Stroke

Question 1

What are modifiable risk factors for a stroke?

Answer 1

Smoking
- Narrows arteries and makes blood more likely to clots
- Raises triglycerides
- Lowers good cholesterol
- Atherosclerosis

Diet
- Atherosclerosis from high cholesterol intake
- Obesity from excessive calorie intake
- High blood pressure from high salt intake
- Type 2 diabetes risk from high sugar intake

Hypertension

Obesity
- Linked to hypertension and diabetes

Diabetes
- Sugar build up in blood and prevents oxygen and nutrients from getting to the various parts of the body
- High blood pressure is common

Excessive alcohol intake
- Hypertension
- Irregular heartbeat
- Weight gain

Question 2

What are some non-modifiable risks of a stroke?

Answer 2

Age
- More likely to have a stroke if you’re over 55
- Chance of having a stroke doubles every 10 years after the age of 55
- 1 in 4 strokes happen to younger people

Family history
- Close relative increases risk

Ethnicity
- Higher risk in south asian, African and Caribbean people due to high rates of diabetes and hypertension in these groups

Medical history
- Previous stroke, TIA or heart attack increases risk of future stroke

Sex
- More common in women than men
- Pregnancy and birth control increases risk

Question 3

What is an ischaemic stroke?

Answer 3

When a blood vessel in the brain becomes block and blood flow is cut off.
Often a result of plague in the blood vessels
80% of strokes

Question 4

What is a haemorrhagic stroke?

Answer 4

When a blood vessel in the brain starts bleeding.
The leaked blood increases pressure on brain cells and damages them

Question 5

What is a transient ischaemic attack?

Answer 5

‘Mini-stroke’
Blood flow to the brain is blocked for a short period of time.
Resolved within 24 hours

Question 6

What is FAST?

Answer 6

F - Face –> drooping on one side of the face
A - Arm –> arm weakness or drooping in one arm
S - Speech –> slurred speech, or unable to speak
T - Time –> call emergency services

Question 7

What are the symptoms of a stroke?

Answer 7

• Complete paralysis on one side of the body
• Sudden loss of vision
• Nausea
• Dizziness
• Dysphagia
• Loss of consciousness

Question 8

What is the DASH diet?

Answer 8

Dietary Approaches to stop Hypertension

• Increase consumption of fruits, vegetables, whole grains, lean proteins, and low-fat diary
• Limiting sodium, saturated and added sugar

Can significantly reduce both systolic and diastolic blood pressure in adults with and without hypertension making it an effective dietary intervention for reducing blood pressure and preventing hypertension in the UK and other populations

Question 9

What is hemianopia?

Answer 9

The loss of one half of the visual filed which could cause you not to be able to see either the left or right of the field of vision

Question 10

What is hemiplegia?

Answer 10

Describes paralysis of one side of the body. This is the total loss of ability to move part of the body

Question 11

What is dysarthia?

Answer 11

Weakness in muscles that control the mouth, lips, tongue or breathing. This can result in slurred or slowed speech and can cause problems swallowing.
Linked to dysphagia

Question 12

What is ischaemic penumbra?

Answer 12

Some brain cells can die in a stroke, known as penumbra. They could heal in the first fe days/ weeks after a stroke spontaneously

Question 13

what is multi-infarct dementia?

Answer 13

Caused by multiple TIAs that take place over time causing widespread damage. They may not be noticed because they are small. Called ‘silent strokes’.

Question 14

What is aphasia?

Answer 14

Difficulty speaking or understanding what people say

Question 15

What is apraxia?

Answer 15

The inability to control and co-ordinate movements or carry out tasks

Question 16

What are the phases recovery?

Answer 16

• Hyperacute –> first 24 hours
• Acute phase –> 7 days
• Early sub-acute –> first 3 months
• Late sub-acute –> 4-6months
• Chronic phase –> from 6 months

Question 17

What members of MDT are involved in stroke care?

Answer 17

Occupational therapist –> assess the individuals ability to participate in activities of daily living such as personal care, kitchen tasks and ability to manage in the home environment. They prove therapy to support both physical and cognitive difficulties

Physiotherapist –> re-educates movement, ,sensation and balance in order to enable the patient to reach their potential for recovery of mobility and independence

Speech and language therapist –> assesses all aspect of communication and will advise how best to help the patient and their family. They will also assess difficulty swallowing and advise the most appropriate way to keep a patients swallow safe.

Dietitian –> explain how food can help post stroke, assessing nutritional requirements for each individual depending upon their needs.

Clinical neuropsychologist –> sees people who are having problems with their thinking, emotions or behaviour after a stroke. They will complete assessments and may carry out therapeutic interventions or advise on rehabilitation strategies to help people cope better

Stroke liaison sister –> provides support and advice to patients and their families regarding a patient’s diagnosis and their care needs, secondary prevention and rehabilitation within the hospital setting. They support the team with complex issues, such as discharge planning or mental capacity issues.

Question 18

What can the psychological impact of a stroke have on families?

Answer 18

• Become caregivers
• Can experience depression
• Reduction in mental and physical quality of life
• Added restrictions on life
• Physically and emotionally draining

Question 19

What is the psychological impact of a stroke on the patient?

Answer 19

Depression:
- Post-stroke depression occurs in one third of stroke survivors
- At higher risk of reduced recovery, recurrent vascular events, poor quality of life
- Predictors of PSD include physical disability, stroke severity, cognitive impairment, lack of familial and social support after a stroke.

Anxiety:
- Anxiety around future strokes
- Generalised anxiety disorder and phobic disorder common
- Associated with poorer patient outcomes

Question 20

What are the benefits of PEG feeding in stroke patients?

Answer 20

Allows patients to meet their nutritional requirements without relying on oral intake.

PEG
- More secure method of feeding stroke patients who require longer-term nutritional support (severe dysphagia) –> it is an invasive procedure that can result in complications associated with increased risk of morbidity and mortality after stroke
- Provides valuable access for nutrition in patients with a functional gastrointestinal system
- Has high effectiveness, safety and reduced cost underlie increasing worldwide popularity
- Better tolerated than NG tubes
- Improve nutritional status
- Easy to use
- Low incidence of complications
- Reduction in aspiration pneumonia associated with swallowing disorders
- Cost effective relative to alternative methods, particularly when reasonably long survival is expected

Question 21

What is the benefits and disadvantages of NG feeding in stroke patients?

Answer 21

NG feeding is the preferred method for short-term feeding in the acute phase of stroke as it has the advantage of being placed at the bedside.

• Minimal complication
• Improve nutritional status
• Less invasive than PEG

Disadvantages/ complications
- Aspiration pneumonia risk
- Failed/ incorrect insertion
- Can be pulled out by patient
- May require reinsertion

Question 22

What is the evidence for the role of diet in the secondary prevention of stroke?
Types of diet?

Answer 22

Mediterranean diet
- High in healthy fats, whole grains, fruits, vegetables and fish
- Can lower risk of stroke by 40% or more in high risk patients
- Low in cholesterol and saturated fat

Potassium rich food
- Lowers blood pressure which is a significant risk factor for a stroke

Omega-3 fatty acids
- Healthy fats found in fish, nuts and seeds
- Found to lower risk of ischemic stroke

Low sodium diet
- Reduce hypertension