Stroke Flashcards
Whats the difference b/wn a stroke + a TIA
Stroke = >24hrs lasting neuro deficit TIA = no lasting neuro deficit >24hrs
Describe the epidemiology of strokes/TIAs in UK
How many stroke pts die within 1m
130k strokes in UK + 50k TIAs
20-30% pts die within 1m of stroke
List the RFs for a stroke (7 Cerebrovasc + 6 other)
HTN Hyperchol/lipidaemia DM BMI Dietary/excercise Smoking Alcohol
Age Male PMH: stroke/TIA or AF DH: illicit / warfarin FH stroke / TIA
What % of strokes are TACS/PACS/LACS/POCS
TACS = 20%; PACS = 35%; LACS = 20%; POCS = 25%
Describe the Dx criteria for a TACS
All 3 of:
- Unilateral weakness / sensory deficit (face/arms/legs)
- Homonymous hemianopia
- Higher dysfunc: dysarthria / visuospatial disorder
Describe the Dx criteria for a PACS
Two of:
- Unilateral weakness / sensory deficit
- Homoymous hemianopia
- Higher dysfunc: dysarthria / visuospatial disorder
Describe the Dx criteria for a LACS
One of:
- Unilateral weakness / sensory deficit
- Pure sensory stroke
- Ataxic hemiparesis
Describe the Dx criteria for a POCS
One of:
- Cerebellar/brain stem syndrome
- Loss of consciousness
- Isolated homonymous hemianopia
Outline the history in a stroke pt
What extra things must be asked about in a younger pt (5)
When/What/How
PMH/DH/FH/SH
Genetic Illicit drugs COC / Miscarriages (antiphospholipid) Trauma Migraines/Epilepsy
Outline the O/E in ?Stroke pt
General inspection GCS ABCDE Cardio Resp Neuro NIHSS - rapid stroke assessment tool
What things are looked for on CV / Resp /Neuro Ex in ?Stroke pt
CV - cause: HR/BP/Murmur (DVT/Dissection/AF/SBE)
Resp - complications: RR/Sats/Crackles (pneumonia, PE)
Neuro: UMN/LMN, Sensory / Speech / Cerebellar / CNs
What other Ix done in ?Stroke pt (8)
CT
MRI
Bloods: LFTs/TFTs/FBC/U+Es Glucose Lipids Coag Thrombophilia/vasculitis screen ESR
ECG
What things are looked for on the ECG of a stroke pt (4)
AF / Sinus / Ischaemia / LVH
List the DDx of a stroke (13)
Syncope
Seizures
Migraines
Cerebral abscess
Encephalitis
Brain tumour/SOL
Subdural haematoma
Peripheral neuropathy
Cervical spine pathology
Psych disorders
Transient global amnesia
Metabolic disorders
Hypoglycaemia
What are the indications for Thrombolysis (4) And contraindications (8)
YES Within 4.5hrs (clear onset) Clinical S+S Stroke Haemorrhage excluded No upper age limit
NO
Previous stroke 3m
Previous head injury 3m
H/o CNS damage
Seizure at onset
Rapidly improving Sx (suggesting TIA)
Severe h’age 21d
Major surg / obstetric 14d
What are the risks of thrombolysis (2)
5% → symptomatic ICH (haemorrhage)
1% → fatal ICH
What is dysphasia
What sided stroke does dysphasia occur in?
What are the 2 diff types of dysphasia + how are they different
Language impairment
Generally occurs in L sided (where Broca’s/Wernicke’s)
Expressive: understands but cannot give fluent response
Receptive: cannot understand but speaks fluently (errors)
Both types often occur together
How is dysphasia assessed (3)
How is dysphasia managed (2)
Ask name/address - do they understand you?
Follow command
Point at object
SALT
Communication ramps/aids
What is dysarthria?
How does it compare to aphasia ?
How is dysarthria managed?
Motor impairment - knows what wants to say bit can’t physically produce the words (facial/tongue mm)
Complete dysarthria sim - DDx to asphasia
Dysarthria however can comprehend/read+write
SALT**
How is dysphagia managed?
SALT
Physio
OT
Diet/thickeners to prevent aspiration
What are some signs of aspiration (6 Acute + 6 Chronic)
Choking/coughing Difficulty breathing Change in colour Raspy voice Gurgly phonation Raised HR
Refusal to eat Avoid certain foods Hunger Wt loss Resp problems XS oral secretions
List some parietal lobe signs (4)
Visuospatial disorders: Sensory neglect Agnosia Asterognosis Apraxia
What emotional changes can occur with a stroke? (5)
Grief features Dep/Anx Emotional lability Increased swearing Frustration
What are some of the causes for delayed onset stroke pain (7)
Central post-stroke pain
Other h’age/infarcts
Headache
Assoc conditions (IHD/OA/Gout/DVT/Dissection) Oedema
Back pain (bed bound) Constipation/retention
What is the incidence of central post-stroke pain?
What types of strokes/syndromes does it occur more frequently in?
Describe the aetiology
8% Lateral medullary syndrome Ventroposterothalamic nucleus strokes ST tract lesion Medial lemniscus lesions w. thalamic disinhibition
Dysfunc neuronal network
Degeneration of corticothalamic neurons (which activated GABA pathways)
What are the features of central post-stroke pain (4)
Central neuropathic disorder
Intermittent/persistent pain
Hyperaesthesia/allodynia
Sensory disturbance (pain/temp sensation)
Outline the treatment of central post-stroke pain (4)
All - start low go slow
Opiates: Morphine / Tramadol, PLUS:
Antidep: Amytriptyline
Anticonvuls: gabapentin, pregabalin, lamotrigine, carba
Deep nerve stimulation
What are some specific things a Physio may do in a stroke rehab pt (3)
What physio tests may they do to assess how well a pt’s doing? (4)
Assess posture/balance
+ advise MDT on approp position/transferring
Devise approp exercises specific for that pt
Advise family on appropriate exercises
Trunk control test
Berg balance
9 Peg Hole
Timed Up+Go
What aspects of rehabilitation do OTs work on (7)
Cognition/Perception: target specific deficits (e.g. neglect)
Daily living: Personal care / ADLs
Home environment
Splinting assessment
Wheelchair/seating assessment
Assess writing
Assess/advise on hobbies/driving
