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Hcoll > Strokes + Rehab > Flashcards

Strokes + Rehab Flashcards

1
Q

Definition of Aphasia

A

Inability to formulate +/or comprehend language

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2
Q

Definition of Dysphasia

A

Impairment of language due to brain damage

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3
Q

What is receptive Dysphasia

A

Inability to understand (Wernickes)

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4
Q

What is expressive dysphasia

A

Inability to formulate language but has full understanding (Brocas)

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5
Q

What is dysarthria

A

Inability to speak due to motor disturbances of face and tongue muscles
Main differentiation between dysphasia = reading/writing unaffected
May exist alongside dysphasia

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6
Q

What is dyspraxia

A

Inability to respond voluntarily in conversation but may reflexively speak (e.g. may greet you but not be able to answer any questions)

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7
Q

What is dysphagia and whats its prevalence post-stroke

A

swallowing issues, must be a problem in the oral, pharyngeal or oesophageal stages of swallowing
30-50%

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8
Q

What must be done once dysphagia is identified

A

PT, SALT, OT + dietitians must be made aware and nurses/HCA may have to assist eating

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9
Q

What are the higher cognitive impairments post stroke

A
  1. Sensory Neglect (unilaterally sensation is ok but bilaterally there is a unilateral decrease in sensationon affected side)
  2. Agnosia (can’t recognise familiar objects)
  3. Asterogosis (can’t recognise numbers drawn on a hand)
  4. Dyspraxia
  5. Homonymous Hemianopia
  6. Dysphasia
  7. Visuospatial neglect
  8. Decreased Conciousness
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10
Q

Risk Factors for Stroke

A 
HT
Cholesterol 
Diabetes 
Smoking 
Alcohol
Poor Diet
Low Exercise 
Increased BMI 
AF
Drugs (IVDU + Warfarin)
Age
Male
PHx
FHx
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11
Q

How do you classify stroke

A

Bamford classification

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12
Q

How do you identify a Total anterior circulation stroke (TACS) using the Bamford classification + state its prevalence

A 
20% of all Ischemic strokes
All 3 of: 
Evidence of higher dysfunction
Motor/Sensory Defect to contralateral face, arm + leg
Homonymous Hemianopia
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13
Q

How do you identify a Partial anterior circulation stroke (PACS) using the Bamford classification + state its prevalence

A

35% of all ischemic strokes
2/3 of:
Evidence of higher dysfunction (e.g. dysphasia)
Motor/Sensory Defect to contralateral face, arm + leg
Homonymous Hemianopia

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14
Q

How do you identify a Lacunar stroke using the Bamford classification + state its prevalence

A 
20% of ischemic cases
ONE of: 
Pure Motor symptoms 
Pure sensory symptoms 
Purely Sensory Motor symptoms 
Ataxic Hemiparesis
No:
New Dysphasia
New Visuospatial problem 
Proprioceptive loss only
Vertebrobasilar Fractures
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15
Q

How do you identify a Posterior Circulation stroke (POCS) using the Bamford classification + state its prevalence

A 
25% of Ischemic cases
ONE of: 
Cranial Nerve Palsy + Contralateral motor/sensory deficit 
Bilateral Motor/Sensory Deficit 
Conjugate eye movement problems 
Cerebellar dysfunction
Isolated Homonymous hemianopia
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16
Q

Prevalence of Haemorrhagic stokes vs Ischemic Strokes

A

15% vs 85%

17
Q

Risk factors for Haemorrhagic Strokes

A 
On anticoagulation
Thrombophillic
Depression
Severe Headache
HT (+++)
Vomiting 
Diabetes
18
Q

Primary Causes of haemorrhagic strokes

A

HTN
Amyloid
Angiopathy

19
Q

Secondary causes of haemorrhagic strokes

A

Underlying lesion coagulopathy

20
Q

How to treat haemorrhagic strokes

A

Reverse any anticoagulant
Stop antiplatelet
Stabilise (decrease BP if possible)
Emergency Neurosurgery

21
Q

What are some common stroke mimics

A 
Migrane
Space-occupying Lesion
Seizure 
Syncope
Metabolic disturbance 
Peripheral neuropathy 
Cervical Spine Pathology
Transient Global Amnesia
Psychiatric Conditions
22
Q

What is the timeframe to get a CT/MRI of a ?stroke

A

<12hours

23
Q

What are some indications for an urgent scan

A 
On anticoagulation
Bleeding disorder
Fluctuating/Progressive Symptoms
Decreased Consciousness
?SAH
24
Q

What are the signs of an infarct on a CT

A

Hyperdense MCA
Loss of Gray/White Differentiation
Sulcal Effacement (erasure)
Loss of insular ribbon (part of cortex)

25
Q

What Bloods should be done in a ?Stroke Patient

A 
FBC
U+E
LFT
TFT
Glucose
Lipids
ESR
Coagulation
Thrombophilia screen
Vasculitic screen
26
Q

Except for urgent scans + blood tests , what other investigations should be done for a ?stroke patients

A

ECG (for AF, LVH (indicates HTN) + ischemic changes (e.g. inverted T waves)

Echo (LVH, Valvular disease)

27
Q

How do you manage ischemic strokes

A

Alteplase 0.9ml/kg - ONLY <4.5 hours from onset, w/ a clear time of onset + clinical symptoms + Haemorrhage excluded

28
Q

Contraindications for Thrombolysis

A 
Bleeding disorders
Rapidly Improving
Stroke/Serious Injury <3 months
Major Surgery in last 2 weeks
Seizure 
Brain tumour
Upper GI bleed
History of CNS damage 
Haemorrhage in last 21 days
29
Q

If Thrombolysis is contraindicated, what should be done

A

Carotid Endoartectomy (within 2 weeks, needs carotid doppler to confirm )

30
Q

What is malignant MCA syndrome

A

Acute MCA infection causing brain swelling and herniation

31
Q

What is the treatment for Malignant MCA syndrome

A

Hemicraniectomy

32
Q

What antiplatelet therapy is indicated in Ischemic stroke treatment

A

Acutely –> Aspirin 300mg

Post Stroke/TIA –> Clopidogrel 75mg

33
Q

.

A

.

34
Q

What is Central post-stroke pain/Thalamic Pain syndrome

A

A Neurological disorder occuring when the Thalamus is damaged by a strokes
Causes Allodynia/Hyperalgesia
8% prevalence
Most commonly a lesion to VTL nucleus but may be anywhere along spinothalamic tract

35
Q

How do you treat Central post-stroke pain

A

Opiates
Antidepressants (TCA 12.5mg —> 50mg)
Anticonvulsants (Gabapentin 300-600mg TDS/Pregabalin 75mg OD)
Deep Brain Stimulation

36
Q

Roles of Physiotherapy/Occupational therapy in stroke rehab

A

just read about it cba

Hcoll (15 decks)

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