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Patho Case Studies > Stroke > Flashcards

Stroke Flashcards

1
Q

What were the patients observations upon admission to the hospital?

A

GCS: 10/15
BP: 185/110 mmHg
HR: 92 beats/min
RR: 30 breaths/min
O2 Sats: 100% on 2L/min
BGL: 16.5 mmol/L

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2
Q

What are the modifiable risk factors of stroke?

A

Excessive alcohol consumption
Certain drugs
High blood pressure
High cholesterol
Obesity
Smoking
Atherosclerosis or vascular disease
Diabetes

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3
Q

What are the non-modifiable risk factors of stroke?

A

Advanced age
Arterial abnormalities
Atrial fibrillation
Certain blood disorders
Ethnic origin (African/Asian)
Family history of stroke or MI
Male sex
Previous stroke/TIA or MI
Patent foramen ovale

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4
Q

What risk factors are specific to this patient?

A

Advanced age
Male sex
Type 2 diabetes
Previous stroke/TIA
Male sex

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5
Q

What are the general signs and symptoms of stroke?

A

Numbness of the face, arm or leg - particularly if only one side of the body is affected
Difficulty seeing with one or both eyes
Difficulty with walking
Dizziness, imbalance, or uncoordinated movement
Facial droop or uneven appearance to the face
Uneven muscle strength in limbs

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6
Q

What signs and symptoms are specific to this patient?

A

Difficulty walking/moving around or uncoordinated movement (bumping into things)
Difficulty hearing
Collapse
Slurred speech
Facial droop
Difficulty moving his arm

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7
Q

What is the FAST acronym

A

F - Face
A - Arms
S - Speech
T - Time

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8
Q

What are the types of stroke?

A

There are 2 types of strokes
Ischemic and hemorrhagic

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9
Q

What is an ischemic stroke?

A

When there is a narrowing or blockage of cerebral arteries leading to tissue ischemia with subsequent tissue infarction if blood supply is not restored quickly. May be caused by either a thrombus or embolus and is the most common type (~80-85%).

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10
Q

What is a hemorrhagic stroke?

A

When there is a rupture of the cerebral arteries, resulting in bleeding and hematoma formation within the surrounding tissues. They lead to direct tissue damage from the blood and tissue ischemia further downstream from the rupture resulting in increased ICP. ~15% of strokes.

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11
Q

What type of stroke did this patient suffer?

A

Ischemic stroke - likely caused by a shower of emboli obstructing blood supply to different regions of his brain. Most probable origin was atherosclerotic plaque

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12
Q

What is the range of scores for GCS and what are the categories?

A

3-15
Verbal response
Eye opening
Motor response

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13
Q

What scans would be used to identify the affected ares of the brain and the type of stroke.

A

CT Scans
MRI Scans

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14
Q

What area of the patients brains showed differences in density of brain tissue?

A

Posterior regions of his brain (the darker areas on scans). The scans showed NO BLEEDING

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15
Q

A neurological exam will also be carried out what will be assessed in this exam?

A

Visual Field
Facial movement
Facial sensation
Corneal reflex
Leg movement (leg lift)
Arm movement (arm lift)

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16
Q

What was observed in this patients visual field?

A

Limited peripheral vision on his right side in both eyes

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17
Q

What was observed in this patients facial movement?

A

Limited movement on the right side of his face

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18
Q

What was observed in this patients facial sensation?

A

Limited sensation on the right side of his face

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19
Q

What was observed in this patients corneal reflex?

A

NO corneal reflex with right eye

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20
Q

What was observed in this patients leg movement?

A

Could lift both legs though there was apparent weakness in his right leg

21
Q

What was observed in this patients arm movement?

A

Significant weakness in his right arm and was unable to lift it.

22
Q

Why were there such significant impacts on his right side?

A

Because he experienced a infarction in his left cerebral hemisphere and some of his RIGHT cranial nerves were affected.

23
Q

What other complications did the patient have?

A

Dysarthria (difficulty speaking)
Dysphagia (difficulty swallowing)
Truncal ataxia (Poor coordination and balance throughout the trunk leading to difficulty sitting upright or standing without support and unsteady gait).
Poor short-term memory
Difficulties with impulse control and cognitive flexibility
Visual disturbances
Fatigue
Depression

24
Q

What is hemiparesis?

A

The most common physical impairment, a weakness of inability to move on one side of the body.

25
Q

What types of visual disturbances can stroke cause?

A

Vision loss
Vision perception problems

26
Q

What type of visual disturbance does the patient have?

A

Homonymous hemianopia
- visual field loss on the same side in both eyes

27
Q

What are the management options for stroke?

A

Though they vary depending on the type of stroke management options may include medications, various rehabilitation services and/or support services.

28
Q

What does immediate management of ischemic stroke usually involve medication wise?

A

rtPA (recombinant tissue plasminogen activator)

29
Q

What is the function/effect of plasmin in the body?

A

Plasmin is a fibrinolytic which breaks down the fibrin holding blood clots together

30
Q

What is the main goal with using rtPA?

A

Reperfusion of the cerebral vessels. It is only used to treat an acute ischemic stroke NOT a hemorrhagic stroke.

31
Q

What makes a patient eligible for rtPA?

A

Not had recent major surgery
Myocardial infarction
Other internal injuries
Must have normal clotting functions and a significant number of platelets.
Should not have significant hypertension

32
Q

What kind of anti-coagulants might be used in addition or instead of rtPA treatment?

A

Aspirin
Clopidogrel
Dabigatran
Dipyridamole
Heparin
Warfarin

33
Q

What is the use of aspirin in the treatment of ischemic stroke?

A

Blocks prostaglandin synthetase action

34
Q

What is the use of clopidogrel in the treatment of ischemic stroke?

A

Inhibits receptor P2Y12, a chemoreceptor on platelet cell membranes

35
Q

What is the use of dabigatran in the treatment of ischemic stroke?

A

Competitive direct inhibitor of thrombin (factor ila)

36
Q

What is the use of dipyridamole in the treatment of ischemic stroke?

A

Inhibits the phosphodiesterase enzyme

37
Q

What is the use of heparin in the treatment of ischemic stroke?

A

Inhibits antithrombin III, which ultimately inactivates blood clotting factor Xa and inhibits blood clotting

38
Q

What is the use of warfarin in the treatment of ischemic stroke?

A

Inhibits vitamin K-epoxide reductase

39
Q

What medications was the patient on after he was discharged from the rehabilitation unit in addition to his pre-existing conditions (i.e. hypertension, type 2 diabetes)

A

Paracetamol
Aspirin
Dipyridamole
Cilazapril
Diltiazem
Clonodine
Gliclizide
Citalopram
Metacloprimide
Omeprazole
Ciprofloxacine

40
Q

What is cilazapril?

A

ACE inhibitor, for lowering BP

41
Q

What is diltiazem?

A

Calcium channel blocker for lowering BP

42
Q

What is clonidine?

A

Vasodilator used to help for lowering BP

43
Q

What is gliclizide?

A

A sulfonulures which acts by stimulating beta cells of the pancreas to release insulin

44
Q

What is citalopram?

A

For low mood/depression

45
Q

What is metacloprimide?

A

Enhances movement of the upper GI tract

46
Q

What is omeprazole?

A

Proton pump inhibitor for gastroesophageal reflux

47
Q

What is ciprofloxacine?

A

Eye drops for corneal ulceration

48
Q

What non-medication based therapies are required for management?

A

Speech-therapy
Physical-therapy
Home care

Patho Case Studies (4 decks)

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