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Long term conditions > Stroke > Flashcards

Stroke Flashcards

1
Q

How many people a year have a stroke?

A

~152000 a year

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2
Q

What percentage of stroke sufferers have good recovery?

A

1/3

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3
Q

What is the oxygen consumption of the brain?

A

20% of the whole body

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4
Q

How long before brain shuts down after blood supply has been cut off?

A

3-6 minutes neurons start dying
After 15 minutes pts brain dead

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5
Q

How is blood supplied to the brain

A

arch of aorta
common carotid artery
internal carotid artery
vertebral artery
circle of Willis formed through these arteries

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6
Q

what are the key arteries in the brain?

A

Anterior cerebral artery (ACA)
Middle cerebral artery (MCA)
Posterior cerebral artery (PCA)

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7
Q

what is a stroke

A

syndrome characterised by rapidly developing clinical symptoms and/or signs of focal loss of cerebral function lasting for more than 24 hours/death and due to a vascular origin

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8
Q

What is a TIA

A

Transient ischemic attack
symptoms and signs last less than 24hrs
Acts as a warning for stroke
Sign that a clot may be forming

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9
Q

how many stroke deaths a year vs survivors

A

5.45 million strok deaths/year and 9 million stroke survivors world wide

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10
Q

What are the classifications of stroke

A

Ischaemic or haemorrhagic

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11
Q

What are the classifications of ischaemic stroke

A

Cardio-embolic
atherothrombo-embolic
small vessel disease
venous thrombosis

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12
Q

what is an ischaemic stroke

A

A stroke where blood supply to an area is prevented due to a clot or other blockage

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13
Q

What are characteristics of a cardio-embolic stroke

A

AF
Mural thrombus
paradoxical embolism through patent foramen ovale
Inefective endocarditis

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14
Q

What is the cause of atherothrombotic-embolic strokes

A

Forms in arteries
Carotid, vertebral, cerebral artery occlusion and carotid dissection

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15
Q

How does small vessel disease lead to stroke

A

easier to clot in small vessels
hypertensive arterial disease, diabetic vasculopathy and vasculitis

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16
Q

What is associated with venous thrombosis

A

Lying in bed for long time, need to check pt has not been clotting

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17
Q

What are types of haemorrhagic strokes

A

sub-arachnoid
parenchymal

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18
Q

What is sub-arachnoid stroke associated with?

A

Arterio venous malformation
Aneurysm

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19
Q

What is parenchymal stroke associated with?

A

Hypertensive arterial disease
amyloid angiopathy

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20
Q

What occurs to form an atherosclerotic artery

A

Fatty streaks form on the intimal layer of the wall
massive extracellular lipids
fibrous plaques with deposits of platelets and fibrin
This stiffens leading to kinking of artery, occlusion or narrowing, decreased perfusion pressure
In combination with HTN a major risk of injury due to stretch of the walls and burst blood vessels

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21
Q

What is a thromboembolism

A

A thrombus is build up such as a clot that forms in vessels
Part breaks off and travels to the brain

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22
Q

What is a berry aneurysm

A

Referred as “tiny bomb inside head”
if part weak when extra pressure can break and bleed in brain
‘berries’ form off of vessels such as internal carotid complex, anterior communicating, trifurcations

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23
Q

What is an avm

A

Means anteriovenous malformation
Artery continous across instead of separating into capilleries
Can lead to hypoxia causing brain cell death

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24
Q

What are moderate effects of ischaemia?

A

Inadequate O2 and glucose
Leads to Inadequate energy supply
Failure of neuronal activity and regional brain dysfunction

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25
Q

What are severe effects of ischaemia

A

Inadequate energy supply feeds
Influx of H2O, Na+. Cl- with influx of Ca+
Anaerobic metabolism results
Leads to irreversible cellular injury and accumulating lactic acid
H+, compromise neuronal integrity

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26
Q

What occurs in advanced ischaemia

A

Effects of mild-to-moderate and severe
lead to loss of function and accumulation of chemicals
further influx of H2O, Na+ and Ca+ occurs
This causes destruction of cell components

27
Q

What occurs in penumbra

A

The thrombus creates an infarction by blocking an artery however neighbouring arteries can continue collateral flow meaning some areas are restored

28
Q

What are risk factors for stroke

A

increased age
male
race e.g. african-americans
diabetes mellitus
prior stroke / TIAs
Family history
asymptomatic carotid bruit
geography / climate
socio-economic factors

29
Q

what are major risk factors for stroke

A

Hypertension
heart disease esp. AF
cigarette smoking
TIA

30
Q

what are secondary risk factors for stroke

A

increased serum cholesterol / lipids
physical activity
obesity
excessive alcohol intake/drug use
acute infection

31
Q

What are different clinical classifications of stroke

A

Total anterior circulation syndrome (TACS)
Partial anterior circulation syndrome (PACS)
Lacunar syndrome (LACS)
Posterior circulation syndrome (POCS)

32
Q

How is TACS diagnosed?

A

Higher dysfunction interruptions
- dysphasia
-visuospatial disturbances
-decreased level of consciousness
homonymous hemianopia
- only see sides or only middle
motor and sensory defects (>2/3 of face arm leg)

33
Q

How is PACS identified

A

2/3 of features of higher dysfunction including:
Dysphasia
Visuo-spatial disturbances
- homonymous hemianopia
- motor and sensory defects
- higher dysfunction alone
- partial motor or sensory defect

34
Q

How is lacunar syndrome diagnosed?

A

Any combination of symptoms of
- pure motor stroke
- pure sensory stroke
- sensorimotor stroke
- ataxic hemiparesis (wobbliness, lack of control)

35
Q

How is POCS identified?

A

Normally largely visual + coordination problems
Any combination of
- cranial nerve palsy and contralateral motor and sensory deficit
- B/L motor or sensory deficits
- conjugate eye problems
- cerebellar dysfunction
- isolated homonymous hemianopia

36
Q

How is stroke diagnosed

A

CT scan
MRI

37
Q

what factors effect prognosis

A

Type
extent of lesion
Access to emergency care
- thrombolysis for ischaemic stroke
MDT input
20-50% death
1/3 left with severe deficits

38
Q

What is the difference between stroke and TIA?

A

Stroke symptoms last longer than 24 hours and TIA less than 24hrs

39
Q

What are symptoms of stroke?

A

Muscle weakness normally on one side
Confusion
Speech difficulties - dysarthria
Blurred vision
Loss of balance
Difficulty walking
Ataxia - impaired coordination
Sensory loss

40
Q

What are possible assessments for stroke?

A

Cognitive
Balance
Gait
ROM - spasticity and tone
Muscle strength

41
Q

What are cognitive tests for stroke

A

Clock drawing test - assesses for hemineglect and cognition
Attention during functional tasks

42
Q

What are balance tests for stroke?

A

Functional reach test
Timed unipedal stance test
4 square step test
Timed up and go

43
Q

How can gait be assessed for stroke?

A

Timed up and go
2 minute walk test

44
Q

How can strength be assessed

A

Oxford scale - e.g. in plinth or sitting in chair
5 time sit to stand - functional mobility, strength

45
Q

How is ROM assessed in stroke

A

Assess range of movement and measure if increased tone on passive movements
Explore if movement reduced
Faster movements for spasticity

46
Q

How is the clock drawing test performed?

A

Ask to drawer clock face
Place numbers on clock
Draw hand to given time
Can be given pre-drawn circle
No one scoring test main aspects are
- correct spacing with even spaces between numbers
- correct placement of 3,6,9,12
- correct in between numbers
- placement of clock hands correct

47
Q

How is the functional reach test performed?

A
  • In standing stand close but not touching wall, and arm closer to wall at 90 degrees flexion. Record initial point of 3rd digit, measure difference between start and end.
  • Modified version for those that can’t stand
  • Yard stick taped to wall, and make final position.

stop if feet lift up from floor/fall

48
Q

What does the result of a functional reach test mean?

A

25cm/greater = low fall risk
15-25cm = 2x greater fall risk
15cm or less = risk of falling is 4x greater than normal
Unwilling to reach: risk of falling is 8x greater than normal

49
Q

How is the unipedal stance test performed?

A
  • Need stopwatch
  • Time how long can stand on one leg
  • One foot eyes open and closed
  • Time how long can maintain
  • Good test-retest reliability and interrater reliability found by Franchignoni et al 1998
50
Q

What are average times for ages open and eyes closed?

A
  • 20-49 28.8s open eyes, 20.7 closed
  • 50-59 24.2 open, 6.1 closed
  • 60-69 27.1 open, 2.0 closed
  • 70-79 18.2 open, 1.0 closed
51
Q

How is the 4 square step test performed?

A
  • May have demonstration and practice trial
  • Meant to perform twice
  • Patient steps over 4 canes that are placed in plus sign
  • Told to complete as quickly as possible
  • Square 1 facing square 2, square four to the right of the patient
  • Time from when foot touches square 2 and last foot reaches square 1
  • Go clockwise then anitclockwise
  • pt unable to side step can turn
  • Fail if lose balance or touch cane
52
Q

What are the cut off score for 4 step test?

A

> 15s or failure for stroke

53
Q

How is the Timed up and go performed?

A
  • Pt in chair with back on back of chair
  • Command go
  • Walk 3 meters at comfortable pace, turns and walks back to chair and sits down
  • Should have a practice trial
  • Can use assistive device
    For 65+
    Has excellent test-retest reliability in stroke according to Flasnbjer et al 2005)
54
Q

What are the cut-off scores for populations in the timed up and go test?

A

Community adults: >13.5s
Older stroke patients: >14s
Older adults at falls clinic: >15s
Frail elderly: >32.6s
LE amputees: >19s
PD: >11.5 /7.95
Hip OA: >10
Vestibular disorder: >11.1

55
Q

How is the 2 minute walk test performed

A
  • Walk as far as possible in 2 minutes
  • Can use walking aids
  • Should be independently mobile
    ~ 15m course
56
Q

What are predicted distances for populations in the 2-minute walk test?

A

Women 260 - (0.7 x age) - (1.7 x BMI)
Men 280 - (0.9 x age) - (1.426 x BMI)

57
Q

How is the 5-minute sit to stand test performed?

A
  • Pt in chair with arms folded across chest and back against chair (with stroke can have affected arm supported or hanging to side)
  • Chair should be free from wall
  • Say go and measure how long to do 5 stands
  • If concern for fatigue can demonstrate to patient what plan is
58
Q

What are the norms for the 5 sit to stand test?

A

Minimal detectable time for test is 3.6-4.2 s
60-69 normal 11.4 s
70-79 normal 12.6 s
80-89 normal 14.8 s

59
Q

What mobility exercises can be given to stroke patients?

A

ROM
- Shoulder flexion/ extension
- Knee flexion/ extension
- Ankle circles

Likely to have circumductory gait
- Step ups for hip flexion
- Marches for hip and knee flexion
- Calf raises / heel raises

60
Q

What are possible strength exersises for stroke?

A

Sit to stand from sitting - start with hands - remove hands / squats
Seated shoulder abduction with theraband / lat raise - heavier weight / more reps
Seated knee extension with theraband - progress to more / stronger band
Bicep curls
Marching
Toe taps with leg to side and holding chair

61
Q

What are possible aspects for self-management exercises for stroke?

A

Frunctional exercises e.g. sit to stands with reach
dressing practice
Gait training practice walking with or without aid
Recommendation of group exercises

62
Q

What education should stroke patients be provided?

A

Local resources e.g. voluntary organisations in the community.
Stroke centres that can help support.
Pacing activity
Performing exercise program
Progressively building up exercise
Remember aims of session
Goal - e.g. diary, can do weekly calls to check
Safety instructions

63
Q

What are key aspects for group exercises to remember?

A

Can do mobility and strengthening exs
Warm up stretches
Cool down stretches
Exercises
Recommend to do exs x times a day
Before start check patients well

64
Q

What are contraindicatiosn to exercise for stroke?

A
  • MI within 2 days and unstable angina
  • Uncontrolled cardiac arrhythmias
  • Symptomatic severe aortic stenosis
  • Uncontrolled symptomatic heart failure
  • Acute pulmonary embolus or pulmonary infaction

Long term conditions (11 decks)

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