Stroke and TIA Flashcards
Is stroke a common cause of disease in developed countries?
Second or third cause of death
Effect of disability due to stroke
Cost to nhs
Burden to family
Pt daily activity change - need to adapt to new pt disability
Stroke definition?
Is a sudden nest of focal neurological symptoms caused by ischamic
TIA?
Transient ischameic attack
Symptoms resolve in 24 hours
2 types of stroke?
Hemorrhagic
Ischemic
Hemorrhagic stroke?
Haemorrhage/ bleed leads to stroke
What part of the brain gives ipsilteral effects?
Cerebellum
Ischaemic stroke?
life-threatening condition that occurs when blood flow to the brain is blocked by a blood clot or plaque buildup
Is a stroke in th basal ganglia big or small effect?
Small - fibres close of ether compared to cortex
Symptoms and signs of stroke?
Motor (clumsy or weak limb)
Sensory (loss of feeling)
Speech (dysarthria/dysphasia
Neglect / visuospatial probems
Vision: loss in one eye, or hmianopia
Gaze palsy
Ataxia/vertigo/ in coordination/nystagmus
Are the symptoms of stroke positive or negative systems?
Negative symptoms
What side of the brain is affected when visiospatial/neglect problems occur?
Right sided hemisphere stroke
symptoms of visual loss is a sign of what stroke?
Posterior stroke
Symptoms of ataxia is a sign of what stroke?
Posterior stroke
Posterior circulation?
Vertebral arteries, basilar artery
- pons, midbrain, hindbrain and cerebellum
Sometimes occipital lobe
Symptoms of posterior stroke?
Ataxia
Vertigo in coordination
Loss of consciousness
Cardiopresiratory control
Nystagmus
What is the only stroke to have loss of consciousness?
Posterior
As basilar artery gives rose to posterior berebellar artery - to both sides, both sides of brain effected - major emergency
What can signs and symptoms tell you bout what type of stroke it is?
What side of the brain
Wat blood vessel
What blood vessel
Location
Type fo stroke
Stroke mimics?
Migraine
Epilepsy
Structural brain lesions
Metabolic/toxic disorders
- hypoglycaemia, thyroid issues
Vestibular disorders
Psychological dosders
Demylenation - MS
Mononeuropathy - brain not communicating to body, not sending the right messages about being able to move
Why do people have strokes?
Problems in large and small arteries
Clots that come from the heart
Rarer causes
Bleeding due to rupture of blood vessels - carotid stenosis
Carotid stenosis?
Occludes blood flow
Or makes oral blood flow - not laminar and make clots - causing a stroke
Plaque rupture and plaque and clotted blood travel in blood stream to brain
Can lodge in brain and cause focal neurological deficits
Cardioembolic stroke cause?
AF commonest cause
Clot to heart
What medication are pt with AF on?
Anticoagulants - warfarin/ apixiba/ riveroxiban
What is a cardioembolic stroke?
occurs when a blood clot or debris from the heart blocks blood flow to the brain
Lacunar stroke?
Small vessel stroke
Cause of lacunae stroke?
occurs when an artery to the deep part of the brain, containing structures like the thalamus or basal ganglia, is blocked. These arteries are very small and branch off directly from a larger artery, making them particularly vulnerable to blockages.
How to diagnose a lacunae stroke?
CT / MRI
Tx for lacunar stroke?
Intravenous thrombolysis
Thrombolysis?
A procedure that breaks up blood clots using medication or a mechanical device. This is usually performed if symptoms have been present for less than 4.5 hours
Non-modifiable risk factor for stoke?
Previous stroke
Old
Male
Family history
Most important modifiable risk factor for stroke?
Hypertension
Family history relating to stroke risk factor?
Hypertension
Diabetes
High cholesterol
Modifiable risk factors for stroke?
Smoking
Diabetes
Hypertension
Alcohol
Weight
Lipids and stroke?
Development of atheroma in blood vessel walls
Why do you need to act quickly in stroke?
Lose neurones, synapses and axons
FAST?
F : facial weakness
A : arm weakness
S : speech problems
T : time to call
What does FAST not take into consideration?
Loss of vision of vertigo
Immediate treatment for stroke?
Thrombolysis - if present within 4.5 hours
Thrombecomy
Early management or stroke?
Concentrates on:
Swallowing
Fluids and oxygen
Early therapy involvement
Good nursing care
Aspirin
When can you manage stroke with thrombolysis?
Pt present within 4.5 hours
Thrombectomy?
a minimally invasive surgical procedure that removes a blood clot from a blood vessel
When is thrombectomy used?
treat acute cerebral ischemic strokes, but can also be used to treat pulmonary embolism (PE) and acute myocardial infarction (MI)
Why is it important to have TIA pt in secondary care?
Likelyhood of TIA within 1 month is high
What can be done to prevent people with TIA going ont o aging a a stroke?
Anticoagulants - DOACs for AF
Antiplatelets - aspirin and clopidogrel
Antihypertensives - important as this is a major cause of stroke
Statins
Carotid endarterectomy
Medication for AF in relation to stroke?
DOACs and warfarin
Effect of stroke and dentistry?
Arm function
Swallow problems
DOACs
Polypharmacy - xerostomia
Not able to understand or comprehend - can’t prompt and do that
Effect of poor oral care and systemic health?
Infection
Atheroma plaques
- strokes
- lung condition
- heart disease
- diabetes
- cancer
- infection of oral procedures could affect surgeries shortly after e.g. hip replacement infection
- endocarditis
—> may be underlying and go to brain and cause stroke
