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BDS3 - BAMS > Strokes > Flashcards

Strokes Flashcards

1
Q

What is the definition of a stroke?

A

acute focal neurological deficit resulting from cerebrovascular disease and lasting more than 24hrs or causing earlier death

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2
Q

Describe what a stroke actually is/what happens in the brain.

A
  • brain equivalent of heart attack
  • blockage in the local cerebral blood flow (so there is no blood flow)
  • get death of brain tissue due to hypoxia (no O2 delivery)
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3
Q

What are the 2 types of strokes? (due to aetiology)

A
  • infarction of tissue
  • haemorrhage into the brain tissue and causing pressure which prevents blood flow to other parts of the brain
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4
Q

What should you look out for when suspecting a stroke?

A

FAST:

  • facial drooping
  • arm weakness
  • speech difficulty
  • time
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5
Q

What does TIA stand for and what happens in these?

A

Transient ischeamic attack

There is temporary ischeamia and localised loss of brain function.

Ischeamia is cleared quickly and there is fully recovery in 24hrs (most in 30mins)

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6
Q

If a patient has has a TIA, what are they at higher risk of?

A

Higher risk of a ‘proper’ stroke over years (also a 2.4% risk of a myocardial infarction)

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7
Q

What are some risk factors for a stroke?

A
  • hypertension
  • smoking
  • alcohol
  • ischaemic heart disease
  • atrial fibrilation
  • diabetes mellitus
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8
Q

Strokes account for what perentage of deaths?

A

12%

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9
Q

What sex are more affected by strokes and how is age influenced?

A

males and more risk as you get older

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10
Q

What are the 4 causes of strokes?

A
  • ischeamic stroke (unsure why this hapens)
  • intercranial bleed (haemorrhage) - aneurysm rupture
  • Embolic stroke - embolism from LHS of heart
  • Atheroma of cerebral vessels
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11
Q

What are some other, less common causes of strokes?

A
  • venous thrombosis
  • ‘borderzone infarction’ - poor brain perfucsion and can lead to brain injury (severe hypotension and cardiac arrest)
  • Vasculitis (narrow blood vessels and limit O2 delivery)
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12
Q

What can increase your risk of venous thrombosis? (3)

A
  • oral contraceptive pill use
  • polycythaemia (high haem)
  • thrombophillia
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13
Q

What are some steps that can be taken to prevent a stroke?

A
  • Reduce risk factors
    • Smoking
    • Diabetes control
    • Control hypertension
  • Antiplatelet action (secondary prevention only)
    • Aspirin
    • Dipyridamol
    • Clopidogrel
  • Anticoagulants - embolic risk – AF, LV thrombus
    • Warfarin, Apixaban
  • Surgery
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14
Q

What surgery can be done to try and prevent strokes?

A

-Carotis endarterectomy (removing plaque from carotid artery)

BUT 7.5% mortality from surgery

-preventative neurosuregry (aneurysm clips, AV malformation correction)

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15
Q

When investigating a potential stroke, what needs to be done?

A
  • need to be able to differentiate the stroke (infarct, bleed, subarachnoid haemorrhage)
  • EARLY info needed to assess treatment options
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16
Q

What imaging can be used to investigate strokes? Give a brief description of their use in stroke investigations.

A
  • CT Scan
    • rapid, easy access
    • poor for ischaemic stroke
    • good for haemorrhage strokes
  • MRI Scan
    • Difficult to obtain quickly
    • Better at visualising early changes of damage
    • MRA (MR angiography) is the best investigation for visualising the brain circulation
  • Digital Subtraction angiography (DSA)
    • If MRA not available
17
Q
A
18
Q

When investiagting a stroke, risk factors should be assessed. How is this done?

A
  • Carotid ultrasound
  • Cardiac ultrasound (LV thrombus)
  • ECG (arrhythmias)
  • Blood pressure
  • Diabetes screen
  • Thrombophilia screen (young patients)
19
Q

What are the effects of a stroke on the patient?

A
  • Loss of functional brain tissue
    • immediate nerve cell death
    • Nerve cell ischaemia in penumbra around infarction
    • Will die if not protected
    • Will vary due to the location of tissue and how large it is
  • Gradual or rapid loss of function
    • Stroke may ‘evolve’ over minutes or hours
    • Gradual inflammation of tissues can lead to a max point
  • Inflammation in tissue surrounding the infarct/bleed
    • Recovery of some function with time
20
Q

What are the possible complications of a stroke?

A
  • motor function loss
  • dysphonia (difficulty speaking)
  • swallowing (aspiration of food and saliva, pneumonia and death)
  • sensory loss
  • body perception (neglect, phantom limbs)
  • cognitive impairment
21
Q
A
22
Q

Describe the cognitive impairments that may occur due to a stroke.

A

The following canbe impaired:

  • Appreciation – special sensation
  • Processing
    • understanding of information
    • Speech and language
      • Dysphasia, dyslexia,dysgraphia & dyscalculia
  • Memory impairment
  • Emotional lability and depression
23
Q

What are the aims of treatment in the acute and chronic phases of a stroke?

A

acute phase - limt damage by reducing amount of tissye loss but managing penumbra effectively

Chronic phase - rehabilitation and reduce future risk

24
Q

Describe the treatment that can be given in the acute phase of a stroke.

A
  • reduce damage to penumbra region using calcium channel blockers
  • improve blood flow/oxygenation
    • Thrombolysis possible within 3 hrs of stroke
    • maintain perfusion pressure to the brain tissue
  • Normoglycaemia (glucose levels in brain) - hypo/hyper is harmful as the brain relies on correct amount of glucose to function
  • Remove haematoma for subarachnoid haemorrhages
  • start to prevent future risk
25
Q

How is the prevention of future risk of strokes started in the acute phase of the stroke?

A
  • give aspirin (300mg daily)
  • anticoagulants if indicated (atrial fibrilation or left ventricular thrombus)
26
Q

Describe the aspects of the chronic phase treatment of a stroke.

A
  • Nursing and Rehabilitation
    • Immobility support
      • Prevention of bed sores
      • Physiotherapy to prevent contractures
  • Speech and language therapy
    • Communications
    • Swallowing and eating
  • Occupational therapy
27
Q

What are the dental aspects of a stroke?

A
  • Impaired mobility and dexterity
    • attendence
    • OH
  • Communication difficulties
    • dysphonia, dysarthria
    • cognitive difficulties
  • Risk of cardiac emergencies
    • MI
    • Further stroke
  • Loss of protective reflexes
    • Aspiration
    • Managing saliva
  • Loss of sensory info
    • Difficulty in adaption to new oral environment (e.g. dentures)
  • ‘Stroke pain’
    • CNS generated pain perception (from the damage and isnt actually from peripheral stimulation )
28
Q
A

BDS3 - BAMS (9 decks)

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