Stroke Flashcards
What are the presentations of a stroke of the frontal lobe
Contra lateral movements of the arm leg face and trunk are affected
Broca’s area is the expressive centre for speech
Prefrontal areas - personality, initiative and sequencing
Cortical inhibition of bladder and bowels
Stroke in the parietal lobe
Sensory cortex present in the post central gyrus
Wernickes area receptive area comprehension
Handling numbers and doing calculations (dominant)
Concepts of body image and awareness of external environment (non dominant)
Visual pathways - deep in Myers’s loop
Damage to the temporal lobe due to a stroke may present as dysfunction of
The auditory cortex
Learning and memory
Olfactory sensation
Emotional behaviour
Visual pathways
What is the difference between positive features and negative features
Loss of function is due to negative features such as paralysis
Abnormal stimulation is due to positive features that ma present as seizures and tremors
What can cause ischaemic strokes
Atheromatous narrowing of the carotid or vertebral artery
Arterial embolism from a distant site
Large artery atheroma affects which main vessels
Carotid
MCA, PCA and ACA
Perforating vessel - lacunar infarction
Other than large vessel atheroma what else can cause occlusion of vessels
= small vessel disease
Vasculitis
Carotid dissection (traumatic or spontaneous)
What are other causes of ischaemic stroke other than atheromatous plaque or dissection
Atheroma 50%
Heart causes: 25% such as AF, valve disorders and endocarditis, PFO, myxoma)
Small end arteries 25%
Fat and air v rare
Causes of haemorrhagic stroke
Hypertension
Artero-venous malformation AVM
Aneurysm
Cerebral amyloid angiopathy CAA
Coagulation disorders or medication related
What deficits are associated with carotid artery occlusion
Contra lateral hemiplegia, hemisensory disturbance
Homonymous hemianopia
Deterioration in consciousness level
Gaze palsy (eyes deviated to the ide of palsy)
Dominant hemisphere - global aphasia
Deficits in branch vessel occlusion: MCA
Contra lateral hemiplegia, hemianesthesia and hemianopia
Dominant hemisphere = aphasia, acalculia and agraphia
Non dominant = neglect, dressing apraxia and failure to recognise faces
Deficits in perforating vessel stroke
Pure motor stroke
Pure sensory stroke
Dysarthria
Ataxic hemiparesis
Sensorimotor stroke
Total anterior circulation infarct TACI
Hemi motor and sensory deficit
Hemianopia
Cortical dysfunction
Partial anterior circulation infarct
Any 2 from total anterior circulation infarct deficits OR isolated cortical dysfunction
Deficits associated with lacunar infarct
Pure motor hemiplegia
Pure sensory loss
Motor and sensory loss
Deficits associated with posterior circulation infarct: POCI
Vertigo
Diplopia
Ataxia
What is the acute treatment for stroke
For an infarct - thrombolysis (clot buster) with tPA or thrombectomy if can treat very soon after onset of symptoms…. Then aspirin and statins
Acute treatment for stroke if caused by haemorrhage
Lower BP to 160/90 at least and reverse anti-coagulation
What are the principles of stroke rehab
MDT assessment within 24-48 hrs
Swallowing - nearly 50% struggle with this
Nutritional status
Cognitive impairment
Communication
Mobility
What does rehab focus on
Setting goals
Screening for depression and anxiety
Physiotherapy to improve mobility
Addressing difficulties with ADLs
Training of carers to handle patient at home
What are the long term problems post stroke
Mobility
Continence (bladder and bowel)
Cognition
Self care
Communication deficits
Chronic pain
What is mortality like post stroke
19% at 0-30 days
12% at 30 days to 1 year
What are predictors of poor recovery
Older age
Comorbidities
How severe the stroke was
Absence of a partner?
Visuospatial defects
Complications of stroke
VTE
Infections such as oenumonia and UTI
Dysphagia and malnutrition
Seizures
Central post stroke pain syndrome
Spasticity
Depression
Stroke recurrence
Falls
Dehydration
