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N&SS - Neuro & Stroke > Stroke - Secondary Prevention & Rehabilitation > Flashcards

Stroke - Secondary Prevention & Rehabilitation Flashcards

1
Q

What is the prognosis after a stroke?

A

20-30% die within a month
Increased risk of recurrence
Many are left with physical disabilities

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2
Q

What are the 4 types of prevention, and where do they occur?

A
  • Primordial - Dept. of health campaigns to prevent onset pf risk factors
  • Primary - GP (reduce incidence)
  • Secondary - GP/Secondary care
  • Tertiary - GP/hospitals/specialist
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3
Q

What kind of things can we do for primary prevention of strokes?

A

Encourage lifestyle modification to promote health and prevent and manage diseases such as HTN, hyperlipidaemia, and diabetes mellitus.

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4
Q

What kind of things can we do for secondary prevention of strokes?

A

In addition to managing HTN, hyperlipidaemia, and DM, manage with antithrombotic therapy, and manage predisposing conditions such as sickle cell, hyperviscosity syndromes, prothrombotic disease.

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5
Q

What is the ABCD2?

A

Screening tool used to estimate risk of stroke after a TIA

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6
Q

What are the categories in the ABCD2 tool?

A 
Age over 60
BP over 140/90
Clinical features
Duration of symptoms
Diabetes
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7
Q

What does ecah category score in the ABCD2 tool?

A

Age - 1 point if over 60
BP - 1 point if BP over 140/90
Clinical features - 1 point for speech disturbance without weakness, 2 points for unilateral weakness.
Duration - 0 if under 10 mins, 1 if 10-60 mins, 2 if over 60 mins
Diabetes - 1 for being diabetic

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8
Q

What is classed as high risk for stroke after TIA?

A

An ABCD2 score of 4 or over

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9
Q

How should pt at high risk of stroke following a TIA be managed?

A

300mg Aspirin daily for 2 weeks, then switch to clopidogrel

Investigation should happen within 24 hours of onset of symptoms.

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10
Q

With stroke rehabilitation, what is it important to establish?

A

Previous baseline/level of function

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11
Q

Who is involved with stroke rehabilitation?

A
  • PT/OT
  • SALT
  • Community nursing team
  • Neurorehabilitation specialists
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12
Q

What can physiotherapy do to help a stroke pt?

A

Exercise helps prevent spasticity and contractures.

Helps pt recover strength after hospital stay.

Helps pt cope with new functional level

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13
Q

What can OT do for a stroke pt?

A

Teach pt how to adapt home and life to new functioning level.

Arrange home alterations to help pts stay living at home and as independant as possible.

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14
Q

What do SALT help with?

A

Dysphasia

Dysphagia

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15
Q

How many strokes are preceeded by a TIA?

A

A quatre

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16
Q

How many people who have had a TIA have a stroke within 3 months?

A

A quatre

17
Q

How many patients with TIAs are dead by 5 years?

A

A quatre

18
Q

How many strokes occur in patients under 65?

A

A quatre

19
Q

How many stroke patients die within a month?

A

A quatre

20
Q

What is the concept of tertiary prevention?

A

Reduce disease progression in pts with established disease

21
Q

What is the concept of secondary prevention?

A

Reduce disease progression i.e. prevalence in pts with early disease

22
Q

How does smoking cessation reduce risk of stroke?

A

Reduces risk from 7% to 4.7%

23
Q

What is the ideal BMI for stroke prevention?

A

Under 25

24
Q

What dietary modifications reduce stroke risk?

A
  • Avoid heavy alcohol intake
  • Low fat
  • Low salt
  • Low sugar
  • High fibre
25
Q

What exercise regimen is recommended for stroke prevention?

A

3-5 x 30 minutes of aerobic exercise per sessions week

26
Q

What is the systolic blood pressure threshold for treatment in stroke prevention?

A

130 mmHg

27
Q

How do we approach blood pressure management in stroke prevention?

A

Just like regular blood pressure management - ACD approach as per BHS guidelines

28
Q

What can be done to manage hypercholesterolaemia in stroke prevention?

A

Intensive statin treatments if total cholesterol over 3.5

29
Q

What are the blood glucose targets for DM pts in stroke prevention?

A

Keep HbA1c under 6.5% in early disease, and under 7.0% in later disease i.e. when the pt is on insulin.

30
Q

A pt who has had a stroke has been shown to have carotid stenosis. What is the threshold for Rx, and what is the surgical Rx for secondary prevntion?

A

Carotid stenosis equal to or more than 50%.

If with symptoms, urgent vascular referral.
If asmptomatic, discussion for vascular surgery.

31
Q

What are the degrees of carotid stenosis?

A

Normal
Minor disease = up to 30% stenosis
Significant disease = 30-50%
Surgical disease = over 50%

32
Q

What complications can arise from secondary prevention of stroke?

A

Medication side effects e.g. of statins

Compliance

33
Q

What % of stroke presentations have some form of dysphagia?

A

50%

34
Q

What issues arise from dysphagia?

A
  • Hydration issues
  • Nutritional issues
  • Medication issues
  • Complications e.g. pneumonia
35
Q

What options are there for stroke pts with dysphagia?

A
  • Thickened fluids
  • Modified diets
  • Assisted nutritional techniques (range from supplements to TPN)
36
Q

When should statins be avoided?

A

In patents with intracerebral haemorrhage.

37
Q

What surgery can be done for carotid artery stenosis?

A

Carotid endarterectomy
Carotid angioplasty
Carotid stenting

N&SS - Neuro & Stroke (10 decks)

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