strokes examinations Flashcards
how are strokes recognised?
through the acronym FAST
Face - has their smile and face fallen
Arms - can they life both arms above their head
Speech - are they slurred or clear and understanding
Time - if any of these things then need to call 999 as is a medical emergency
what is the first stage in the process of a stroke consultation?
help to make a diagnosis
where is the lesion - is it focal or global
focal is stroke global is bells palsy
what are the neurological symptoms
from establishing there the lesion is how can you make a diagnosis?
what is the most likely diagnosis
time of onset and duration of symptoms - this is quick in a stroke but the symptoms of a TIA will not be present after 24 hours with no permanent damage - are the symptoms still present?
associated symptoms - headaches, visual disturbances, fever, drowsiness and seizures - what types, sudden onsets and how severe?
possible causes - head injury, medication, PMHx and RFs
what are the RFs for stroke?
CVD, DM, hypertension and FHx
what are the PMHx that need to be considered in strokes?
neurological conditions and AF
what is the second stage in a stroke consultation?
decide on an emergency treatment - thrombolysis decisions need the precise times of onset
what are the clinical examinations done in strokes?
assessments of consciousness level, neurological examinations of the limbs, cranial nerve examinations, examinations of other systems such as CVS
what scales are used to assess consciousness?
AVPU or GCS
what is AVPU?
alert, responds to voice, responds to pain, unresponsive
what is the GCS?
the glasgow coma scale eye opening from 1-4 1 - none 2 - responds to painful stimuli 3 - responds to verbal stimuli 4 - spontaneous verbal - from 1-5 1 - none 2 - non specific sounds 3 - inappropriate words 4 - confused 5 - orientated motor - from 1-6 1 - none 2 - extension to pain 3 - abnormal flexion to pain 4 - normal flexion 5 - localises the pain 6 - follow commands
what are the differential diagnoses for strokes?
stroke or TIA depending on the symptoms onset and resolution hypoglycaemia todds paresis after seizures focal migraine subdural haematoma subarachnoid haemorrhage encephalitis space occupying lesion
what is power grading?
it is a scale from 0-5
0 - no muscle contraction visible
1 - muscle contraction but no joint movement
2 - joint movement when the effects of gravity are eliminated
3 - movement is sufficient to overcome the effects of gravity
4 - movement is sufficient to overcome effects of gravity and some resistance
5 - normal power
what would be the result of an UMN lesion on the inspection, tone, power, reflexes and plantar babinski reflex?
inspection - normal tone - increased power - weakness reflexes - increased plantar reflex - clonus present and extensor response
what would be the result of an LMN lesion on the inspection, tone, power, reflexes and plantar babinski reflex?
inspection - fasciculations and wasting tone - normal or decreased power - focal weakness in the distribution of nerve root or peripheral nerve reflexes - decreased or absent plantar reflex - flexor with no clonus
what muscles allow hip flexion and extension, what is their innervation and what are the nerve roots of these?
hip flexion - iliopsoas which is innervated by iliofemoral nerve which has the nerve roots L1-2
hip extension comes from the gluteus maximus which is innervated by the sciatic nerve wshich comes from the nerve roots L5-S1
