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Orthoptics III > 5.5 Stroke I > Flashcards

5.5 Stroke I Flashcards

1
Q

What happens in a stroke?

A

Blood supply to the brain (or retina) is interrupted.

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2
Q

Stroke V TIA

A

Stroke – persistence symptoms
o >24 hours
TIA (transient ischemic attack/amaurosis fugax) – transient symptoms.
o A few minutes to up to 24 hours
o A mini stroke which is a warning sign of a full stroke – which requires urgent assessment

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3
Q

What does the acronym B.E.F.A.S.T. mean?

A
  • Both
  • Eyes
  • Face
  • Arms
  • Speech
  • Time
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4
Q

What does the acronym Very.F.A.S.T. mean?

A
  • Vision
  • Face
  • Arm
  • Speech
  • Time
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5
Q

What are the two types of strokes?

A

Ischemic (clot) (85%)
o Blood supply to the brain abruptly distributed due to a blood clot.
o Subclassified: Bamford Oxford Classification – TACS, PACS, LACS, POCS
Haemorrhagic (bleed) (15%)
o A weakened blood vessel bursts with bleeding within the brain parenchyma, ventricular system, or subarachnoid space
o Further divided into intracerebral (ICH) and subarachnoid (SAH)

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6
Q

What is TACS?

A

Total Anterior Circulation Stroke (anterior cerebral and middle cerebral arteries)

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7
Q

What does TACS effect?

A
  • Unilateral weakness +/- sensory deficit face and/or arm and/or leg
  • Homonymous hemianopia
  • Higher cerebral dysfunction – dysphasia, visuospatial dysfunction (e.g neglect, agnosia)
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8
Q

What is PACS?

A

Partial Anterior Circulation Stroke (anterior cerebral and middle cerebral arteries)

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9
Q

What does PACS effect?

A

2/3 of TACS
* Unilateral weakness +/- sensory deficit face and/or arm and/or leg
* Homonymous hemianopia
* Higher cerebral dysfunction – dysphasia, visuospatial dysfunction (e.g neglect, agnosia)

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10
Q

What is LACS?

A

Lacunar Stroke (deep perforating arteries)

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11
Q

What does LACS effect?

A
  • Pure motor hemiparesis
  • Pure sensory
  • Ataxic hemiparesis
  • Dysarthria-clumsy hand syndrome
  • Sensorimotor
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12
Q

What is POCS?

A

Posterior Circulation Stroke (Vertebro-basilar arteries)

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13
Q

What does POCS effect?

A
  • Brainstem or cerebellar syndrome
  • Loss of consciousness
  • Isolated homonymous hemianopia
  • Diplopia/VF defects
  • Dizziness/dysarthria & dysphagia/ataxia
  • Brain stem syndromes
    o Wallenberg/Lateral medullary syndrome (posterior inferior cerebellar A)
    o Nystagmus, vertigo, ipsilateral Horners, ipsilateral facial sensory loss, contralateral pain & temp loss
    o Locked-in syndrome/basilar artery occlusion – affects the pons with paralysis of all voluntary muscles except eye movement muscles.
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14
Q

What causes thrombus?

A

Local blockage due to atherosclerosis precipitated by vascular risk factors like hypertension and smoking or small vessel disease like sickle cell and vasculitis etc.

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15
Q

What causes embolus?

A

Propagation of a blood clot leading to obstruction typically due to atrial fibrillation or carotid artery disease

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16
Q

What causes dissection? (RARE)

A

Tearing of the inner layer of an artery typically the internal carotid which can occur spontaneously or related to trauma.

17
Q

What can cause haemorrhagic stoke?

A
  • Commonest cause – hypertension
  • Other causes: vascular malformations, brain tumours, vasculitis, or bleeding disorders
  • Trauma is also a major cause.
18
Q

List risk factors of stroke

A
  • Hypertension
  • Diabetes
  • Age
  • High cholesterol
  • Smoking
  • Obesity
  • Atrial fibrillation
  • Carotid artery disease
  • Sickle cell disease
  • Thrombophilic disorders e.g. antiphospholipid syndrome
  • Cocaine use, trauma, infections, vasculitis, genetics, vascular malformations
  • Migraine
19
Q

List signs and symptoms of stroke

A
  • Begin suddenly, vary from person to person, depend on the part of the brain affected and the extent of the damage involved.

o Sudden blurring or loss of vision
o Diplopia
o Confusion
o Dizziness
o Loss of consciousness
o Balance or co-ordination difficulties
o Dysphagia

20
Q

What are the assessments that need to be performed on stroke patients?

A

o Cranial nerves assessment – look for facial asymmetry
o Vision and VF
o Pupils
o Eye movements
o Motor assessment (arm drift) – sensory deficits, cerebellar testing, gait etc.

21
Q

What are some common presentations of stroke patients?

A

o Headache
o Altered mental status
o Nausea and vomiting
o Seizures
o Focal neurological deficits
o Visual symptoms/loss of vision/VF deficit

22
Q

What are some physical effects of stroke?

A

o Pain
o Muscle weakness
o Stiffness/changes in sensation
 Touch
 Temperature

23
Q

What elements of communication are effected by stroke?

A

o Reading
o Speaking
o Writing
o Understanding

24
Q

List some life effects of stroke

A
  • Emotional
  • Memory and thinking
  • Hallucinations and delusions
  • Sex and relationships
  • Behavioural changes
  • Memory and thinking
  • Neuroplasticity
  • Locked- in syndrome
  • Vascular dementia
25
Q

What are the stroke scales for NIHSS scoring?

A

0: No stroke symptoms
1-4: Minor stroke
5-15: Moderate stroke
16-20: Moderate to severe stroke
21-42: Severe stroke

26
Q

What is the clinical relevance of the NIHSS scoring?

A

<4 - good clinical outcome
>22 - Significant brain ischemia with a high risk of a cerebral haemorrhage with thrombolysis
>26 - thrombolysis contraindicated in most cases.

27
Q

What management may be considered for Haemorrhagic strokes?

A

o Neurosurgical intervention may be indicated depending on the extent of the bleeding and suitability for intervention, comorbidities, frailties etc

28
Q

What management may be considered for ischemic strokes?

A

o If the CT scan does not reveal signs of intracerebral haemorrhage, then decision re thrombolysis is made based on
 Timeframe usually within 4.5 hours
 Severity NIHSS scale >5 and <26
 Contraindications excluded, neurosurgery within 3/12, active internal bleeding

29
Q

What treatment is available for stroke patients?

A

o Synthetic tPA tissue plasminogen activator Alteplase (“clot busting” drug)
o Mechanical thrombectomy is performed according to NICE guidelines by interventional radiologists
If thrombolysis/thrombectomy is not appropriate then start on PO aspirin 300mg OD for 2 weeks.
After 2 weeks start secondary prophylaxis PO Clopidogrel unless anticoagulation is appropriate eg for atrial fibrillation
PO aspirin is started 24-48 hours after thrombolysis/thrombectomy

30
Q

How would orthoptists look at expanding a stroke patients visual field?

A

Peli prism

31
Q

What are some lifestyle changes that need to be considered following a stroke?

A
  • Improve eating habits – low saturated fat, avoiding trans fat, salt and added sugars
  • Avoid smoking and second hand smoke
  • Limit alcohol
  • Regular BP checks and management if high
  • Physical activity
  • Compliance with medications
  • Reach and maintain a healthy weight
  • Regular medical check ups to manage underlying health conditions.
  • Emotional support
  • Decrease stress levels
  • Adapting home environment
  • Counselling
  • Sex
  • Driving

Orthoptics III (13 decks)

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