Stroke Rehab Flashcards by Kate Bailey

Where is Broca’s located?

inferioir frontal gyrus
Frontal lobe

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Where is Wernicke’s area located?

superior temporal gyrus
Temporal lobe

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What lung is likely to aspirate?

Right - angle & larger bronchus

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What is subluxation of the shoulder & why does it happen in stroke?

Dislocation - happens as muscle no longer takes the wait

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What is baclofen? What is it used for?

It is a GABA agnoist and is used to reduced spacitiy

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Where is the cerebellar located?

Posterior inferior region
supplied by;
superior cerebellar artery - basialr
inferior anterior - from basialr
inferior posterior artery - from the vertebral artery

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What produces the CSF?

choroid process

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What is the key difference in cerebellar strokes?

They are ipsilateral - they affect the side they are on

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What does the cerebellum do?

Coordination & balance

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What would you see in examination

Nystagmus - rhythmic oscilations
Rub leg up & down shin
Touch nose to your finger - they would miss - potenitally tremor

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What is a VP shunt

Ventricular-Peritoneum shunt
Used to allow CSF to leave the skull down to the peritoneum

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What does hydrocephalus look like on a CT?

blockage in 4th ventricle in the base - so lateral ventricles look wider
Increased ventricular pressure causes the septum pellucidum to look thinner

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What is the MOA of edoxaban, rivaroxaban, apixaban?

Factor Xa inhibitor
this inhibits cleavage of prothrombin to thrombin

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What predisposes to Intracerebral bleed?

HTN
Trauma
After Thrombolysis
Cerebral amyloid angiopathy
Charcot-Bouchard Aneurysm
Alcholism - damage to the liver affecting coagulation

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What is the ‘antidote’ of direct inhibitors of factor Xa

Andexanet alfa

Xa inhibtors - rivaroxban, apixaban, edoxaban

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What is the MOA of Dabigatran & its ‘antidote’?

Direct inhibitor of factor IIa
Both clot-bpund & free thrombin
antidote- Idarucizumab

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What is the MOA of Warfarin?

Inhibits the reduction of Vit K
prevents the y-carboxylation of glutamate so inhibits factos II, VII, IX & X

to remember; II plus VII = IX and then X

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What is the MOA of Heparin?

Accelarates the action of antithrombin III increasing inactivation of factors IIa and Xa
Smaller effect on IXa, XIa & XIIa

What is another name for factor IIa

Thrombin

What is the MOA of low-molecular weight heparin

e.g. dalteparin

Accelarates the action of antithrombin III increasing inactivation of factor Xa

What monitoring is needed with Warfarin?

INR
this is derived from Prothrombin time

How is Heparin given? Why?

BY SC or IV due its short halflife of 40-90 min

What monitoring is needed in Heparin?

Dosage is adjusted according to activated partial thromboplastin time (APTT)

What is a heparin or dalteparin overdose treated with?

Protamine sulfate

What are 2 key side effects of anticoagulants?

Bleeding Thrombocytopaenia

What do you do in major bleeding when on Warfarin?

Stop Warfarin Administer IV Vit K Prothrombin complex or fresh plasma

What do you do in high INR 5-8 on Warfarin?

Stop Warfarin 5-8 with minor bleeding - give slow IV of Vit K 5-8 with no bleeding - withhold a few doses & reduce maintenance dose Restart Warfarin when INR <5

What do you do if INR >8 on Warfarin?

>8INR with no bleeding Stop warfarin & give oral vit K >8INR with minor bleeding Stop Warfarin, give a slow IV of Vit K Dose of Vit K can be repeated in 24hrs if INR still high Restart Warfarin when INR <5

What is the MOA of Aspirin?

COX inhibtor in the prostaglandin synthesis pathway. Lowdoseinhbits COX-1 and so platelet aggregation (TXA2) At larger doses it can also inhibt COX-2

What are oral thienopyridines?

**Clopidogrel, Ticagrelor**, Ticlopidine, Prasugrel# They selectively inhibt adenosine diphosphate-induced platelet aggregation

How do anticoagulants work?

They act at different sites of the coagulation cascade

What is a carotid endartecetomy?

Carotid stenosis is removed using a fogarty catheter to reduce risk of stroke

What must apply for a carotid endarterectomy?

* high degree of internal carotid artery stenosis - more than 50% * Patient is expected to survive 2 years * less than 3/5% of stroke or death

What drugs should a patient be on post stroke?

* Clopidogrel 75mg OD Aspirin if not tolerated * Atorvastatin 20-80mg OD * If secondary to Afib - Warfarin or DOAC - 2 weeks post stroke * Antihypertensive if HTN - 2 weeks post stroke

Who is considered for Carotid endarterectomy?

Patients who have had a stroke or TIA

What lifestyle advice should you offer post stroke?

* increased physical activity - stroke rehab programme * Smoking cessation * Diet - low salt, reduced saturated facts, fish twice a week * reduce alcohol intake

What is dysphagia?

difficulties swallowing

What is spasticity?

increased tone & reflexesdue to loss of inhibtion in upper motor neurons

What is a risk due to dysphagia?

An Aspiration Pneumonia Difficulties in swallowing leads to food & drink entering the airway

How should Dysphagia be managed?

SALT assessment within 72hrs Barium swallow or Fibreoptic evaluation of swallow

What are alternative methods of feeding?

* NG tube with Bridle * Percutaneous endoscopy gastrostomy (PEG) * Radiologically inserted percutaneous gastrostomy (RIG)

Why is there an increased risk of DVT post stroke?

Motor weaknes leads to venous stasis in the lower limbs. This can also lead to a PE

How can Spasticity be managed?

Stretching affected limbs Splints Baclofen Botox