Clinical Features + Symptoms

Question 1

Recognising stroke

Answer 1

> BE FAST 
- Balance problems
- Eyesight problems
- Facial weakness
- Arm weakness
- Speech problems
- Time to call 999
\+ cognitive problems

Question 2

Clinical features

Answer 2

> depend on area affected (not type of stroke)

• motor symptoms
• sensory symptoms
• speech symptoms
• cognitive symptoms
• Hemiplegia = paralysis of one side of body
• ie. right hemiplegia = left sided paralysis
• Hemiparesis = weakness in one side of body

Question 3

Motor Symptoms

Answer 3

> Via corticospinal tract
Alterations in tone
- low tone (flaccidity)
- high tone (spasticity) - 30-40% of people
- Ataxia (unco-ordinated movements)
Weakness (different to low tone as not about stimulation) - 80% of people post stroke
Asymmetry
- loss of normal movement patterns
- loss of postural adjustments
- loss of balance
- compensations to counterbalance losses (ie. affected side is used less so exaggerates difference)

Question 4

Spasticity Patterns

Answer 4

> UL = flexed tone

• Girdle - elevated + retracted (traps)
• shoulder joint - adducted + medially rotated (pec maj)
• Elbow - flexed (biceps)
• RuJ’s - pronated (pronator teres)
• Wrist - flexed (fcr/fcu/fds/fdp)
• Fingers - flexed + adducted

> LL = extensor tone

• Hip - flexed or extended + adducted
• Knee - extended
• Ankle - plantar flexion + inversion

Question 5

Sensory symptoms

Answer 5

> via dorsal column for touch 
> Sensory Impairment (hyper/hypo/altered sensation)
- Impaired cutaneous sensation
- Stereognosis 
- proprioceptive input 
> Visual problems 
- visual field loss
- homonymous hemianopia (loss of one field of vision)

Question 6

Speech symptoms

Answer 6

> Dysarthria (slurred speech)
> Expressive dysphasia
- Broca's area (left frontal lobe - associated with right hemiplegia)
- lose ability to produce speech 
> Receptive dysphasia 
- Wernicke's area (temporal lobe)
- lose ability to understand speech 
> Global aphasia 
- complete loss of speech 

*Can get motor problems in vocal cords

Question 7

Cognitive Symptoms

Answer 7

> Perceptual problems
- Agnosia (inability to recognise objects using one sense) : Astereognosis (touch)/ Visual Agnosia (sight)/ Auditory agnosia(hearing) + smell
- Depth perception
Apraxia (lack of motor planning - tasks = out of sequence)
Anosagnosia (don’t realise they’ve had a stroke)
Neglect (fail to attend stimuli of one side - more common with left hemiplegia)
- Visual - don’t see it
- Sensory - don’t feel it
- Cognitive - don’t recognise as part of own body
*Expect functional problems - eating/dressing/self care

Question 8

Other symptoms

Answer 8

> Emotional disorder
Dysphagia (struggle to swallow - aspirational pneumonia risk)
Incontinence
Secondary MSK problems (e.g subluxed shoulder)
Balance/gait problems - falls risk
Functional difficulties
Social Problems