Question About a CVA

nursemike, ASN, RN · Oct 22, 2005

Hello,
I have a question. My patient had a CVA that affected the Left side of him. He has trouble walking and left-hemiparathesis. Now, my question is, i know it "hit" the right-side of his brain, but what part? And is the gray matter what's affected? Please help.
~Janine

Do you mean hemiparesis (paralysis)(oh--I see you said trouble walking) or hemiparesthesia (numbness)? Either way, it's likely to be in the cerebral cortex, in the frontal and/or parietal lobe. That would be grey matter. Other symptoms, such as aphasia, could help clarify the location and extent. Motor function tends to be a frontal lobe problem, sensory can be more parietal. But brains vary, so it's hard to be too specific from symptoms. An MRI can help determine the location and extent of the damage.

If the patient was right-handed prior to the event, he may need encouragement not to ignore the left side entirely.

Right-brain strokes can also be impulsive--they're often the ones who "forget" they need help and climb out of bed on their own.

I think that's about all I recall from my stroke workshop, two weeks ago. Which is more than I thought I remembered!

Janinern84 · Oct 22, 2005

Do you mean hemiparesis (paralysis)(oh--I see you said trouble walking) or hemiparesthesia (numbness)? Either way, it's likely to be in the cerebral cortex, in the frontal and/or parietal lobe. That would be grey matter. Other symptoms, such as aphasia, could help clarify the location and extent. Motor function tends to be a frontal lobe problem, sensory can be more parietal. But brains vary, so it's hard to be too specific from symptoms. An MRI can help determine the location and extent of the damage.
If the patient was right-handed prior to the event, he may need encouragement not to ignore the left side entirely.
Right-brain strokes can also be impulsive--they're often the ones who "forget" they need help and climb out of bed on their own.
I think that's about all I recall from my stroke workshop, two weeks ago. Which is more than I thought I remembered!

hemiparesis (paralysis) is what I meant (sorry). He was good at hand grasps and foot pdeals. They were equal in myassessment. It was when I was moving (transferring, walker etc) where he just couldn't do it...anymore input on that?

nursemike, ASN, RN · Oct 22, 2005

I checked the Taber's on my PDA, and it mentions that proximal muscles (shoulder, hip) may be more affected than distal (hands, feet) which sounds consistent with your assessment.

Janinern84 · Oct 22, 2005

I checked the Taber's on my PDA, and it mentions that proximal muscles (shoulder, hip) may be more affected than distal (hands, feet) which sounds consistent with your assessment.

Ok, so overall. The weakness on the left side is because of the CVA "hitting" the grey matter in the cerebral cortex in the right frontal lobe d/t decreased motor ability because of weekness to poroximal muscles (shoulders and hip)?

How's that sound?

Janinern84 · Oct 23, 2005

Anyone, hows that sound?

geekgolightly, BSN, RN · Nov 1, 2005

it affected the motor strip on the right side. the motor strip is anterior to the central sulcus. if it was mostly his face (facial droop check by asking him to smile, stick out his tongue and raises his eyebrows) and arms it was the MCA (middle cerebral artery) if it was more in his leg it was the ACA (anterior cerebral artery) affected. an MCA that was low close to the internal carotid then it affected both MCA and ACA flow and thus total left paralysis.

if he has some movement then its called hemiparesis, if he has no voluntary movement, its called hemiplegia.

here is a great picture showing flow. ill try and find a picture showing where the motor strip is and you can see how the flow of blood would stop in a particular area giving the symptoms you describe.

i love neuro nursing!

blood flow

mapped areas of brain including motor strip

detail of motor strip and exactly which parts of the body are affected at which areas of the motor strip

geekgolightly, BSN, RN · Nov 1, 2005

p.s. ischemics that hit that low can be treated now within a six hour window if the hospital has a MERCI device. its SO important to educate the public about where to go for strokes. we have trained interventional radiologists who were in the MERCI trials and i see miracles on a weekly basis. people come here unable to walk or speak and as soon as the clot is retrieved they can move and speak. its AMAZING to watch. i've seen in in the rad suite.

geekgolightly, BSN, RN · Nov 1, 2005

http://www.health.wvu.edu/cbulletin/merci/merci.htm

Home Health Columnist / Guide · Nov 1, 2005

Thanks Geek for the pics and info!

Just saying to myself last week that I was loosing memory of Neuro exam and cranial nerves affected. Your posts helped me alot especially this pic:

geekgolightly, BSN, RN · Nov 1, 2005

Thanks Geek for the pics and info!
Just saying to myself last week that I was loosing memory of Neuro exam and cranial nerves affected. Your posts helped me alot especially this pic:

aww, you're welcome! I am glad to finally be of use because I have learned so much from your posts. :)