Stroke 1

Question 1

What is a stroke

Answer 1

Sudden impairment of brain function (eg sudden loss of sensation or paralysis)
Results from disturbance of cerebral circulation

Question 2

What are the two main causes of stroke?

Answer 2

Hemorrhagic Stroke - Blood vessel bursts and bleed into the brain.
Ischemic Stroke - Blood flow to the brain stops, therefore brain is deprived of oxygen causing tissue death

Question 3

Demographics:

Answer 3

Common in elderly due to other co-morbidties
Males get it earlier compared to females
Higher incidence in Maori and Pacifica

Question 4

What causes an ischemic stroke?

Answer 4

Thrombus Formation developed from:

• Atrial Fibrillation, Patent Foramen Ovale
• Atherosclerotic Plaque in Carotid artery
• Surgery

Question 5

What causes a hemorrhagic stroke?

Answer 5

• Arterial rupture - usually the middle cerebral artery
• Aneurysm
• Arterio-venous malformation

Question 6

Risk Factors: (Vascular-paths)

Answer 6

Smoking
Obesity
Diabetes
Atrial Fibrillation
Alcohol
High Blood Pressure
High Cholesterol

Question 7

Treatment for Ischemic Stroke:

Answer 7

Acute (First 6 hours): Clot Busting Therapy, Clot Retrieval
Sub-Acute: Endarterectomy,carotid stent
Secondary Prevention: Medication and Lifestyle changes

Question 8

Describe an example of Clot Busting Therapy:

Answer 8

RTPA
Powerful Drug which is used for within the window of opportunity (4.5 hours) of recognition of stroke which only 10% of patients are actually eligible.

Question 9

Give examples of medications stroke patients may be on

Answer 9

Beta Blockers 
Anti-hypertensives 
Anti-platelets 
Anti-coagulants
Diabetes Control

Question 10

Treatment for hemorrhagic Stroke:

Answer 10

Acute: 
- Decrease BP and Intracranial pressure 
Sub-Acute:
- Surgery to remove clot , aneurysm and arterio-venous malformation
Secondary Prevention:
Anti-hypertensives

Question 11

Describe medical management vs rehabilitation

Answer 11

Medical - Vasular not neural (Nothing to do with the brain) Risk factors
Rehabilitation - Neural not medical (no drugs to treat stroke)

Question 12

3 main areas and aim of rehab in Stroke patients:

Answer 12

Practice
Training
Strategy
Aim: To gain independence again

Question 13

When is rehab most effective?

Answer 13

Within the first 100 days after stroke

Question 14

Describe plasticity:

Answer 14

• Changes in number and strength of connections between neurons
• Reorganization of surviving neurons to regain function

Question 15

How does rehab promote plasticity?

Answer 15

Repetition
Attention and motivation
Progression and variation

Question 16

Compare good vs poor recovery

Answer 16

Good: Increased activity in lesioned hemisphere - trying to promote symmetrical brain activity
Poor: Plastic reorganization of the neurons in the normal hemisphere (suppresses the lesioned side) overuse of non- affected limbs - promotes asymmetry of brain activity

Question 17

Signs of Stroke:

Answer 17

• Sudden numbness or weakness in the face, arm, or leg, especially on one side of the body.
• Sudden confusion, trouble speaking, or difficulty understanding speech.
• Sudden trouble seeing in one or both eyes.
• Sudden trouble walking, dizziness, loss of balance, or lack of coordination.
• Sudden severe headache with no known cause.

Question 18

How will you recognize stroke?

Answer 18

F—Face: Ask the person to smile. Does one side of the face droop?
A—Arms: Ask the person to raise both arms. Does one arm drift downward?
S—Speech: Ask the person to repeat a simple phrase. Is their speech slurred or strange?
T—Time: If you observe any of these signs, call 9-1-1 immediately.

Question 19

What is priming and how can this be done?

Answer 19

Preparing the brain for a more plastic response to therapy, this might augment response to therapy (Trying to make the brain as plastic as possible before therapy)

• Non-invasive brain stimulation
• Co-ordinated movement patterns
• Pharmacological agents - (Dopamine, serotonin)

Question 20

What is important to determine before starting rehab?

Answer 20

Predict the patients potential for recovery.

Question 21

Who are more likely to gain higher independence from rehab?

Answer 21

People with only motor deficits compared to people with both motor/sensory and/or vision deficits

Question 22

What are some prognostic indicators for recovery?

Answer 22

Brain stimulation and imaging

Question 23

Secondary Prevention of Stroke:

Answer 23

Lose weight 
Control diabetes
Stop smoking 
Reduce drinking 
Reduce salt and fat intake

Question 24

Barriers to physical activity in stroke patients

Answer 24

Impaired:
- voluntary movement 
- vision 
- communication 
Loss of confidence 
Depression 
Fatigue