Stroke And Rehabilitation Flashcards
Risk factors
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
Stroke syndromes
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
Symptoms
About onset Speech disturbance Other higher cortical dysfunction Limb weakness Sensory disturbances Visual impairment Brain stem symptoms NOT black outs or falls
TIA
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
Middle cerebral artery territory
Most commonly middle cerebral artery territory -> total or partial ant. Circulation
- hemiplegia/hemianaesthesia
- homonymous hemi-anopia
- cortical problem
Capsular warning TIA
Ischemia due to haemodynamic phenomena in diseased, single, small, penetrating vessel.
Leads to lacuna infarct
Posterior circulation TIA
True diplopia
Past pointing
Dysarthria
Transient global amnesia
Sudden onset disorientation
Speech intact
No other focal neurology
Resolves in minutes
FAST Tool
Facial weakness Arm weaknesss Speech problems Test all three Does not take pre existing disability in to account
Expressive dysphasia
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
Receptive dysphasia
Wernickes
Inability to understand language
Can not follow a 3 stage command
Dysarthria
Motor disturbance of speech
Weakness of tongue or facial muscles
Look for facial droop
Dysphagia
Swallowing abnormality
30-50% initially
Parietal lobe signs
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
Motor and sensory deficits
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
Homonymous hemianopia
Loss of one half of a visual field
Unaware of stimulus in that visual field
Can’t comment on visual neglect
Cerebellar signs
Dysarthria Nystagmus Intention tremor Past pointing Broad base staggering gait
Brain stem lesions
Cerebellar signs
Locked in syndrome
Cranial nerve lesions
Posterior circulation stroke-> crossed signs-> cranial nerve lesion on one side and contra lateral hemiparesis
Oxford stroke classification/ Bramford classification
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
Prognosis
TACS 60% 5% dead at one year, recurrence
PACS 15% 20%
LACS 10% 10%
POCS 20% 20%
Thrombolysis
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
Types of stroke
85% ischaemic
- embolic
- thrombotic
12% haemorrhagic
Management
Thrombolysis Anti platelets Cholesterol lowering VTE risk Nutrition and hydration Prevention and treatment of complications
What is a stroke
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
