Intro lecture Flashcards
who does stroke generally occur in?
Older population
Speech can play an important role in helping identify where the stroke is
- located in the left hemisphere of brain in 90% of people even if they are left handed
- If speech is slurred then one knows that pathology is likely located in the left hemisphere
What is the Acute Thrombolytic/clot busting time window?
< 3 hours for the best effect
Why has it happened?
Wall irregularities; cause of thrombus
e.g. as a result of one of the many risk factors
Stroke Epidemiology
Incidence:
- 114/100 000
- 75% > 65 years
Results of Stroke :
1/3 recover well
1/3 significant disability - these ppl have life changed immensely
1/3 die
Total annual cost of stroke
£7000 million
Single most important risk factor
HIGH BLOOD PRESSURE
increased b.p. leads to increased risk of stroke
R.F #2
Diabetes
Increases risk of stroke
relative risk is roughly x2
Diabetics MORE LIKELY TO DIE than non-diabetics
R.F #3
Cigarette smoking
males and females equally affected
RR = x1.5
Risk declines after cessation of smoking
Association btwn carotid diease and smoking
R.F #4
High Cholesterol
deposition of cholesterol in vessel wall occurs as one gets older
this narrows vessels; makes blood flow IRREGULAR
STATINS: lower cholesterol
Hard to lower cholesterol via diet alone, pts are put on statins
Summary of risk factors
- High B.P
- Diabetes
- Smoking
- High cholesterol
- Alcohol (not independently but goes along with the others)
- Lifestyle
Blood supply to the Brain:
Anterior & posterior circulation
Anterior Circulation (+middle):
- made up of the Right and Left Common Carotid Arteries
Posterior Circulation:
-
Right and left Vertebral arteries
- these form the Basilar artery
Posterior circulation event
involves problems with:
- Vision
- Co-ordination (due to cerebellum affected)
- Breathing (brainstem affected)
Anterior Circulation Event:
Involves problems with:-
- Parietal lobe
- Motor cortex
- Movement and Sensory problems
- perhaps also speech depending on which hemisphere is involved (speech usually in the left)
Aphasia/dysphagia
Dysarthria
Aphasia: Lack of speech completely
Dysphagia: Difficulty getting words out; more left sided
Dysarthria: slurred speech
Function of Motor Cortex
movement
Function of Frontal lobe
- Judgement
- Foresight
- voluntary movement
Function of Broca’s area
speech
Function of Frontal lobe
smell
Function of Temporal lobe
Intellectual and emotional functions
Function of Brainstem
- swallowing
- breathing
- heartbeat
- wakefullness centre
- other involuntary functions
Carotid Bruit
- systolicsound heard over the carotid artery area during ausculation in neck
- May occur as a result of Carotid Artery Stenosis
- narrowing of the vessel
Sign of an UPPER MOTOR NEURON LEISON
Extensor Plantar
means that something has occured in the motor cortex to the anterior horn cell
e.g. stroke, M.S. etc
sign of a LOWER MOTOR NEURON
Flexor Plantar
Anterior horn cell in spinal cord and down
e.g. Motor neurone disease, polio etc
N.b.: in babies toes are extensor for the first 3 months as the fibres are not myelinated yet. once they become myelinated they become flexor
Diagnosis of Stroke
CLINICAL DIAGNOSIS!!
n.b. still need to do a CT scan ASAP to see if there is a clot or a bleed
FAST test - 93-95% accurate
Face, Arm , Speech test
Blood on CT
What should you NOT do?
if there is blood on a CT it shows there is a Haemorrhage
appears bright white on a CT
CANNOT give thrombolytics - this will make the bleed worse otherwise
CT IMAGING IS DONE BEFORE THROMBOLYSIS TO EXCLUDE HAEMORRHAGE
Management of Acute Ischaemic Stroke
- recognise:
- symptom recognition, call 999
- react
- paramedics diagnose stroke, priority transfter to hospital with ASU
- respond
- triage to stroke team, Urgent CT for <3hr, reduces LOC
- reveal
- confirm diagnosis, assess for thromobylsis
- Rx/Reperfusion
- thromobolysis, aspirin, optimise physiology
- Rehabilitaion
- MDT assessment and treatment
where shoud all patients with ACUTE stroke be admitted to?
A hospital with a multidisciplinary stroke unit
telemedicine
enables all hosptials to continue to provide hyperacute care
Conclusions
Stroke is common
Prevention in terms of vascular risk factors = VERY IMPORTANT
Acute stroke therapies work well
