Topic 3 - Stroke and TIA Flashcards
Define stroke. What are the causes (6)?
Stroke is sudden onset of focal neurological symptoms, assumed to be vascular aetiology, which lasts for longer than 24 hours.
The causes are cerebral infarction, or haemorrhage.
Atheroembolism, cardioembolism, intracranial small vessel disease, and other (cocaine and alcohol use, AF) are the causes of cerebral infarction.
Haemorrhage is because an aneurysm bursts and the blood compresses on brain tissue which leads to neurological symptoms dependent on which tissue has been compressed.
What are the risk factors for a stroke?
Age, gender, ethnicity, family history of heart disease, previous history of heart disease, diabetes mellitus, atrial fibrillation.
High BP, high cholesterol, overweight, lack of exercise, smoking, alcohol and drugs.
Define TIA. How is it different to a stroke?
TIA - lasts for less than 24 hours and there isn’t residual neurological symptoms less after it.
The thrombus may eventually dislodge as it’s smaller than the one in stroke. The plaque may go elsewhere. And the plaque may just cause interrupted blood flow as it just reduces the blood flow but not occludes it fully.
In a cerebral haemorrhage, does the infarcted area try to get other blood?
Collateral blood vessels attempt to give supply but it would only be at best a partial compensation.
What is the area surrounding an infarcted area called?
Penumba.
What do the features of stroke depend on?
The size of haemorrhage or bleeding
Location of brain tissue injured
What features present in an acute stroke?
- Rapid onset of symptoms
- Sudden speech problems
- Sudden blindness
- Weakness in one or more limbs, maybe on one side
- Facial paralysis
- Confusion
- Dizziness
- Thunderclap headache
- Coma or death
How do you assess if somebody’s had a stroke?
- Facial drop
- Arms - can they lift them
- Slurred speech
- If yes to any, send to a hospital 999
How do you treat a stroke?
Early CT brain scan to assess if haemorrhage or ischaemia.
- Thrombolysis
- Thrombectomy
- Other things like craniotomy
- Rehabilitation
Neuroplasticity (forging of new neurones) can take some time and only recover partially.
What is primary prevention, secondary prevention and tertiary prevention?
Primary prevention - preventing a disease from occurring by modifying risk factors
Secondary prevention - once a disease has occurred, to modify risk factors to prevent the impact
Tertiary prevention - consequences of disease has occurred and now you’re minimising impact
What is the long term management of strokes and TIA?
Lifestyle changes - exercise, smoking cessation, diet.
Statins prescribed
BP checked and if required hypertensive tablets prescribed
Antiplatelets; aspirin or clopidogrel
Anticoagulants: NOACs or warfarin
Carotid endarterectomy
Swallowing issues - NG tube or soft diet.
Continence care
Rotate bedbound patients to prevent pressure sores
Psychological support
What are some long term effects of stroke and TIA?
- Continence
- Communication deficits
- Cognition
- Pain
- Difficulty bathing
- Self-care problems
- Mobility issues
What are some oral healthcare considerations for stroke/TIA?
- Visual disturbance
- Pain which may be in the orofacial region as a result of neurological effects
- Facial palsy makes denture retention difficult
- Swallowing problems so patient may struggle to eat so nutritional difficulties which can present on mucosa
- Disability - may not attend unless required as difficult
- Depression may occur so that affects oral hygiene
- May be on anticoagulants so that affects dental treatment
- Cognition/memory problems - informed consent can be tricky
