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BDS3 BAMS > Stroke > Flashcards

Stroke Flashcards

1
Q

What is Stroke?

A
  • Acute focal neurological deficit resulting from cerebrovascular disease and lasting more than 24hrs or causing earlier death
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2
Q

What happens during a stroke?

A
  • Death of brain tissue from hypoxia
  • No local cerebral blood flow
  • Leads to infarction of tissue
  • Haemorrhage into brain tissue
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3
Q

What are the types of stroke?

A
  • Ischaemic stroke
  • Haemorrhagic stroke
  • Transient Ischaemic attack (TIA)
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4
Q

What is a Transient Ischaemic attack?

A
  • Mini stroke (25% that of stroke)
  • Happens when rapid loss of localised brain function but also rapid recovery of function
  • Is Ischaemic event and not haemorrhage
  • Patient within 24hrs recovers all neurological function lost (most recover within 30mins)
  • Thought it is because platelet emboli in blood vessels in neck block blood flow to brain tissue causing ischaemia, also rapid removal so no permanent damage occurs
  • Higher risk of stroke in future (12
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5
Q

What acronym is used to help people recognise a stroke?

A

FAST
- Facial drooping
- Arm weakness
- Speech difficulty
- Time

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6
Q

What are Risk factors for stroke?

A
  • Hypertension (if DIASTOLIC >110mm Hg then at x15 risk compared to <80mm Hg)
  • Smoking
  • Alcohol
  • Ischaemic heart disease
  • Atrial fibrillation
  • Diabetes Mellitus
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7
Q

What is the incidence of stroke?

A
  • 12% of all deaths
  • Commonest cause of adult disability
  • Infarction 85%
  • Haemorrhage 10%
  • Subarachnoid haemorrhage 5%
  • Venous thrombosis <1%
  • Male > Female
  • Increasing incidence with age
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8
Q

What are causes of Ischaemic stroke?

A
  • Mostly uncertain
  • Narrowing of blood vessels, plaque forming and ischaemia same as cardiac event
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9
Q

What are the causes of Haemorrhagic stroke?

A
  • Intracranial bleed via aneurysm rupture
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10
Q

What are the causes of Embolic stroke?

A
  • Can be from an embolism from left side of heart caused by Atrial fibrillation, Heart valve disease or Recent MI
  • Can be from atheroma of cerebral vessels at carotid bifurcation, or internal carotid artery or Vertebral artery
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11
Q

What are less common causes of stroke?

A

Venous thrombosis
- Oral contraceptive use
- Polycythaemia
- Thrombophilia

Borderzone infarction
- Severe hypertension
- Cardiac arrest

Vasculitis (inflammation of the blood vessels causing them to be swollen and narrow - limits oxygen delivery and stroke)

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12
Q

How can stroke be prevented?

A

Reduce risk factors
- Smoking
- Diabetes control
- Control hypertension

Antiplatelet action (secondary action only)
- Aspirin
- Dipyridamole
- Clopidogrel

Anticoagulants like Warfarin and Apixaban
- Embolic risk

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13
Q

How can stroke be prevented via cardiac surgery?

A

Carotid Endarterectomy can be performed
- Surgeon makes cut along neck and open carotid artery, remove plaque deposits clogging artery. Repair artery with stitches or a patch made with vein or artificial material
- For people with Severe stenosis (Prevents aortic valves opening and closing properly)
- Or who have had previous TIA’s
- Or <85 years old

  • 7.5% mortality from surgery
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14
Q

How can stoke be prevented by neurosurgery?

A
  • Aneurysms clips
  • AV malformation correction (small incision via AVM and seal surrounding arteries and veins so don’t bleed and remove AVM)
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15
Q

What to do when investigating a stroke?

A
  • Need to differentiate between Infarction/ Bleed/ Subarachnoid haemorrhage
  • Early info needed to assess best treatment options
  • Treatment needs to be started almost immediately to prevent loss of tissue
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16
Q

What imaging can be used to investigate a stoke?

A

CT Scan
- Rapid, easy access
- But poor for showing Ischaemic stroke (most common)

MRI Scan
- Shows both types
- Hard to obtain quickly
- better at visualising early changes of damage
- MRA (MR angiography) best investigation for visualising brain circulation

Digital Subtraction angiography (DSA)
- Shows Blood flow in brain not brain tissues
- Use if MRA not available

17
Q

How to assess risk factors when investigating stroke?

A
  • Carotid ultrasound
  • Cardiac ultrasound in case thrombus forming in LV
  • ECG to check arrhythmias and atrial fibrillation
  • Blood pressure
  • Diabetes screen
  • Thrombophilia screen esp in young patient as they have tendency to form clots more than usual
18
Q

What are the effects of stroke?

A

Loss of functional brain tissue
- Immediate nerve cell death
- Nerve cell ischaemia in penumbra around infarction and will die if not protected by specialist treatment

Gradual or rapid loss of function
- Stroke may evolve over minutes or hours

Inflammation in tissue surrounding infarct/bleed
- As inflammation settles some recovery can be made

19
Q

What are the complications of stroke?

A

Motor function loss
- Dysphonia (hoarseness)
- Swallowing (food cannot be kept out of airway so aspiration of food and saliva is risk and may lead to pneumonia and death
- Cranial nerve or somatic (opposite side) loss
- Autonomic in brainstem lesions

Sensory loss
- Cranial nerve or somatic loss
- Body perception (phantom limbs experience and can lead to neglect of that body part) - May not be immediate

Cognitive impairment
- Appreciation (special sensation)
- Processing like understanding of of info and speech and language (dysphasia, dyslexia, dysgraphia, dyscalculia)
- Memory impairment
- Emotional lability and depression

20
Q

How do you manage stroke?

A

Acute phase
- Vital to limit damage and reduce future risk

Chronic phase
- Rehabilitation and reduce future risk

21
Q

What is included in acute phase treatments?

A

Reduce damage
- Aim to reduce the penumbra region damage by calcium channel blockers such as Nimodipine

Improve blood flow/oxygenation
- Thrombolysis possible within 3hrs (alteplase)
- Maintain perfusion pressure to brain tissue

Normoglycaemia
- Maintain brains normal glucose levels as hyper/hypo is harmful

Remove haematoma
- Can be done mostly in subarachnoid haemorrhage

Prevent future risk
- Aspirin 300mg daily
- Anticoagulation if indicated if patient has history of atrial fibrillation or LV thrombus

22
Q

What is included in Chronic Phase treatment?

A

Nursing and Rehabilitation
- Immobility support for prevention of bed sores and physiotherapy to prevent contractures

Speech and language therapy
- Communication
- Swallowing and eating

Occupational therapy

23
Q

What are the dental aspects of stroke?

A

Impaired mobility and dexterity
- Attendance affected
- Oral hygiene affected

Communication difficulties
- Dysphonia, Dysarthria
- Cognitive difficulties

Risk of cardiac emergencies
- MI
- Further stroke

Loss of protective reflexes
- Aspiration
- Managing saliva (Anticholinergic drugs may help)

Loss of sensory info
- Difficulty in adaptation to new oral environment like dentures

‘Stroke pain’
- CNS generated pain perception, may report pain that isn’t actually present

BDS3 BAMS (15 decks)

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