Stroke Flashcards
stroke, TIA or amaurosis fugax
Stroke - Neurological deficit of cerebrovascular cause that persists beyond 24 hours or is interrupted by death within 24 hours
TIA -Neurological deficit of cerebrovascular cause that persists less than 24 hours
Amaurosis Fugax - Painless temporary loss of vision – curtain descending over vision
definition of stroke
vascular
rapid onset
focal/global cerebral dysfunction
>24h or death
(TIA
importance of stroke
3rd leading causw of death 130,000 affected each year (1 every 5 minutes)
single biggest cause of sever adult disability
2.8 billion to NHS and 7 billion everall
neurology terms
dysarthria = speech issue due to muscle weakness
dysphagia = abnormal swallowing; 30-50% of strokes; asp pn. risk
dysphasia = language issue; receptive and/or expressive; can affect reading and writing
hemianopia - loss one haf of visual fields
expressive aphasia
receptive aphasia
apraxia - motor task difficulty
asterognosis - inability to identify objects by touch alone
agnosia - inability to recognise objects
innattention (neglect) - inability to attend to stimuli bilaterally despite intact sensation
stroke features
sudden onset
no seizure activity, syncope, or LoC
no secondary cause e.g. infection
motor/sensory: paresis/plegia
visual: homonymous hemianopia
language: dysphasia
parietal function: agnosia, asterognosia, neglect, dyspraxia
brainstem: CN palsy, ataxia, locked-in, ‘DANISH’ (cerebellar)
coortdination/balance/dizziness
crossed signs : ipsilateral CN, contralateral hemiparesis
Dysdiadokinesis Ataxia Nystagmas Intention Tremor Slurred Speach Hypotonia
stroke assessment
FAST
history:
onset: gradual/sudden, exact time (/last normal)
what: body parts, vision; progression; define deficits
PMH: bleeding RF, clotting RF; falls, trauma, injury, AF
FH: clotting and strokes
DH: anticoags, COCP
SH: premorbid function and independence; support; substances; driving
examination:
General observation
GCS + ABCDE
CVS: RFs, Murmurs, BP, HR, HF, DVT, dissection
resp: complicaitons (DVT, PE, pneumonia)
neuro: locate lesion, confirm, umn or lmn
Ix
CT head for bleed
ECG - AF? MI?
Bloods (FBC, UE, LFTS, ESR, Glc, Lipids, platelets)
Dx
NIHSS: severity, ?location, ?thrombosis (NIH stroke scale/score) 0 = no stroke and 42 = most severe stroke
Rosier scale: ?admission; - assess between stroke and stroke mimics
stroke management
ABCDE
- Hx and exam (NIHSS-stroke severity score)-BAMFORD classification
- Within 4.5hrs-thrombolysis? (suspected I stroke and ruled out haemorhage with CT head)
- Thrombectomy within within 6-24 hrs depending where clot is (confirm with CTangiography or MRangiography
- 300mg aspiri within 24hrs for 2/52 then clop 75mg
Direct admission to stroke unit O2 Glucose level maintenance Hydration and nutrition (swallow assessment) Antiplatelets (if NOT a bleed) Statins Antihypertensives Assess/investigate risks (Echo, CDs) VTE prophylaxis Positioning Early MDT assessment
hemicraniotomy?: ICP, malignant MCA syndrome
OT application
splinting: ROM(range of movement) preservation and contracture prevention
home assessment
functional assessment: ADLs
cognition and perception: visspat, neglect/agnosia, dyspraxia, memory/attn, planning, problem solving
anxiety and depression
promote independence provide equipment seating/positioning driving/leisure advice referrals
PT application
optimise movement
sensorimotor stimulation (neural drive)
bone and muscle: alignment, activation, strength
reduced compensation and ineffective coping, and pain
-bobath concept and assisting neuroplasticity
NM perception, integration and response to environment
CNS coordination
normal movement: tone, posture, reciprocal innervation, sensory feedback (proprioception)
assessment and advice for MDT: positioning, transfer, exercise provide equipment weekly groups nursing asistants review, update, refer advise family/carers: continue recovery
stroke DDx
AKA stroke mimics (BEHIND_
- Brain tumour, haemorrhage, contusion
- Epilepsy (post ictal state)
- Hypoglycaemia/Hyponatraemia
- Intoxication/Infection
- Neuro: Peripheral/Migraine/MS/Myasthesia gravis/GBS/Mnd/ spinal cord lesions
- Dissection/Disc prolapse
Syncope
Electrolyte abnormalities
Functional disorders
Cerebral vasculitis
TIA stats
35 per 100,000; - 1/3 go on to have a stroke . . .most in the first 24hrs
classification (Oxford Bamford)
20% TACS = all of;
- Higher Dysfunction
- Dysphasia
- Decreased level of consciousness
- Visuspatial Neglect
- Asterognosis or Apraxia
- Dysphasia
2.Homonimous Hemianopia
- Motor/Sensory Deficit
- > 2/3 of face/arm/leg
35% PACS = higher dysfunction alone or 2/3 of the TAC domains
20%LACS = any one of;
- Pure Motor ( >2/3 of face/arm/leg)
- Pure Sensory ( >2/3 of face/arm/leg)
- Sensorymotor( >2/3 of face/arm/leg)
- Ataxic Hemiparesis
25% POCS = any one of;
- Cranial Nerve Palsy AND Contralateral Motor/Sensory deficit
- Bilateral Motor OR Sensory Deficit
- Conjugate Eye Movement problems
- Cerebellar Dysfunction
- Isolated Homonymous Hemianopia
stroke prognosis
TACS at 1 year: 60% dead, 35% dependent, 5% independent, 5% recurrence
PACS: 15% dead, 30% dependent, 55% independent, 20% recurrence
LACS (best): 10% dead, 30% dependent, 60% independent, 10% recurrence
POCS: 20% dead, 30% dependent, 50% independent, 20% recurrence
stroke RF
ABCD2: age, BP, clinical, duration, DM; 2&7 day risk - NOT IN UK
CHA2DS2VASC: CHF, HTN, age (75), DM, stroke/sim, vasc disease, age (65-74), sex (F) - risk of stroke if AF
risk factors:
HTN (3-4x), DM (2-4x), AF, IHD (2-4x), CCF (2-4x), IE
smoking (1.5-3x), alcohol (4x) cholesterol, pro-thrombo, IVDU
age, male, PMH, FHx
age risk doubles every decade >55y
stroke complications
DVT/PE aspiration/hydrostatic pneumonia pressure sores depression seizure incontinence post-stroke pain (common): opiates, amitriptyline, gabapentin, pregabalin, DBS
