stroke Flashcards
Stroke/CVA
brain attack
A stroke, also known as a cerebrovascular accident (CVA), is the rapid loss of brain function(s) due to disturbance in the blood supply to the brain. This can be due to ischemia (lack of blood flow) caused by blockage (thrombosis, arterial embolism), or a haemorrhage (leakage of blood).
Classification
Haemorrhagic stroke
Ischaemia stroke
Haemorrhagic stroke
bleeding from a cerebral artery
Subarachniod haemorrhage
bleeding into subarachnoid space
due to rupture of congenital anerysm or trauma
sudden intense headache, vomiting, neck stiffness and loss of consciousness
10% die within two hours
40% die within two weeks
Aneurysm
saccular
fusiform
ruptured
treated by surgical clipping
Intracerebral haemorhage
bleeding in deeper part of brain longstanding hypertension arterial wall weaken micro-aneurysm develop rupture and bleed sever headache and vomitting
Ischaemic stroke
80% strokes due to occulsion
atherom of cerecral artery
emboli from atheromatous plaque in hear/neck vessel
Most common vessel: MCA > PCA > ACA> brainstem (more serious)
Embolic stroke
completed stroke -tia-
sudden onset
blood clot that forms elsewhere in the body (embolus) breaks loose and travels to the brain via the bloodstream.
lodges in cerebral artery distruptiung the flow of blood
artrial fibrilation
Atrial fibrillation is irregular heartbeat,blood clots are more likely to form in your heart, increasing stroke risk
thrombotic stroke
completed stroke-tia- overnight develops over several days early full recovery 20% risk of full CVA with a month
Bamford classification
TACS – Total anterior circulation stroke
PACS – Partial anterior circulation stroke
POCS– Posterior circulation stroke
LACS – Lacunar stroke(deep penetrating arteries)
(TAC)S=stroke
(TAC)I=infarct
(TAC)H=haemorrhage
Tramatic brain injury
injury to the brain caused by external physical force,
altered state of consciousness
impairment of cognitive or physical abilities
disturbances of behaviour or emotional functioning
temporary or permanent
Mechanism of injury
Penetrating injury-risk of infection
Compression - inner cerebral traume
Deceleration- outer cerebral injury discrete cognitive deficit
Diffuse axonal injury– poor communication between brain structures, reduces processing speed, global impairment
Extradural haemorrhage
bleeding into extradural space
cause by severe trauma
subadural haemorrhage
bleeding in subdural space
usually cause by severe trauma
maybe be delayed symptons
headache drowsiness stupor- altered state of conciousness hemiparesis coma
Secondary damage of TBI
raised ICP (intercranial pressure) infection ischaemic changes vasospasm complication of systemic dysfunction
Transient ischaemic attack TIA
A TIA is a sign that part of the brain is not getting enough blood, and there is a risk of a more serious stroke in future
Hemiplegia
paralysis at one side of the body
Clinical features of stroke
MOTOR
Alterations in tone
Low tone - flaccidity
High tone – spasticity
Ataxia Weakness Asymmetry Loss of normal movement patterns,postural adjustments and balance Compensations
Pattern of spasticity
Flexor pattern in upper limb Shoulder elevation & retraction Internal rotation & adduction forearm pronation elbow worst and and finger flexion
Extensor pattern in lower limb Hip retraction Hip extension Knee extension Ankle plantarflexion & inversion
Clinical features of stroke
SENSORY
impaired cutaneous sensation
stereognosis
proprioceptive impairment
Visual field loss- Homonymous Hemianopia
Clinical features of stroke
SPEECH
Expressive dysphasia
Damage to Brocas area
Loose ability to produce speech
Receptive dysphasia
Damage to Wernikes area in temporal lobe
Lose ability to understand speech
global aphasia
Clinical features of stroke
COGNITIVE
Perceptual Problems
Astereognosis Visual Agnosia Auditory Agnosia Depth perception Apraxia Anosagnosia Inattention/neglect
Agnosia
Inability to recognise
Neglet
more common with left hemiplegia
patients fails to attend to stimuli from the one side
poor prognosis if persists
results in many functional problems
Clinical features of stroke
Disorders of emotion Delay / absent swallow reflex Incontinence Secondary musculoskeletal problems Gait problems Functional difficulties Social problems
Physiotherapy treatment
prevent complications,
minimise impairments and to maximise function
Assessment Identification of problems Clinical reasoning Goal setting Objective outcomes Choice of Rx method Interdisciplinary input
Factors affecting recovery
Extent and nature of lesion
Integrity of collateral circulation
Capacity of Nervous System to re-organise
Environment Pre-morbid status Age Co-exisiting conditions Nutrition/Hydration Medication
Motivation participation and Attitude of patient
Medical management
Treat as medical emergency MRI/CT scan Ischaemic stroke (80%)– aspirin, anticoagulants - thrombolysis SAH – surgery or endoplastic procedures SDH/EDH/ICH – treat hypertension TIA – aspirin, prevention work Other tests – Blood tests, angiography, echocardiology Other medication – osmotic agents Surgery – carotid endarterectomy
National Stroke startergy
Treat Stroke as a medical emergency
Effective assessment and treatment of vascular risk factors
TIAs assessed and scanned within 24hrs
Suspected stroke transferred to specialist stroke unit with MDT treatment and assessment
Range of services available locally to support long-term needs
Opportunity to return to work
lacunar stroke
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