Case study - Stroke

Question 1

If someone has a faint or a fit or a collapse what do you ask ?

Answer 1

A before

A during

An after

++ collateral history

Question 2

Dysphasia

Answer 2

the problem of language production

eg brokars ( can understand but cant say anything)
eg vernickers (receptive) limited understanding.
eg global (both brokers and vernickers)
eg conductive

Question 3

Disarphia >?

Answer 3

Problem with speech production

Question 4

0/5 right-sided limb weakness.

What does this mean?

Answer 4

There is no movement.

Question 5

Hemianopia

Answer 5

A hemianopia is a loss of one-half of your visual field.

Question 6

What is a critical test that must be done when someone comes in with neurological deficit!

Answer 6

Blood glucose level !!

Question 7

What is a ROSIER ?

Answer 7

Recognition of Stroke in the Emergency Room (ROSIER) Scale

Question 8

What is the relevant ROSIER score that signifies a stroke

Answer 8

Anything 1 or more.

Question 9

What are the two types of types of stroke ?

Answer 9

Ischaemic
Haemmoraghic

Question 10

How to tell if someone has a haemorrhagic stroke

Answer 10

Headache

Question 11

How often will TIA symptoms usually stop.

Answer 11

Within 1 hour

Definitely within 24

ANGINA OF THE BRAIN

Question 11

Differentials for a stroke

Answer 11

• Stroke
• TIA
  -Hypoglycemia
• Seziure/TODD’S paresis
• Infection
• Migraine
• Cancer

Question 12

What is the onset for a stroke ?

Answer 12

SUDDEN - BANG
MAKE SURE YOU ASK THIS IN HC .

Question 13

Describe an upper motor neuron distribution of a right facial palsy.

What do you get?

Answer 13

Sparing of the forehead

++ look in mclouds

Question 14

What is bells palsy caused by ?

Answer 14

It’s idiopathic we don’t know.

We can give prednisolone

Answer 15

cns - upper motor nueron
pns - lower motor nueron problem

Question 16

What is

Answer 16

Acute onset vascular origin leading to focal neurological dysfunction.

Question 17

What can cause an ischameic stroke?

Answer 17

• Thrombus
• DRUGS - Cocaine
• Atherosclerosis
• AF
• Sickle cell anaemia - RBC can clot together.
• thrombocytopenia
• Endocarditis

Question 18

What can cause hemorrhagic stroke ?

Answer 18

• Injury
• Aneurysm
• On anticoagulants

Question 19

Classifications of strokes (TOAST)

Answer 19

• ## Large artery athersclerosis

Question 20

if you check someone has a regular hr does it mean they are not in AF?

Answer 20

PAROXISMAL

Question 21

conduction aphasia.

Answer 21

Broca’s area and Wernicke’s area are connected by a bundle of nerve fibers called the arcuate fasciculus. Damage to the arcuate fasciculus causes a disorder called conduction aphasia.

Question 22

In regards to asphagia, how would you document a verbal response?

Answer 22

Just put NT - look on the website.

Question 22

Other symptoms of stroke

Answer 22

dizziness (vertigo)
Hearing changes
Visual field loss.

Question 23

What do you have to have to have vertigo

Answer 23

Have to have a sense of movement eg the room spinning around you, or you’re spinning.

-coming from the ear or cerebellum.

Question 24

Bamford classification of stroke

Answer 24

Question 25

Ataxic hemiparesis

Answer 25

weakness and un co-ordinated

Question 26

NIH stroke scale

Answer 26

used in specialised centres.

Question 27

Management of an ischaemic stroke.

Answer 27

• CT - ASAP
• ECG
• COAG SCREEN
• U+E
• Glucose
• Thrombolysis within 4.5 hours of onset of symptoms.
• CT angio
• Echo
• MRI - After CT, the CT may have been done too early; it can sometimes take a few hours to appear.

Question 27

Guidelines to use?

Answer 27

National Clinical guidelines for stroke and the UK and ireland.

bmj best practice +++

Question 28

What sats for stroke ?

Answer 28

93% OR LOWER

DO NOT GIVE MORE THAN 96 BECAUSE THAT IS A VASOCONSTRICTOR.

Question 29

When not to do thrombolysis

Answer 29

• On anticoagulants
• Recent Surgery
• Evidence of a bleed on the brain.
• Trauma
• HTN can’t be high when doing this procedure.

Question 30

Aim of thromylsis

Answer 30

• Restore blood flow
• Support brain metabolism
• Treat complications of oedema

Question 31

Who is a thrombectomy done by ?

Answer 31

Radiologist

Question 32

What is the procedure which can move the clot from the brain ?

Answer 32

Thrombectomy

Question 33

When there are MCA ischemic strokes, there tends to be a lot of swelling; what can the neurosurgeons do?

Answer 33

hemicraniectomy

Question 34

What is CHA2DS2-VASC

Answer 34

CHA2DS2-VASc Score for Atrial Fibrillation Stroke Risk

Answer 35

• Swallow assessment within 4 hours.
• Hydration
• Temperature - the ability to regulate temp can be knocked. Thermodisregulation.
• Continuous ECG monitoring for 24 hours.
• Monitor for increased ICP (GCS), vomiting, headache, photophobia, and neck stiffness.
• Antiplatley - Asprin.
• PPI

Question 36

Long-term management of a stroke.

Answer 36

• rehabilitation
• Physio/ OT
• Speech and language therapy
• MUST
• Continence management
• Analgesia for spasticity
• Skin bundle
• Avoid aspiration pneumonia
• Statin
• VTE prevention
• Often, DO NOT GIVE ENOXAPARIN FOR 2 WEEKS. DON’T WANT THEM TO BLEED.

Answer 37

https://www.wypartnership.co.uk/application/files/7916/4198/7428/WYH_ISDN_Newsletter_December_2021.pdf

Answer 38

Central post-stroke pain is a neuropathic type of pain.

• Co-analgesics
• Pain team.

Question 39

Musculoskeletal issues

Answer 39

• Immobility
• Abnormal posture
• Positioning
• Mobilising
• TENS machine
• NAIDS

EG FROZEN SHOULDER AND SWOLLEN HAND.

Question 40

Spasticity

Answer 40

• Physio
• Borulinum toxin injections + splints
• Muscle relaxants.