Stroke And Rehabilitation

Question 1

Risk factors

Answer 1

AF x17
Hypertension x3-4
Alcohol x4
Migraine x2.16
IHD x2-4
CCF x2-4
Diabetes x2-4
Smoking x1.5-2.9
Hyperlidpidaemia

Question 2

Stroke syndromes

Answer 2

Mimic stroke presentation 
Epilepsy -> todds paresis 
Hypoglycaemia 
Brain tumours -> invidious onset
Migraine-> rapidly improving transient weakness
Encephalitis -> infection 
Cerebral access->infection features 
Subdural haematoma -> gradual onset, trauma

Question 3

Symptoms

Answer 3

About onset
Speech disturbance
Other higher cortical dysfunction 
Limb weakness
Sensory disturbances
Visual impairment
Brain stem symptoms 
NOT black outs or falls

Question 4

TIA

Answer 4

Transient ischaemic attack
Acute loss of focal cerebral or ocular function with symptoms lasting less than 24 h
Higher risk of stroke within 4 weeks

Question 5

Middle cerebral artery territory

Answer 5

Most commonly middle cerebral artery territory -> total or partial ant. Circulation

• hemiplegia/hemianaesthesia
• homonymous hemi-anopia
• cortical problem

Question 6

Capsular warning TIA

Answer 6

Ischemia due to haemodynamic phenomena in diseased, single, small, penetrating vessel.
Leads to lacuna infarct

Question 7

Posterior circulation TIA

Answer 7

True diplopia
Past pointing
Dysarthria

Question 8

Transient global amnesia

Answer 8

Sudden onset disorientation
Speech intact
No other focal neurology
Resolves in minutes

Question 9

FAST Tool

Answer 9

Facial weakness 
Arm weaknesss
Speech problems
Test all three 
Does not take pre existing disability in to account

Question 10

Expressive dysphasia

Answer 10

Can understand but not answer 
Can the patient understand you? 
-name objects
Recognise speech does not make sense
Three stage command
Use of neologisms-> similar sounding words

Question 11

Receptive dysphasia

Answer 11

Wernickes
Inability to understand language
Can not follow a 3 stage command

Question 12

Dysarthria

Answer 12

Motor disturbance of speech
Weakness of tongue or facial muscles
Look for facial droop

Question 13

Dysphagia

Answer 13

Swallowing abnormality

30-50% initially

Question 14

Parietal lobe signs

Answer 14

Sensory neglect-> can feel both signs but not when tested bilaterally
Visual neglect
Agnosia-> inability to remember familiar objects -> can’t identify coins
Asterognosis-> inability to recognise numbers drawn on hand
Dyspraxia-> inability to perform tasks, problem with information processing

Question 15

Motor and sensory deficits

Answer 15

Hemiparesis-> weakness down one side of body, upper motor neurone nature
Grade using MRC scale
-> power assesment
Hemisensory loss -> loss of light tough sensation down one side

Question 16

Homonymous hemianopia

Answer 16

Loss of one half of a visual field
Unaware of stimulus in that visual field
Can’t comment on visual neglect

Question 17

Cerebellar signs

Answer 17

Dysarthria 
Nystagmus
Intention tremor
Past pointing 
Broad base staggering gait

Question 18

Brain stem lesions

Answer 18

Cerebellar signs
Locked in syndrome
Cranial nerve lesions
Posterior circulation stroke-> crossed signs-> cranial nerve lesion on one side and contra lateral hemiparesis

Question 19

Oxford stroke classification/ Bramford classification

Answer 19

Lacunar-> motor or sensory deficit only
Partial anterior circulation -> motor or sensory deficit, higher cortical dysfunction, hemianopia (2/3)
Total anterior circulation-> all of the above
Posterior circulation-> isolated hemianopia, brain stem signs, Cerebellar ataxia

Question 20

Prognosis

Answer 20

TACS 60% 5% dead at one year, recurrence
PACS 15% 20%
LACS 10% 10%
POCS 20% 20%

Question 21

Thrombolysis

Answer 21

4.5 hour limit (6h in young people) anterior strokes 
1/30 harmed by thromboloysis
1/3 significant improvement 
Posterior strokes 12h 
Tissue plasminogen activator

Question 22

Types of stroke

Answer 22

85% ischaemic
- embolic
- thrombotic
12% haemorrhagic

Question 23

Management

Answer 23

Thrombolysis
Anti platelets
Cholesterol lowering
VTE risk
Nutrition and hydration
Prevention and treatment of complications

Question 24

What is a stroke

Answer 24

A clinical syndrome of presumed vascular origin
Typified by rapidly developing signs of focal or global disturbance disturbance of cerebral functions
Lasting more than 24 hours