Basics of stroke/ Depression/Dementia Flashcards
The majority of strokes occur in which blood vessel?
Bigger strokes occur in M1, M2 or M3?
-Middle cerebral artery.
-M1 as it affects the cortex as well.
How do you define a stroke?
- Sudden onset
- Neurological deficit - face, arm, speech
- Focal rather than global - one part of the brain
- Vascular - blood vessel issue
- Lasting more than 24 hours
What causes a stroke?
- Clot in blood vessel in the brain (ischaemic)
- Rupture of the blood vessel and bleeding into the brain (haemorrhage)
- Therefore damage to the brain tissue
Symptoms of a stroke depend on the part of the brain damaged, for example…
- Right side of brain controls left side of body and vise versa
- Left brain for speech
- Back of brain for balance and vision
What are the risk factors for stroke?
- Hypertension
- Diabetes
- Ischaemic heart disease
- Atrial fibrillation
- High cholesterol
- Smoking
- Excessive alcohol intake
- Age
- Gender (more common in males)
- Ethnicity
- Family history
Treatment options / considerations for the first 24 hours?
- Confirm onset of symptoms
- Quick assessment - NIHSS (tells us the severity of the stroke)
- Urgent CT head, CT angio and CT perfusion
- Find penumbra (area that can be revascularised)
- Risk vs benefit of treatment
- Decision regarding thrombolysis / thrombectomy
- Consent: thrombolysis does not necessarily need consent whereas thrombectomy will need consent.
Treatment options / considerations for the first 72 hours?
- Admission to a ward, e.g. hyper acute stroke unit
- Blood pressure control
- Nil by mouth until swallow assessment
- IV fluids to hydrate
- Close monitoring
- Repeat CT head in 24 hours
- Check bloods, ECG and CXR
- Commence secondary prevention
The patient should be referred following their stroke to which healthcare professionals?
Speech and language therapist, Occupational therapist and Physiotherapist for assessments.
What are the key symptoms of depression according to ICD10?
- persistent sadness or low mood/or
- loss of interests or pleasure
- fatigue or low energy
>at least one of these, most days, most of the time for at least 2 weeks
With depression when would you ask about associated symptoms?
disturbed sleep
poor concentration or indecisiveness
low self-confidence
poor or increased appetite
suicidal thoughts or acts
agitation or slowing of movements
guilt or self-blame
What are some causes of depression?
In moderate management of depression what would doctors advise?
> Most episodes will self resolve
Self care
Sleep hygiene
Exercise
Daily motivational goals
Talking therapy
Medication not indicated
In Moderate to severe management of depression what would doctors advsise?
- All of the previous slide
Talking therapy
Cognitive behavioural therapy
Medication
SSRI (selective serotonin reuptake inhibitor) eg citalopram
SNRI
ECT (and no, it isn’t what you are imagining)
Only if life threatening
No other treatment has worked
Most psychiatrists would choose to have ECT
What is dementia?
- Dementia is a syndrome (group of symptoms) that include:
Progressive memory loss
Difficulty with weighing information and making a decision
Language difficulties including comprehension and expression
Personality changes
What are the 4 common types of dementia?
Alzheimer’s Disease - Brain atrophy
Vascular (and mixed) - Area of brain deprived of blood, mini strokes
Frontotemporal
Parkinson’s disease dementia
Why do people get dementia?
Symptoms of dementia?
