Stroke 1 Flashcards
What is a stroke
Sudden impairment of brain function (eg sudden loss of sensation or paralysis)
Results from disturbance of cerebral circulation
What are the two main causes of stroke?
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
Demographics:
Common in elderly due to other co-morbidties
Males get it earlier compared to females
Higher incidence in Maori and Pacifica
What causes an ischemic stroke?
Thrombus Formation developed from:
- Atrial Fibrillation, Patent Foramen Ovale
- Atherosclerotic Plaque in Carotid artery
- Surgery
What causes a hemorrhagic stroke?
- Arterial rupture - usually the middle cerebral artery
- Aneurysm
- Arterio-venous malformation
Risk Factors: (Vascular-paths)
Smoking Obesity Diabetes Atrial Fibrillation Alcohol High Blood Pressure High Cholesterol
Treatment for Ischemic Stroke:
Acute (First 6 hours): Clot Busting Therapy, Clot Retrieval
Sub-Acute: Endarterectomy,carotid stent
Secondary Prevention: Medication and Lifestyle changes
Describe an example of Clot Busting Therapy:
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.
Give examples of medications stroke patients may be on
Beta Blockers Anti-hypertensives Anti-platelets Anti-coagulants Diabetes Control
Treatment for hemorrhagic Stroke:
Acute: - Decrease BP and Intracranial pressure Sub-Acute: - Surgery to remove clot , aneurysm and arterio-venous malformation Secondary Prevention: Anti-hypertensives
Describe medical management vs rehabilitation
Medical - Vasular not neural (Nothing to do with the brain) Risk factors
Rehabilitation - Neural not medical (no drugs to treat stroke)
3 main areas and aim of rehab in Stroke patients:
Practice
Training
Strategy
Aim: To gain independence again
When is rehab most effective?
Within the first 100 days after stroke
Describe plasticity:
- Changes in number and strength of connections between neurons
- Reorganization of surviving neurons to regain function
How does rehab promote plasticity?
Repetition
Attention and motivation
Progression and variation
Compare good vs poor recovery
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
Signs of Stroke:
- 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.
How will you recognize stroke?
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.
What is priming and how can this be done?
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)
What is important to determine before starting rehab?
Predict the patients potential for recovery.
Who are more likely to gain higher independence from rehab?
People with only motor deficits compared to people with both motor/sensory and/or vision deficits
What are some prognostic indicators for recovery?
Brain stimulation and imaging
Secondary Prevention of Stroke:
Lose weight Control diabetes Stop smoking Reduce drinking Reduce salt and fat intake
Barriers to physical activity in stroke patients
Impaired: - voluntary movement - vision - communication Loss of confidence Depression Fatigue
