stroke

Question 1

81 y.o. woman found collapsed on bedroom floor by sheltered housing warden the day after a trip to her bingo

CT scan of brain reveals an area of ischaemia in the left parietal cortex, consistent w cerebral infarct

she is badly bruised and has an obvious weakness on the right side of her body

she is confused and her speech sounds slurred

(a) what is the definition of a stroke?

Answer 1

injury to the brain of a vascular cause that causes a focal (sometimes global) neurological deficit lasting >24 h or interrupted by death < 24 h

Question 2

(b) suggest 4 risk factors for stroke?

Answer 2

1. HTN
2. hyperlipidaemia
3. AF
4. smoking
5. IHD
6. previous stroke / TIA

Question 3

(c) the CT scan of the brain showed an area of ischaemia.

Explain the pathogenesis of this causing her stroke.

Answer 3

over the years pt has developed atherosclerosis (build up of fatty deposits around the lumen of arteries). this is due to age and other risk factors e.g. smoking.

atherosclerotic plaque from an artery (e.g. internal carotid artery) has ruptured → thrombus forms → breaks off to embolise in an artery in the left parietal cortex → blocks blood supply to that region → hypoxia + focal signs

Question 4

(d) given this lady’s sx, which is the most likely artery to have been affected by this stroke?

Answer 4

left MCA

Question 5

(e) list 4 significant non-neurological complications of stroke.

Answer 5

1. aspiration pneumonia
2. depression and anxiety
3. bed sores
4. DVT / PE

• falls leading to #
• dehydration
• contracture
• constipation

Question 6

(f) this pt shows slow improvement over the next 3 months.

outline 2 mx options that the OT would be able to help with in cases like these.

Answer 6

assessing moving and handling risk at home and providing adaptations

1. installation of railing into bathroom for toilets and bathtub
2. installation of chairlift for stairs