Stroke

Question 1

What is a stroke?

Answer 1

Stroke is a clinical syndrome, of presumed vascular origin, typified by (focal or global) of cerebral functions lasting more than 24 hours or leading to death.

Question 2

What is a cerebro-vascular disease?

Answer 2

Cerebro-vascular diseases are those in which brain damage occurs secondary to pathology of the blood vessels, usually the arteries, or the blood supply

Question 3

What is a transient ischaemic attack (TIA)?

Answer 3

A TIA is an acute loss of focal cerebral or ocular function with symptoms lasting <24 hours. The blood supply to a localised area of the brain is temporarily disturbed and complete clinical recovery occurs within 24 hours. It is sometimes referred to as a ‘mini stroke’. TIA often proceeds a stroke.

Question 4

What are the two main types of stroke?

Answer 4

Ischaemic and haemorrahgic

Question 5

What is an infarction?

Answer 5

An infarction is defined as an area of brain in which the blood flow has fallen below the critical level necessary to maintain tissue viability.

Question 6

What causes ischaemic strokes?

Answer 6

Caused either by atherosclerosis occluding the blood supply from a large vessel, or from emboli breaking off a plaque and lodging in a smaller vessel and therefore occluding the blood supply

Question 7

Name the main structures of the brain that are obstructed during an ischaemic stroke

Answer 7

Major cerebral arteries: middle cerebral artery (MCA), posterior cerebral artery (PCA), anterior cerebral artery (ACA). And the vertebral/basilar artery.

Question 8

What equipments allows identification if a stroke has occurred?

Answer 8

CT, MRI or angiogram

Question 9

What parts of the brain does the vertebral or basilar artery supply?

Answer 9

Brainstem, nuclei of the cranial nerves and pyramidal (motor) and sensory tracts

Question 10

What does the brainstem control?

Answer 10

Vital functions; respiration, blood pressure, consciousness

Question 11

What brain areas does the MCA supply?

Answer 11

Basal ganglia & internal capsule

Question 12

What does a stroke in the vertebral artery cause?

Answer 12

It is life-threatening. If they survive sensory loss, cranial nerve palsies and quadraparesis (paralysis or weakness of all 4 limbs)

Question 13

What areas of the brain does the PCA supply?

Answer 13

Medial part of the temporal lobe, thalamus, occipital lobe

Question 14

What does a stroke in the PCA cause?

Answer 14

Visual - hemianopia (inability to see one side of the visual field of both eyes). Sensory and memory loss.

Question 15

What does a stroke in the MCA cause?

Answer 15

Contralateral hemiplegia (paralysis/weakness on one-side of the body) affecting arm, leg, trunk and face. Visual field loss, speech and communication, perception of sensation.

Question 16

What part of the brain does the ACA supply?

Answer 16

Medial frontal lobe, parasagittal strip of the cortex (the area from the frontal to the occipital lobes)

Question 17

What does an occlusion of the ACA result in?

Answer 17

Monoplegia (paralysis of 1 limb) of the leg, contralateral sensory loss, cognitive/behavioural problems

Question 18

What is lipohyalinosis?

Answer 18

Weakening of the walls of the small arteries of the brain which occurs due to hypertension. Small herniations or micro-aneurysams develop which can rupture.

Question 19

What are the risk factors for stroke? (11)

Answer 19

Hypertension, 
diabetes mellitus, 
ischaemic heart disease, 
raised blood cholesterol, 
high salt diet, 
smoking, 
lack of exercise, 
excessive drinking of alcohol
high-oestrogen contraceptive pill
obesity
severe COVID-19 infection

Question 20

What impairments would someone have if they had a moderate stroke?

Answer 20

Weakness causing reduced dexterity, an inability to walk, probably difficulty standing and transferring but have sitting balance

Question 21

What impairments would someone have if they had a severe stroke

Answer 21

difficulty sitting, requiring a lot of assistance to transfer, inability to stand)

Question 22

What is the aim of physiotherapy in the acute phase?

Answer 22

To help direct the early mobilisation of the patient. Promoting mobility within 24 hours of stroke has been identified as being key in acute stroke care and thought to help reduce common complications associated with immobility e.g. contractures, chest infections, pressure sores and deep vein thrombosis

Question 23

What needs assessment before physiotherapy begins in the acute phase?

Answer 23

Determining if the patient is medically stable (blood pressure and pre-existing conditions), level of consciousness (to determine if they are experiencing an extension of the stroke), optimum positioning (to reduce risk of pressure sores & contractures), early mobilisation (within 1st 24hr), bladder and bowel management, respiration complications (secretions), pain, communication (with family - referral to SLT), issues with swallowing (SLT)

Question 24

What are the most common secondary complications after stroke?

Answer 24

Shoulder pain

Contractures/soft tissue shortening

Question 25

What causes shoulder pain post-stroke?

Answer 25

Weak muscles around the scapula and glenohumeral joint. Pre-morbid joint degeneration can increase risk of shoulder pain

Question 26

How to treat shoulder pain in stroke survivors?

Answer 26

Mobilising the scapula and GH joint, lengthening shortened muscles, functional electrical stimulation for deltoid and supraspinatus

Question 27

What causes contractures post-stroke?

Answer 27

Weakness (lack of activity), pain, neural components (spastic dystonia), perceptual neglect, loss of sensation, learned non-use

Question 28

What are the most common sites affected by contractures? 6

Answer 28

Elbow, wrist and finger flexors, hip flexors, GH adductors and internal rotators