Case study - Stroke Flashcards
If someone has a faint or a fit or a collapse what do you ask ?
A before
A during
An after
++ collateral history
Dysphasia
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
Disarphia >?
Problem with speech production
0/5 right-sided limb weakness.
What does this mean?
There is no movement.
Hemianopia
A hemianopia is a loss of one-half of your visual field.
What is a critical test that must be done when someone comes in with neurological deficit!
Blood glucose level !!
What is a ROSIER ?
Recognition of Stroke in the Emergency Room (ROSIER) Scale
What is the relevant ROSIER score that signifies a stroke
Anything 1 or more.
What are the two types of types of stroke ?
Ischaemic
Haemmoraghic
How to tell if someone has a haemorrhagic stroke
Headache
How often will TIA symptoms usually stop.
Within 1 hour
Definitely within 24
ANGINA OF THE BRAIN
Differentials for a stroke
- Stroke
- TIA
-Hypoglycemia - Seziure/TODD’S paresis
- Infection
- Migraine
- Cancer
What is the onset for a stroke ?
SUDDEN - BANG
MAKE SURE YOU ASK THIS IN HC .
Describe an upper motor neuron distribution of a right facial palsy.
What do you get?
Sparing of the forehead
++ look in mclouds
What is bells palsy caused by ?
It’s idiopathic we don’t know.
We can give prednisolone
cns - upper motor nueron
pns - lower motor nueron problem
What is
Acute onset vascular origin leading to focal neurological dysfunction.
What can cause an ischameic stroke?
- Thrombus
- DRUGS - Cocaine
- Atherosclerosis
- AF
- Sickle cell anaemia - RBC can clot together.
- thrombocytopenia
- Endocarditis
What can cause hemorrhagic stroke ?
- Injury
- Aneurysm
- On anticoagulants
Classifications of strokes (TOAST)
- ## Large artery athersclerosis
if you check someone has a regular hr does it mean they are not in AF?
PAROXISMAL
conduction aphasia.
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.
In regards to asphagia, how would you document a verbal response?
Just put NT - look on the website.
Other symptoms of stroke
dizziness (vertigo)
Hearing changes
Visual field loss.
What do you have to have to have vertigo
Have to have a sense of movement eg the room spinning around you, or you’re spinning.
-coming from the ear or cerebellum.
Bamford classification of stroke
Ataxic hemiparesis
weakness and un co-ordinated
NIH stroke scale
used in specialised centres.
Management of an ischaemic stroke.
- 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.
Guidelines to use?
National Clinical guidelines for stroke and the UK and ireland.
bmj best practice +++
What sats for stroke ?
93% OR LOWER
DO NOT GIVE MORE THAN 96 BECAUSE THAT IS A VASOCONSTRICTOR.
When not to do thrombolysis
- On anticoagulants
- Recent Surgery
- Evidence of a bleed on the brain.
- Trauma
- HTN can’t be high when doing this procedure.
Aim of thromylsis
- Restore blood flow
- Support brain metabolism
- Treat complications of oedema
Who is a thrombectomy done by ?
Radiologist
What is the procedure which can move the clot from the brain ?
Thrombectomy
When there are MCA ischemic strokes, there tends to be a lot of swelling; what can the neurosurgeons do?
hemicraniectomy
What is CHA2DS2-VASC
CHA2DS2-VASc Score for Atrial Fibrillation Stroke Risk
- 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
Long-term management of a stroke.
- 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.
https://www.wypartnership.co.uk/application/files/7916/4198/7428/WYH_ISDN_Newsletter_December_2021.pdf
Central post-stroke pain is a neuropathic type of pain.
- Co-analgesics
- Pain team.
Musculoskeletal issues
- Immobility
- Abnormal posture
- Positioning
- Mobilising
- TENS machine
- NAIDS
EG FROZEN SHOULDER AND SWOLLEN HAND.
Spasticity
- Physio
- Borulinum toxin injections + splints
- Muscle relaxants.
