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Medicine: PBL wrap-ups > Unit 6 Case 2: Stroke > Flashcards

Unit 6 Case 2: Stroke Flashcards

1
Q

what is a stroke

A

rapid onset of symptoms, focal (function) loss of cerebral function, cells die in minutes as brain doesn’t have its own energy storage

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2
Q

3 types of stroke

A

ischaemic
hemorrhagic
TIA

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3
Q

what is a TIA

A

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

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4
Q

haemorhagic stroke

A

cerebral blood vessels burst

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5
Q

ischaemic stroke or TIA

A

narrowing or occlusion of a blood vessel

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6
Q

types of hemorrhagic stroke

A

intercerebral or subarachnoid

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7
Q

types of ischaemic stroke/ TIA

A

embolic or cerebral

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8
Q

presentation of stroke

A

may be difficult to detect at the time
acute onset
arm weakness
leg weakness
facial weakness
speech disturbance

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9
Q

risk factors for stroke

A

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

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10
Q

differential diagnoses for a stroke

A

seizure
syncope
sepsis
migraine
brain tumour
dementia
postural drop

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11
Q

investigations carried out for suspected stroke

A

physical exam
ROSIER scale
blood tests
scans
carotid ultrasound
echocardiography
cerebral angiogram
swallow tests

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12
Q

physical examination in a stroke

A

medical history: ask questions vascular, lifestyle, family history, onset, positive and negative symptoms
neuro exam
physical exam: blood pressure, mental awareness (GCS) and FAST

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13
Q

questions you may ask someone with suspected stroke

A

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

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14
Q

what does FAST stand for

A

facial weakness
arm weakness
speech problems
time to call 999

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15
Q

ROSIER scale

A

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

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16
Q

blood tests carried out in stroke

A

FBC
serum electrolytes
blood clotting tests
heart attack tests
thyroid function tests
blood glucose
cholesterol tests
c- reactive protein tests

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17
Q

FBC

A

diagnose infection, anaemia, clotting problems and other blood problems

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18
Q

serum electrolytes

A

electrolytes can cause stroke like symptoms (confusion/muscle weakness)
show dehydration
kidney problems

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19
Q

blood clotting tests

A

coagulation panel
blood clots too quickly could be ischameic stroke
too slowly could be hemorrhagic stroke

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20
Q

heart attack tests

A

some heart problems lead to stroke

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21
Q

thyroid tests

A

measure thyroid hormones
hyperthyroidism increases risk of atrial fibrillation may lead to stroke

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22
Q

blood glucose tests

A

low glucose common diabetic complication may lead to stroke like symptoms without a stroke

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23
Q

cholesterol tests

A

see if high cholesterol is a cause

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24
Q

c reactive protein

A

substances body releases during inflammation, damage to arteries is a cause of inflammation

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25
Q

what are the 2 blood clotting tests

A

prothrombin time
partial thromboplastin time

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26
Q

prothrombin time

A

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

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27
Q

partial thromboplastin time

A

looks at one proteins in coagulation cascade and measures their clotting ability

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28
Q

blood clotting too slowly

A

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

29
Q

blood clotting too fast

A

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

30
Q

why would scans be completed

A

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

31
Q

Ct scan for stroke

A

detect if ischaemic or hemorrhagic
first call
quicker than MRI

32
Q

MRI scan for stroke

A

people with complex symptoms where extent/ location of damage is unknown
used in people recovering from TIA
tissue in greater detail

33
Q

carotid ultrasound

A

help show if any narrowing/blockages in the neck arteries that supply to the brine
transducer: sends sound waves to the body

34
Q

echocardiography

A

images of heart to check problems related to stroke
ultrasound across chest (transthoracic)
may use transoesophageal

35
Q

cerebral angiogram

A

uncommonly used
catheter inserted through small incision in groin
guided through blood vessels, dye injected to make blood vessels visible on x ray

36
Q

swallow tests

A

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

37
Q

when would you complete a neurological examination

A

blurry vision
change in behaviour
seizures
weakness
tremor
slurred speech
changes in balance/coordination
numbness/ tingling in arms/ legs

38
Q

different treatment options for stroke

A

thrombolysis
thombectomy
anti-platelet medications
haemorrhagic stroke treatments

39
Q

thromboylsis

A

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

40
Q

when do you not use thrombolysis

A

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

41
Q

thrombectomy

A

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

42
Q

anti-platelet medications

A

aspirin, clopidogrel, ticagrelor
prevent blood clot formation and reduce risk of recurrent strokes
within 24 hours of an ischaemic stroke

43
Q

hemorrhagic stroke treatments

A

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

44
Q

long term effects of stroke, physical

A

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

45
Q

emotional affect of stroke

A

depression
anxiety
anger
confidence
motivation

46
Q

how can impacts of stroke be managed

A

psychologists
occupational therapists
physiotherapy
psychiatrist
rehabilitation nurses
social workers
family support
carers
speech and language therapists

47
Q

how much of the body’s blood oxygen supply goes to the brain

A

1/5th

48
Q

circle of willis

A

anastomotic circular network
supplies the brainstem with oxygenated blood

49
Q

blood supply to the cerebellar

A

superior, anterior inferior and posterior inferior cerebellar arteries

50
Q

cranial nerves and their foramina: olfactory

A

cribriform plate in the ethmoid bone

51
Q

cranial nerves and their foramina: optic

A

optic canal in the sphenoid bone

52
Q

cranial nerves and their foramina: oculomotor

A

superior orbital fissure in the sphenoid bone

53
Q

cranial nerves and their foramina: trochlear

A

superior orbital fissure in the sphenoid bone

54
Q

cranial nerves and their foramina: trigeminal

A

foramen ovale in the sphenoid bone

55
Q

cranial nerves and their foramina: abducens

A

superior orbital fissure in the sphenoid bone

56
Q

cranial nerves and their foramina: facial

A

facial canal in the temporal bone

57
Q

cranial nerves and their foramina: vestibulocochlear

A

internal acoustic meatus in the temporal bone

58
Q

cranial nerves and their foramina: glossopharyngeal

A

jugular foramen

59
Q

cranial nerves and their foramina: vagus

A

jugular foramen

60
Q

cranial nerves and their foramina: accessory

A

jugular foramen between the occipital and temporal bones

61
Q

cranial nerves and their foramina: hypoglossal

A

hypoglossal canal in the occipital bone

62
Q

brocas area

A

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

63
Q

angular gyrus

A

assembles information to help us understand words and concepts

64
Q

wernickes area

A

works with angular gyrus, insular cortex and basal ganglia
to process words and word sequences to determine context and meaning

65
Q

insular cortex

A

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

66
Q

dysphasia

A

language part of the brain is damaged

67
Q

dysarthria

A

muscle weakness
slurred speech, quiet voice

68
Q

apraxia

A

can’t move facial muscles

Medicine: PBL wrap-ups (21 decks)

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