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Y4 OPIC > Stroke > Flashcards

Stroke Flashcards

1
Q

What type of stroke would you experience staccato speech in?

A

Posterior stroke- cerebellar
Dysarthria

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2
Q

What are stroke mimics?

A
  • Seizure- Todd’s paralysis
  • Hypoglycemia
  • TIA
  • SOL
  • Migraines
  • Bell’s palsy
  • Ramsay hunt syndrome
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3
Q

Radiological assessments for stroke

A

OCSP
NIHSS

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4
Q

Targeted assessment tools for stroke

A

ECG
24 hour tape
Echo
Carotid US
Thrombophilia screen
Angiography

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5
Q

What are the complications of stroke

A

Immediate
- Hydrocephalus
- Cerebral oedema- can lead to brain herniation
- Malignant MCA syndrome

Later
- Paralysis
- Hearing loss

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6
Q

What is target blood pressure after a stroke?

A

130/80

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7
Q

When does infarction of brain tissue happen after ischaemia?

A

2-6 hours

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8
Q

When should thrombolysis be done?

A

Thrombolysis (using tPA) should ideally be administered within 4.5 hours from symptom onset to improve outcomes.

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9
Q

When should mechanical thrombectomy be done?

A

Mechanical thrombectomy can be effective up to 6 hours and even longer in certain cases with salvageable brain tissue.

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10
Q

Example of emotional support services for people who have had strokes

A

Stroke association offers a 1 to 1 counselling service
After that there are peer support groups, local community groups

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11
Q

What is ischaemic pneunumbra and how is it relevant to recurrence of stroke?

A

Yes, exactly! The ischaemic penumbra is the area around the core of the stroke that is at risk. If the blood supply isn’t restored to this area in time, the tissue in the penumbra starts to die, causing the stroke to expand. Essentially, the stroke “spreads” from the core to the surrounding areas, making the damage larger and more severe. This is why prompt revascularisation therapy (like thrombolysis or thrombectomy) is crucial in the acute phase to salvage the penumbra and prevent further brain tissue death.

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12
Q

What is the stroke bundle?

A

Admission to the stroke unit
* Revascularisation therapy
* Optimising physiology (via surveillance, prevention and early intervention
of complications) and nutritional support
* Secondary prevention
30
* Rehabilitation and reablement

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13
Q

What are the chief considerations for rehab in stroke patients?

A

Chief considerations will include return to instrumental activities e.g. driving, resumption of
leisure activities and return to employment or education.

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14
Q

How long does a CT head scan typically take?

A

5–10 minutes for the scan itself, though total process time (including setup) may take 15–30 minutes.

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15
Q

When should an MRI be performed after a CT head in stroke patients?

A
  • When clinical symptoms suggest posterior circulation stroke.
  • If CT is negative but symptoms persist.
  • To assess brainstem or cerebellar infarcts (e.g., lateral medullary syndrome).
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16
Q

What does the NIHSS score measure, and what is the scoring range?

A

Measures stroke-related neurological deficits. Scoring range: 0-42, with higher scores indicating more severe deficits.

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17
Q

What is the Modified Rankin Scale (MRS) used for?

A

Measures disability or dependence in daily activities after stroke. Range:
0 = no symptoms,
6 = death.

18
Q

What does the Barthel Index assess in stroke rehabilitation?

A

Functional independence in daily living activities such as mobility, feeding, bathing, and dressing. Scoring range: 0–100.

19
Q

What is the ABCD² score used for, and what factors does it assess?

A

Predicts the risk of stroke after a TIA. Factors include:

A: Age ≥60 years (1 point).
B: Blood pressure ≥140/90 mmHg (1 point).
C: Clinical features (unilateral weakness: 2 points; speech disturbance: 1 point).
D: Duration (≥60 minutes: 2 points; <60 minutes: 1 point).
D²: Diabetes (1 point).

20
Q

Why is trigeminal neuralgia considered a stroke mimic?

A

It can cause sudden, severe, and focal facial pain, which may be mistaken for a stroke symptom.

21
Q

What is lateral medullary syndrome, and why is it significant in stroke care?

A

A type of posterior circulation stroke affecting the medulla, often associated with dysphagia and seen on coronal FLAIR MRI. Difficulty swallowing should prompt consideration.

22
Q

What are the top three goals of stroke rehabilitation?

A
  • Restore function (e.g., mobility, speech).
  • Prevent complications (e.g., aspiration pneumonia, contractures).
  • Reintegration into home/community settings.
23
Q

What assessments should be performed after a stroke?

A
  • Swallowing test: Evaluate risk of aspiration.
  • Mobility assessment: Check for gait stability and motor recovery.
  • Continence assessment: Assess bladder and bowel control.
  • Communication and cognitive assessment: Screen for aphasia and memory issues.
  • Nutritional status and hydration:
  • Check for malnutrition or dehydration.
24
Q

How is care continued when patients go home after a stroke?

A
  • Community teams: On-call stroke teams, community stroke rehabilitation (CSTR) packages.
  • Referrals: Physiotherapy, occupational therapy (OT), speech therapy.
  • Social services: Home adaptations, carer support, AgeUK or day centers.
25
Q

What does an OT assess for stroke patients?

A

Functional independence (e.g., dressing, cooking).
Ability to drive post-stroke.
Home safety and adaptations.

26
Q

How soon should a stroke patient have a TIA clinic referral?

A

Within 24 hours for high-risk patients or 7 days for low-risk.

27
Q

What is the initial treatment after a TIA?

A
  • Aspirin 300 mg daily and clopidogrel for 3 weeks.
  • Then switch to clopidogrel 75 mg daily long-term.
28
Q

When can a patient drive again after a stroke or TIA?

A
  • Standard license: 4 weeks if no residual deficits.
  • HGV: 12 months, with evidence of no residual impairments.
29
Q

When is thrombectomy indicated in stroke management?

A

MRS < 2 (independent before stroke).
NIHSS > 6.
Large vessel occlusion (e.g., MCA) confirmed.
Within 24 hours of symptom onset.

30
Q

What is the life expectancy after a diagnosis of Alzheimer’s disease?

A

On average, approximately 3 years.

31
Q

What medication is commonly used for Alzheimer’s disease, and what does it do?

A

A: Donepezil, a cholinesterase inhibitor that slows cognitive decline.

32
Q

Mnemonic for stroke mimics

A

Brain: mass, haemorrhage and confusion
Epilepsy and post ictal stroke
Hyponatremia and hypoglycaemia
Intoxication and infection
Neuro: migraine and multiple sclerosis
Dissection, disc prolapse

33
Q

Why does a stroke syndrome event focal and sudden?

A

Only the neurovascular units in the concerned vascular territory are affected.

34
Q

What are migrating symptoms and sequential evolution more common in?

A

Stroke mimics

Migrating symptoms- symptoms that spread slowly, like tingling sensation in the arm.

Sequential evolution- symptoms that appear one after the other

Migranous aura= gradual onset of visual disturbances

Focal seizures= jerking movements or a sensation moving across the body

35
Q

What is stereotyping?

A

Repeated episodes of identical symptoms with full recovery in between.
Flashing lights- on the same hand every few weeks.

Strongly suggestive of stroke mimics:
- Migrainous aura
- Focal seizures
- Functional neurological episodes

36
Q

What are stroke like patterns instead of mimics

A

Capsular warning syndrome- small strokes are occurring repeatedly

Intracranial stenosis- blood flow to the brain is compromised but may not yet result in permanent damage.

37
Q

What is a cryptogenic stroke and how is it diagnosed?

A

Where the underlying cause cannot be identified despite thorough testing.

Once you rule out:
- Atrial fibrillation
- Large artery disease
- Small vessel disease
- Other rare causes- blood clotting disorders, vasculitis or arterial dissection

38
Q

Why should you ask about a patient’s dominant hand?

A

Dominant hand determines dominant hemisphere of the brain
Speech centre is in dominant hemisphere of the brain
(right hand means left hemisphere is dominant)
If you have a left sided stroke- speech will be impaired

39
Q

What to ask when examining a stroke patient?

A

Is your arm or leg weaker?

40
Q
A

Y4 OPIC (15 decks)

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