stroke Flashcards
what is stroke - textbook?
acute focal neurological deficit lasting for more than 24hrs
describe a stroke
death of brain tissue from hypoxia
no local cerebral blood flow caused by infarction of tissue or haemorrhage into brain tissue
what does FAST stand for?
facial drooping
arm weakness
speech difficulty
time
what does TIA stand for?
transient ischaemic attack
what is ischemia?
restriction of blood supply and therefore oxygen to any tissue/part of body
what is a transient ischemic attack?
localised loss of brain function
full recovery of brain tissue within 24 hrs (most recover in 30 min)
people that have suffered a TIA are at higher risk of what?
proper stroke
myocardial infarction
what are risk factors for stroke?
hypertension
smoking
alcohol
diabetes mellitus
what is the most common cause of stroke?
infarction 85%
followed by haemorrhage 10%, subarachnoid haemorrhage and venous thrombosis <1%
also vasculitis
what are the causes of stroke?
ischemic - cause uncertain
intracranial bleed
embolic stroke
atheroma of cerebral vessels
venous thrombosis
what causes an embolic stroke?
embolism from L side of heart
atrial fibrillation, recent MI or heart valve disease
what causes inter-cranial bleed/haemorrhage stroke?
aneurysm rupture
where might you find an atheroma of cerebral vessels?
carotid bifurcation
internal carotid
vertebral artery
give examples of stroke prevention
reduce risk factors - smoking, diabetic control, hypertension control
anti platelet action - aspirin, clopidogrel
anticoagulants if embolic risk - AF, LV thrombosis - warfarin, apixiban
carotid endarectomy, preventative neurosurgery
what tests can be used to assess risk factors of stroke?
carotis ultrasound
cardiac ultrasound
ECG
blood pressure
diabetes screen
what imaging techniques can investigate stroke?
CT
MRI
MRA - best to visualise brain circulation
DSA - if MRA not available
what does CT stand for in imaging?
computerised tomography
what does MRI stand for in imaging?
magnetic resonance imaging
what does MRA stand for in imaging?
magnetic resonance angiography
what does DSA stand for in imaging?
digital subtraction angiography
what impact does stroke have on dentistry?
impaired mobility and dexterity - OH and attendance
communication - dysphonia, dysarthria
risk of cardiac emergency - MI
loss of protective reflexes - aspiration
loss of sensory information - dentures
stroke pain
how would you assess risk factors of stroke?
carotid ultrasound
cardiac ultrasound - LV thrombosis
ECG to check arrhythmias
blood pressure
diabetes screen
thrombophilia screen - young patients
what are the effects of a stroke on brain?
loss of functional brain tissue - immediate nerve cell data or ischaeamia in penumbra around infarction
inflammation in tissue surrounding infarct/bleed
what are the complications of a stroke?
motor function loss
dysphonia
swallowing - aspiration of food and saliva leading to pneumonia
sensory loss
cognitive impairment
body perception
a stroke affecting cranial or somatic nerve will affect which side of body?
opposite side to lesion
cognitive impairment affects what?
appreciation
processing
understanding
speech and language - dysphasia, dyslexia
memory impairment
emotional
how is a stroke managed?
acute phase - limit damage and reduce future risk
chronic phase - rehab and reduce future risk
what is involved in the acute phase of stroke treatment?
reduce damage - penumbra region survivable ischaemia, Ca channel blockers
improve blood flow and oxygenation
normoglycaemia as hyper or hypo is harmful
remove haematoma in subarachnoid haemorrhage
prevent future risk - 300mg aspirin daily
what dose of aspirin should be given daily as a prevention of future stroke risk?
300mg daily
what indicates anticoagulation medication after a stroke?
AF
left ventricular thrombosis
(warfarin, apixiban)
what is involved in the chronic phase of stroke treatment?
nursing and rehab - immobility support, prevent bed sores and physiotherapy
speech and language therapy - communication, eating
occupational therapy
what are the two types of stroke?
ischaemic stroke
haemorragic stroke
