding intracranial aneurysm
B or C
14 Mr. Franklin is exhibiting decerebrate posturing. What does this term mean?
Increased tone in the extensor muscles with active tonic nect reflexes resulting in all four limbs being rigidly extended.
A stooped, hyper-flexed posture with postive Kernig's sign.
Externally rotated and extended lower extremities with upper extremities flexed at the elbows.
Sustained muscular contractions which lead to fixed contractures.
15 What does this posturing generally indicate?
Frontal lobe dysfunction
Upper motor neuron dysfunction
Severe injury to the brain and brain stem
Lower motor neuron dysfunction