Stroke Flashcards

0
Q

Stroke symptoms

A
  • limb and facial weakness/numbness
  • speech disturbance
  • visual loss
  • disturbance of balance
  • swallowing problem
  • neglect
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1
Q

Definition of stroke WHO

A

Sudden onset of acute focal neurological deficit probably due to pathological process in blood vessels

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2
Q

Epidemiology of stroke

A

Common - 110,000 per year in UK
At 30 days 17% will have died
50% died or disabled at 6 months
A quarter of stroke victims are under 65 yo

Cost NHS £7 billion per year

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3
Q

Ischameic stroke

A

85% of all strokes
Brain artery blocked by blood clot

  • embolic: clot formed outside the brain and lodges in part of the brain (atherosclerosis)
  • thrombotic: formation of blood clot in BRAIN artery
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4
Q

Haemorrhagic stroke

A

15% of strokes
Brain artery bursts causing bleeding

  • intracerebral: blood enters into substance of brain
  • subarachnoid: blood enters various spaces surrounding brain
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5
Q

CT scan densities and colours

A

White: high density (bone, clotted blood)
Grey: normal brain tissue
Black: low density (water or CSF)

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6
Q

CT scan in ischaemic stroke

A

Oedema develops in area of tissue with the reduced blood flow.
Therefore will have area of relatively low density (blacky grey)

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7
Q

CT scan in haemorrhagic stroke

A

High arterial pressure blood ruptures into brain substance (brain paranchyma)
Area of clotted blood will show up white on CT

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8
Q

Risk factors for ischaemic stroke

A
  • high blood pressure
  • hi cholesterol
  • left ventricular hypertrophy
  • peripheral pulses
  • carotid bruit

SMOKER, OBESITY, STRESS

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9
Q

Transient ischaemic attack TIA

A

Mini stroke

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10
Q

ROSIER form

A

Recognition Of Stroke In Emergency Room
Clinical assessment form that nurses can do quickly to ring dr up with results
Admit if result between 1 and 6

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11
Q

Acute management of stroke - BRAINATTACK

A
Blood pressure
Respiration: keep O2 sat above 95%
Airway management
Iv saline
Normoglycaemia
Aspirin: if haemorrhage excluded
Temperature: keep <37 degrees
TEDS compression stockings (avoid DVT)
Assess water swallow test
CT as soon as possible
Keep 30 degree head tilt
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12
Q

Thrombolysis

A

Unblocking of arteries using a tissue plasminogen activator like ateplase.
Fibrinalysis

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13
Q

Who is eligible for thrombolysis

A

Acute onset stroke with haemorrhage excluded on scan
Within 6 hours, preferably 3
In unit with properly trained staff
Access to imaging

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14
Q

Complications of thrombolysis

A

2 in 3 will not be OK. Breaking clot thins blood, increasing risk of intracranial (4 in 100) and extracranial (GU, GI) bleeding
Angio oedema: immune mediated swelling of tongue leading to resp failure
Or simply no clinical improvement

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15
Q

Swallowing problems after stroke

A

Modify diet and assess swallowing by speech and lang therapist
Videofluroscopy (xray) and fibre optic endoscopic evaluation of swallowing

16
Q

Surgery for haemorrhagic stroke

A

Aspirate some blood out

If ICP is very high then take bone flap out to relieve prssure and prevent coning of brain

17
Q

Silent symptoms after suffering a stroke

A

Cognitive impairment, fatigue, depression, anxiety

18
Q

Cartiac endartectomy as preventative measure

A

If over 50% stenosis on carotid artery then send for this.
Cut exposing carotid artery, bypass blood using a bypass to remove any clot before it gets to the brain.
Prevents 1 stroke per 6 ppl every 5 yrs

19
Q

Rehabilitation from stroke

A

Recovery can take 3-12 months
Relearn skills that have forgotten and learn new skills
Learn ways to manage any permanent disabilities
Posture, balance, movement, speech, emotional and mental difficulties

20
Q

Stages of rehab

A

Assessment to determine patients disability extent
Goal planning: patient centred- accommodation, support and social role of patient
Intervention: reduce risk of further attack
Neurological evaluation

21
Q

ADL assessment

A

Daily self care assessment. For health professionals
Use to measure functional status of the patient
Basic
Instrumental

22
Q

Basic ADL

A
DEATH
Dressing
Eating
Ambulating
Toilet
Hygiene
23
Q

Instrumental ADLs

A
SHAFT
Shopping
Housework
Accounting
Food prep
Telephone n transport
24
Q

When must DVLA be notified after stroke?

A

If motor and neuro deficits still felt 1 month after stroke
Brain surgery required
More than 1 stroke in 3 months
Drs concerned about ability to drive
Possession of large goods vehicle or passenger carrying vehicle

LEADS TO GROUP 2 ENTITLEMENT

25
Q

Group 1 entitlement

A

TIA- no need to notify dvla but dont drive for a month

Stroke- dont drive for a month. May resume if clinical recovery satisfactory. No need to notice unless (previous slide)

26
Q

Group 2 entitlement

A

Licence revoked for a year after TIA or stroke. Can be considered after this time if no residual impairment has occurred.
Subject to satisfactory medical reports like ecg test
No need for cardiac assessment if <50% aortic stenosis and no previous CVD