Stroke Rehabilitation Flashcards
What is a stroke?
Rapidly developing clinical symptoms and/or signs of loss of brain function with symptoms lasting >24hrs or leading to death with no other cause
What are important things to note when taking the history of a stroke?
Time of onset, symptoms, how did they progress
How common are stroke mimics?
1/3 of all stroke presentations are stroke mimics
What are some examples of stroke mimics?
Seizure, sepsis, toxins, SOL, syncope, delirium, vestibular dysfunction, dementia
What are the questions asked when generating a Rosier score?
Has there been loss of consciousness or syncope?
Has there been seizure activity?
New onset of = asymmetric facial weakness, asymmetric arm weakness, asymmetric leg weakness, speech disturbance, visual field defect
How is the Rosier Score graded?
Scores range from -2 to +5
Score >0 is likely to be stroke
Score <= 0 has low likelihood of being stroke
Is a stoke technically classed as a diagnosis?
No = it is an experience of persisting neurological complications of CV disease
What are the types of stroke?
Infarct = atheroembolic, small vessel, cardioembolic
Haemorrhage = structural abnormality, hypertensive, amyloid angiopathy
Subarachnoid haemorrhage
What is the limitation of using CT to image strokes?
Scans aren’t sensitive for blood after about 1 week
In hyperacute setting CT may appear normal
What is the management of stroke patients?
Thrombolysis/thrombectomy and imaging
Swallow assessment, nutrition and hydration
Antiplatelets and DVT prevention
Stroke unit care
What are some factors to consider when deciding whether to thrombolyse a patient?
Age, time since onset, previous intracerebral haemorrhage/infarct, atrophic changes, blood pressure, diabetes
What are the benefits of brain imaging?
Establishes diagnosis and indicates therapeutic decisions
Facilitates clinical management, patient flow and information for patient
How effective are stroke units in caring for patients?
Highly effective = for every 33 patients treated there is 1 extra survivor, for every 20 patients treated 1 extra patient is discharged back to their own home
What investigations should be done before prescribing antiplatelets after a stroke?
Do a CT first to exclude a bleed
What antiplatelet is prescribed after a stroke?
Aspirin 300mg prescribed ASAP = must wait 24hrs if patient was thrombolysed
What is the purpose of prescribing antiplatelets after a stroke?
Aim is to reduce further infarct = risk highest early on
Why are stroke patients at higher risk of DVT?
Due to immobility
What are some options for DVT prophylaxis?
Heparin reduces risk but benefit outweighed by bleeding risk
TED stockings don’t give overall benefit
Intermittent pneumatic compression can reduce risk
How is dysphagia screened for in stroke patients?
Initial swallow screen takes place
How is dysphagia managed in patients with an abnormal swallow screen result?
Assessment by speech and language therapists
May need NG tube placement or textured diet and thickened fluids depending on swallow
What is a transient ischaemic attack (TIA)?
Brief episode of neurologic dysfunction caused by focal brain or retinal ischaemia without evidence of acute infarction
How long do symptoms of a TIA usually last for?
Typically last for <1 hour
What is done as part of the rapid assessment at the rapid access neurovascular clinic?
History, carotid imaging, ECG, blood tests
What immediate therapies are offered following diagnosis at the rapid access neurovascular clinic?
Medication, carotid endarterectomy
How should intracerebral haemorrhage patients who present <6hrs onset with systolic BP >150 be treated?
Treat urgently = lower systolic BP to 140 for at least 7 days
What are some associations of intracerebral haemorrhages?
15% associated with anticoagulation = worst outcomes associated with vitamin K antagonists (warfarin)
What can reduce the incidence and improve outcomes of intracerebral haemorrhages?
DOAC = still worse outcomes than if not anticoagulated
What is the mortality of intracerebral haemorrhages?
Mortality rate of 30-50%
What is the immediate management of intracerebral haemorrhages?
Anticoagulation reversal
How is warfarin reversed?
Vitamin K/Prothrombin complex
What are some specific anticoagulation antidotes?
Idarucizumab = reverses direct thrombin inhibitors
Andexanet alpha = reverses direct factor Xa inhibitors
What are some methods of anticoagulation reversal when specific antidotes aren’t available?
Prothrombin complex advised
May also use tranexamic acid or rFVIIa
