stroke part 2 Flashcards
what is anterior circulation stroke
Anterior cerebral artery:
• may be asymptomatic
• if hemiparesis, the leg is affected more
• aphasia may occur with expressive difficulties or mutism
Middle cerebral artery:
• hemiparesis: face and arm often more affected
• hemianopia: optic radiation passes through MCA territory
• aphasia: expressive and/or receptive (dominant hemisphere)
• apraxia: present with infarction in either hemisphere
what is posterior circulation stroke
Brainstem and cerebellar involvement: • vertigo • diplopia • nausea and vomiting • unsteadiness and ataxia • deafness • dysarthria • hemiparesis—but will spare face if below pons • hemisensory loss • loss of consciousness • bilateral or crossed weakness/sensory disturbance
Posterior cerebral artery involvement: • hemianopia
• cortical blindness (owing to basilar occlusion and disruption of both
posterior cerebral arteries)
• confusion/amnesia (owing to branches supplying posterior
thalamus)
summary history of stroke
Stroke is almost always sudden in onset • Determine the time of onset • The time course of symptoms is essential. First, make the diagnosis: • Is it a stroke? • Could it be a mimic? • What vascular territory is affected? Second, look for a cause, e.g.: • Heart disease • Drug use. Third, look for the risk factors: • Hypertension • Diabetes • Smoking • Heart disease • Cholesterol • Age • Family history
examination of a stroke patient
Airway, breathing and circulation (ABC).
Vital signs including blood pressure, heart rate, oxygen saturation, and temperature.
The cardiovascular system — look for signs of heart failure, arrhythmias (such as atrial fibrillation), murmurs, valvular heart disease, endocarditis.
The neurological system — look for clinical signs of stroke or TIA such as unilateral weakness, visual or speech disturbance, ataxia, and nystagmus.
The Face Arm Speech Test (FAST test) can be used for rapid assessment — it is positive if one or more of new facial weakness (asymmetry such as the mouth or eye drooping), arm weakness, or speech difficulty (such as slurring or difficulty in finding names for commonplace objects) are present.
Carry out fundoscopy to identify intraocular haemorrhage (present in one in seven people with aneurysmal SAH).
in an acute setting v non acute setting how would u assess the degree of neurological impairment and disability
NIH stroke scale
Modified Ranking and the Barthel scales
components of a neurological examination
- Inspection
- Conscious level
- Speech and language
- Higher mental function
- Cranial nerves
- Peripheral nervous system • General examination.
what do u do in inspection of stroke
Is the patient alert or drowsy?
• Is the patient having absences?
• Is the speech abnormal?
• Is the head normal size and shape? Is there evidence of head injury?
• Is there pallor or cyanosis?
• It there abnormal facial asymmetry?
• Is there eye deviation to one side or a squint?
• Are the limbs normal length? A fractured limb may be apparent from
observation
• Are all limbs moving or is there a particular pattern of lack of movement
(e.g. hemiplegia/paraplegia/tetraplegia)?
• Is there resting tremor or jerking of any limbs?
what is dysarthria
slurred speech
commonest cause is weakness of the face and facial palsy
bulbar related - air escape through the nose
UMN, pseudobulbar, spastic dysarthria - speaking with a boiled sweet in their mouth
cerbellar dysarthria - ‘monosyllabic quality’
parkisonian, extrapyramidal dysarthria - quiet, monotonous and slow
what is dysphonia
problem with sound production
speech articulation is normal
may be caused by vocal cord paralysis
what is aphasia
problem with language
expressive or receptive
receptive - this is when wernickes affected in the temporal lobe
test by asking them to perform various commands
expressive - lesion in the frontal lobe affecting the broca area
what is apraxia
loss of ability to perfomr previously learned or well practised motor task
types of apraxia
gait
dressing
ideomotor - cant mime a response to your command but will do it spontaneously
ideational - caanot perform a three part command or series of movements
constructional - where the patient cannot copy
what is agnosia
failure to recognise objects in spite of normal input ie normal sensation or vision
what is neglect
failing to recongise or attend to stimuli on one side of the body
lesion parietal lobe - right sided
what memory tests are available
abbreviated mental score
minimental test examination
montreal cognitive assessment
