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HCoLL > Stroke > Flashcards

Stroke Flashcards

1
Q

Whats the difference b/wn a stroke + a TIA

A 
Stroke = >24hrs lasting neuro deficit
TIA = no lasting neuro deficit >24hrs
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2
Q

Describe the epidemiology of strokes/TIAs in UK

How many stroke pts die within 1m

A

130k strokes in UK + 50k TIAs

20-30% pts die within 1m of stroke

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3
Q

List the RFs for a stroke (7 Cerebrovasc + 6 other)

A 
HTN
Hyperchol/lipidaemia
DM
BMI
Dietary/excercise
Smoking
Alcohol
Age
Male
PMH: stroke/TIA or AF
DH: illicit / warfarin
FH stroke / TIA
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4
Q

What % of strokes are TACS/PACS/LACS/POCS

A

TACS = 20%; PACS = 35%; LACS = 20%; POCS = 25%

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5
Q

Describe the Dx criteria for a TACS

A

All 3 of:

  1. Unilateral weakness / sensory deficit (face/arms/legs)
  2. Homonymous hemianopia
  3. Higher dysfunc: dysarthria / visuospatial disorder
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6
Q

Describe the Dx criteria for a PACS

A

Two of:

  1. Unilateral weakness / sensory deficit
  2. Homoymous hemianopia
  3. Higher dysfunc: dysarthria / visuospatial disorder
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7
Q

Describe the Dx criteria for a LACS

A

One of:

  1. Unilateral weakness / sensory deficit
  2. Pure sensory stroke
  3. Ataxic hemiparesis
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8
Q

Describe the Dx criteria for a POCS

A

One of:

  1. Cerebellar/brain stem syndrome
  2. Loss of consciousness
  3. Isolated homonymous hemianopia
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9
Q

Outline the history in a stroke pt

What extra things must be asked about in a younger pt (5)

A

When/What/How
PMH/DH/FH/SH

Genetic
Illicit drugs
COC / Miscarriages (antiphospholipid)
Trauma
Migraines/Epilepsy
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10
Q

Outline the O/E in ?Stroke pt

A 
General inspection
GCS
ABCDE
Cardio
Resp 
Neuro
NIHSS - rapid stroke assessment tool
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11
Q

What things are looked for on CV / Resp /Neuro Ex in ?Stroke pt

A

CV - cause: HR/BP/Murmur (DVT/Dissection/AF/SBE)

Resp - complications: RR/Sats/Crackles (pneumonia, PE)

Neuro: UMN/LMN, Sensory / Speech / Cerebellar / CNs

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12
Q

What other Ix done in ?Stroke pt (8)

A

CT
MRI

Bloods:
LFTs/TFTs/FBC/U+Es
Glucose
Lipids
Coag
Thrombophilia/vasculitis screen
ESR

ECG

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13
Q

What things are looked for on the ECG of a stroke pt (4)

A

AF / Sinus / Ischaemia / LVH

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14
Q

List the DDx of a stroke (13)

A

Syncope
Seizures
Migraines

Cerebral abscess
Encephalitis
Brain tumour/SOL
Subdural haematoma

Peripheral neuropathy
Cervical spine pathology

Psych disorders
Transient global amnesia

Metabolic disorders
Hypoglycaemia

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15
Q 
What are the indications for Thrombolysis (4)
And contraindications (8)
A 
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

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16
Q

What are the risks of thrombolysis (2)

A

5% → symptomatic ICH (haemorrhage)

1% → fatal ICH

17
Q

What is dysphasia
What sided stroke does dysphasia occur in?
What are the 2 diff types of dysphasia + how are they different

A

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

18
Q

How is dysphasia assessed (3)

How is dysphasia managed (2)

A

Ask name/address - do they understand you?
Follow command
Point at object

SALT
Communication ramps/aids

19
Q

What is dysarthria?
How does it compare to aphasia ?
How is dysarthria managed?

A

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**

20
Q

How is dysphagia managed?

A

SALT
Physio
OT
Diet/thickeners to prevent aspiration

21
Q

What are some signs of aspiration (6 Acute + 6 Chronic)

A 
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
22
Q

List some parietal lobe signs (4)

A 
Visuospatial disorders:
Sensory neglect
Agnosia
Asterognosis
Apraxia
23
Q

What emotional changes can occur with a stroke? (5)

A 
Grief features
Dep/Anx
Emotional lability
Increased swearing
Frustration
24
Q

What are some of the causes for delayed onset stroke pain (7)

A

Central post-stroke pain
Other h’age/infarcts
Headache

Assoc conditions (IHD/OA/Gout/DVT/Dissection)
Oedema
Back pain (bed bound)
Constipation/retention
25
Q

What is the incidence of central post-stroke pain?

What types of strokes/syndromes does it occur more frequently in?

Describe the aetiology

A 
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)

26
Q

What are the features of central post-stroke pain (4)

A

Central neuropathic disorder
Intermittent/persistent pain
Hyperaesthesia/allodynia
Sensory disturbance (pain/temp sensation)

27
Q

Outline the treatment of central post-stroke pain (4)

A

All - start low go slow

Opiates: Morphine / Tramadol, PLUS:
Antidep: Amytriptyline
Anticonvuls: gabapentin, pregabalin, lamotrigine, carba
Deep nerve stimulation

28
Q

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)

A

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

29
Q

What aspects of rehabilitation do OTs work on (7)

A

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

HCoLL (8 decks)

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