Unit 6 Case 2: Stroke Flashcards
what is a stroke
rapid onset of symptoms, focal (function) loss of cerebral function, cells die in minutes as brain doesn’t have its own energy storage
3 types of stroke
ischaemic
hemorrhagic
TIA
what is a TIA
transient ischemic attack
caused by a temporary disruption to blood supply to part of the brain
only last a few minutes and fully resolve within 24 hours
haemorhagic stroke
cerebral blood vessels burst
ischaemic stroke or TIA
narrowing or occlusion of a blood vessel
types of hemorrhagic stroke
intercerebral or subarachnoid
types of ischaemic stroke/ TIA
embolic or cerebral
presentation of stroke
may be difficult to detect at the time
acute onset
arm weakness
leg weakness
facial weakness
speech disturbance
risk factors for stroke
hypertension
overweight/obesity
drugs, alcohol and smoking
blood thinners
air pollution
anxiety, depression and high stress levels
family history/genetics
race/ ethnicity
age/ gender
infections/ inflammation
brain aneurysms
high cholesterol
heart and blood vessel diseases
diabetes
differential diagnoses for a stroke
seizure
syncope
sepsis
migraine
brain tumour
dementia
postural drop
investigations carried out for suspected stroke
physical exam
ROSIER scale
blood tests
scans
carotid ultrasound
echocardiography
cerebral angiogram
swallow tests
physical examination in a stroke
medical history: ask questions vascular, lifestyle, family history, onset, positive and negative symptoms
neuro exam
physical exam: blood pressure, mental awareness (GCS) and FAST
questions you may ask someone with suspected stroke
ever suddenly gone blind in one eye
double vision more than a few seconds
jumbled/ slurred speech?
weakness/ loss of feeling in face/arm/leg
what does FAST stand for
facial weakness
arm weakness
speech problems
time to call 999
ROSIER scale
used to differentiate between stroke and differential diagnoses
score 1-5= stroke possible
score -2-0= stroke unlikely
score -1= seizure/ loss of consciousness
score +1= facial, arm and leg weakness, speech disturbance, visual field defect
blood tests carried out in stroke
FBC
serum electrolytes
blood clotting tests
heart attack tests
thyroid function tests
blood glucose
cholesterol tests
c- reactive protein tests
FBC
diagnose infection, anaemia, clotting problems and other blood problems
serum electrolytes
electrolytes can cause stroke like symptoms (confusion/muscle weakness)
show dehydration
kidney problems
blood clotting tests
coagulation panel
blood clots too quickly could be ischameic stroke
too slowly could be hemorrhagic stroke
heart attack tests
some heart problems lead to stroke
thyroid tests
measure thyroid hormones
hyperthyroidism increases risk of atrial fibrillation may lead to stroke
blood glucose tests
low glucose common diabetic complication may lead to stroke like symptoms without a stroke
cholesterol tests
see if high cholesterol is a cause
c reactive protein
substances body releases during inflammation, damage to arteries is a cause of inflammation
what are the 2 blood clotting tests
prothrombin time
partial thromboplastin time
prothrombin time
protein produced by the liver
helps the blood to clot
most often monitored if the patient takes blood thinners e.g. warfarin
average time to clot is 10-13 seconds
international normalised ratio= patient PT divided by control PT
people not on thinners= 1.1 or below is normal and thinners is 2-3
increased INR is slower clotting than normal
partial thromboplastin time
looks at one proteins in coagulation cascade and measures their clotting ability
blood clotting too slowly
can be caused by blood thinning medications
liver problems
inadequate levels of protein causing blood to clot
vitamin K deficiency
other substances in the blood that prevents work of clotting factors
blood clotting too fast
can be caused by
supplements that contain vitamin K
high intake of foods that contain vitamin K: liver, broccoli, chickpeas, green tea, kale, turnip greens and products that contain soybeans
oestrogen- containing medications such as birth control pills and hormone replacement therapy
why would scans be completed
to see if ischaemic or hemorrhagic stroke
which part of the brain is affected
how severe stroke is
early scan is useful when: people may benefit from treatment e.g. thrombolysis, already taking anti-coagulants and lower level of consciousness
Ct scan for stroke
detect if ischaemic or hemorrhagic
first call
quicker than MRI
MRI scan for stroke
people with complex symptoms where extent/ location of damage is unknown
used in people recovering from TIA
tissue in greater detail
carotid ultrasound
help show if any narrowing/blockages in the neck arteries that supply to the brine
transducer: sends sound waves to the body
echocardiography
images of heart to check problems related to stroke
ultrasound across chest (transthoracic)
may use transoesophageal
cerebral angiogram
uncommonly used
catheter inserted through small incision in groin
guided through blood vessels, dye injected to make blood vessels visible on x ray
swallow tests
performed after stroke
teaspoons of water given to drink, if successful then half a glass
any difficulty then referred to a SALT for detailed assessment
may need to administer fluids IV
when would you complete a neurological examination
blurry vision
change in behaviour
seizures
weakness
tremor
slurred speech
changes in balance/coordination
numbness/ tingling in arms/ legs
different treatment options for stroke
thrombolysis
thombectomy
anti-platelet medications
haemorrhagic stroke treatments
thromboylsis
uses alteplase or recombinant tissue plasminogen activator (rt-PA)
can brea down and disperse a clot that is preventing blood reaching the brain
needs to be within 4-5 hours of stroke onset
when do you not use thrombolysis
brain bleed
don’t know onset time
don’t reach hospital in time
bleeding disorder
recent major surgeries
stroke/ head injury in last 3 months
current medication isn’t compatible with alteplase
thrombectomy
removes brain clot
mesh device into artery in groin and move it to the brain and pull the clot out
only works if clot is in a large artery
must be within hours of the stroke onset
small amount of cases eligible
anti-platelet medications
aspirin, clopidogrel, ticagrelor
prevent blood clot formation and reduce risk of recurrent strokes
within 24 hours of an ischaemic stroke
hemorrhagic stroke treatments
may be given medication for hypertension
if not on anti-coagulants: given medication to reverse effects and reduce bleeding
due to burst aneurysm: surgical procedure to repair blood vessel, also reduce pressure caused by fluid build-up
nimodipine: avoid further brain damage due to lack of blood supply
long term effects of stroke, physical
vision problems
hearing problems
speech and language
swallowing/ dysphagia
cognitive dysfunction
continence problems
neuropathic/ musculoskeletal pain
increased risk for vascular dementia
emotional functioning and personality changes
locked in syndrome
sexual dysfunction
increased risk of future strokes
recurrent seizures
kidney problems
loss of muscle movement/ paralysis
emotional affect of stroke
depression
anxiety
anger
confidence
motivation
how can impacts of stroke be managed
psychologists
occupational therapists
physiotherapy
psychiatrist
rehabilitation nurses
social workers
family support
carers
speech and language therapists
how much of the body’s blood oxygen supply goes to the brain
1/5th
circle of willis
anastomotic circular network
supplies the brainstem with oxygenated blood
blood supply to the cerebellar
superior, anterior inferior and posterior inferior cerebellar arteries
cranial nerves and their foramina: olfactory
cribriform plate in the ethmoid bone
cranial nerves and their foramina: optic
optic canal in the sphenoid bone
cranial nerves and their foramina: oculomotor
superior orbital fissure in the sphenoid bone
cranial nerves and their foramina: trochlear
superior orbital fissure in the sphenoid bone
cranial nerves and their foramina: trigeminal
foramen ovale in the sphenoid bone
cranial nerves and their foramina: abducens
superior orbital fissure in the sphenoid bone
cranial nerves and their foramina: facial
facial canal in the temporal bone
cranial nerves and their foramina: vestibulocochlear
internal acoustic meatus in the temporal bone
cranial nerves and their foramina: glossopharyngeal
jugular foramen
cranial nerves and their foramina: vagus
jugular foramen
cranial nerves and their foramina: accessory
jugular foramen between the occipital and temporal bones
cranial nerves and their foramina: hypoglossal
hypoglossal canal in the occipital bone
brocas area
important part of language formation
even if someone has the motor ability to form the sounds necessary for words brooks area is necessary to form and express language
angular gyrus
assembles information to help us understand words and concepts
wernickes area
works with angular gyrus, insular cortex and basal ganglia
to process words and word sequences to determine context and meaning
insular cortex
underneath the outer lobes of the cerebral cortex
important for many functions including motor control, emotion and self-awareness but also important in the processing of language
dysphasia
language part of the brain is damaged
dysarthria
muscle weakness
slurred speech, quiet voice
apraxia
can’t move facial muscles
