Rehab

Question 1

Does a normal CT exclude a stroke?

Answer 1

No

Question 2

When should you image in a stroke?

Answer 2

If there is an indication for thrombolysis or anticoagulation, if the patient is on anticoagulation therapy or known bleeding tendency, if the GCS is <13, if there is unexplained progressive or fluctuating symptoms, papilloedema, neck stiffness or fever, or if there is a sever headache at the onset of the stroke symptoms.
CT scan with one hour!!!

Question 3

On a CT if there blob is white, what does it indicate?

Answer 3

Acute haemorrhage

Question 4

How does the ischaemic tissue appear in an ischaemic stroke?

Answer 4

Hypodense (darker on CT), oedema is INTRACELLULAR. Also wedge shaped, involveing cortex and in distribution of vascular territory.

Question 5

How might a thrombus appear in an early infarct?

Answer 5

Hyperdense, be careful not to confuse with haemorrhage

Question 6

What would a wedge shaped hypo density area in the MCA territory with a white blob suggest?

Answer 6

Initial infarct with haemorrhagic transformation

Question 7

What is malignant MCA syndrome?

Answer 7

This is when a LARGE MCA infract occurs and there is EXTRACELLULAR (look for loss of bone) oedema with catastrophic brain swelling and a rise in ICP, mass effect- this is life threatening and requires decompressive craniotomy.

Question 8

What is a total anterior circulation stroke? (TACS)

Answer 8

This is a large cortical stroke in the MCA/ACA territory.

Question 9

What are the symptoms of TACS?

Answer 9

All 3 of;

• Unilateral weakness and/or sensory disturbance of arm or leg.
• Homonymous hemianopia
• Higher cerebral dysfunction (dysphasia, visuospatial disorder)

Question 10

What are the symptoms of PACS (partial anterior circulation stroke)?

Answer 10

2 of***

• Unilateral weakness and/or sensory disturbance of arm or leg
• Homonymous hemianopia
• Higher cerebral dysfunction (dysphasia, visuospatial disorder

Question 11

What is a PACS?

Answer 11

Cortical stroke in the ACA or MCA territory

Question 12

What is a posterior circulation stroke? (POCS)

Answer 12

This is a stroke in the brain stem, cerebellum or the occipital lobe

Question 13

What are the symptoms of POCS?

Answer 13

This is one of

• Cerebellar or brainstem syndrome
• Loss of consciousness
• Isolated homonymous hemianopia

Question 14

What is a LACS/lacunar stroke?

Answer 14

This is a subcortical stroke

Question 15

What are the symptoms of LACS?

Answer 15

One of

• Unilateral weakness (and/or sensory deficit) to face and arm, arm and leg , or all three
• Pure sensory stroke
• Ataxic hemiparesis

Question 16

What is the general rehab pathway?

Answer 16

1) Minimising tissue injury/preserving function after an acute event, then
2) assessing and managing impairment (cognition, swallowing, mobility) work on functional tasks (toiling, meal prep etc)
3) Assess home environment and plan discharge
4) Post D/C rehab, follow up, long term support and participation

Question 17

What are the consequences of limb spasticity in a patient with spinal cord injury?

Answer 17

Spasicity increases the metabolic load and therefore the patients energy and there is a risk of malnutrition so peg must be considered. Bed sores, DVTs, ulcers, pneumonia, urinary retention, constipation etc are all consequences and must be managed.

Question 18

Therefore tx of spasticity

Answer 18

Treat the infection, use baclofen, pillows, appropriate mattress, DVT thromboprophylaxis, catheter, laxatives etc