Stroke - Secondary Prevention & Rehabilitation Flashcards
What is the prognosis after a stroke?
20-30% die within a month
Increased risk of recurrence
Many are left with physical disabilities
What are the 4 types of prevention, and where do they occur?
- Primordial - Dept. of health campaigns to prevent onset pf risk factors
- Primary - GP (reduce incidence)
- Secondary - GP/Secondary care
- Tertiary - GP/hospitals/specialist
What kind of things can we do for primary prevention of strokes?
Encourage lifestyle modification to promote health and prevent and manage diseases such as HTN, hyperlipidaemia, and diabetes mellitus.
What kind of things can we do for secondary prevention of strokes?
In addition to managing HTN, hyperlipidaemia, and DM, manage with antithrombotic therapy, and manage predisposing conditions such as sickle cell, hyperviscosity syndromes, prothrombotic disease.
What is the ABCD2?
Screening tool used to estimate risk of stroke after a TIA
What are the categories in the ABCD2 tool?
Age over 60 BP over 140/90 Clinical features Duration of symptoms Diabetes
What does ecah category score in the ABCD2 tool?
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
What is classed as high risk for stroke after TIA?
An ABCD2 score of 4 or over
How should pt at high risk of stroke following a TIA be managed?
300mg Aspirin daily for 2 weeks, then switch to clopidogrel
Investigation should happen within 24 hours of onset of symptoms.
With stroke rehabilitation, what is it important to establish?
Previous baseline/level of function
Who is involved with stroke rehabilitation?
- PT/OT
- SALT
- Community nursing team
- Neurorehabilitation specialists
What can physiotherapy do to help a stroke pt?
Exercise helps prevent spasticity and contractures.
Helps pt recover strength after hospital stay.
Helps pt cope with new functional level
What can OT do for a stroke pt?
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.
What do SALT help with?
Dysphasia
Dysphagia
How many strokes are preceeded by a TIA?
A quatre
How many people who have had a TIA have a stroke within 3 months?
A quatre
How many patients with TIAs are dead by 5 years?
A quatre
How many strokes occur in patients under 65?
A quatre
How many stroke patients die within a month?
A quatre
What is the concept of tertiary prevention?
Reduce disease progression in pts with established disease
What is the concept of secondary prevention?
Reduce disease progression i.e. prevalence in pts with early disease
How does smoking cessation reduce risk of stroke?
Reduces risk from 7% to 4.7%
What is the ideal BMI for stroke prevention?
Under 25
What dietary modifications reduce stroke risk?
- Avoid heavy alcohol intake
- Low fat
- Low salt
- Low sugar
- High fibre
What exercise regimen is recommended for stroke prevention?
3-5 x 30 minutes of aerobic exercise per sessions week
What is the systolic blood pressure threshold for treatment in stroke prevention?
130 mmHg
How do we approach blood pressure management in stroke prevention?
Just like regular blood pressure management - ACD approach as per BHS guidelines
What can be done to manage hypercholesterolaemia in stroke prevention?
Intensive statin treatments if total cholesterol over 3.5
What are the blood glucose targets for DM pts in stroke prevention?
Keep HbA1c under 6.5% in early disease, and under 7.0% in later disease i.e. when the pt is on insulin.
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?
Carotid stenosis equal to or more than 50%.
If with symptoms, urgent vascular referral.
If asmptomatic, discussion for vascular surgery.
What are the degrees of carotid stenosis?
Normal
Minor disease = up to 30% stenosis
Significant disease = 30-50%
Surgical disease = over 50%
What complications can arise from secondary prevention of stroke?
Medication side effects e.g. of statins
Compliance
What % of stroke presentations have some form of dysphagia?
50%
What issues arise from dysphagia?
- Hydration issues
- Nutritional issues
- Medication issues
- Complications e.g. pneumonia
What options are there for stroke pts with dysphagia?
- Thickened fluids
- Modified diets
- Assisted nutritional techniques (range from supplements to TPN)
When should statins be avoided?
In patents with intracerebral haemorrhage.
What surgery can be done for carotid artery stenosis?
Carotid endarterectomy
Carotid angioplasty
Carotid stenting
