Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

PBL > Unit 6 : Stroke > Flashcards

Unit 6 : Stroke Flashcards

1
Q

What is a stroke?

A

A medical emergency when blood supply to parts of the brain is significantly reduced or stopped leading to necrosis of brain tissue.
Is often cardiovascular in origin and results in neurological deficits

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How can the degree of damaged tissue after a stroke be classified?

A

Necrotic tissue - immediate area of direct and irreversible tissue death
Ischemic pneumbra - reversibly damaged brain tissue, that may or may not die depending on intervention, typically surrounds the necrotic tissue.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How can stroke damaged the blood brain barrier?

A

Necrotic tissue releases DAMPs, this triggers acute inflammation in the brain tissue, this can cause secondary damage to the brain tissue.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What would be the effect of a stroke depending on what lobe of the brain was damaged?

A

Frontal - movement and executive function
Parietal - sensory information
Occipital - vision
Temporal - hearing, smell, memory, language, facial recognition

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What would be the effects if the cerebellum was damaged by stroke?

A

Decrease in muscle co-ordination and balance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What would be the effects if the brainstem was damaged by a stroke?

A

Difficulty controlling:
Heart rate, Bloood pressure, breathing, GI function and consciousness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the risk factors for a stroke?

A

High cholesterol - thrombus risk increases
Hypertension - damaged arterial walls - increase risk of a hemorrhage
Diabetes - tend to have high blood pressure and atherosclerosis
Atrial fibrilation - increased risk of cardioembolism
Obesity - raised levels of cholesterol
Diet - alcohol increase BP
Smoking - nicotine and carbon monoxide damage the blood vessels
30-40% of strokes are thought to have a genetic element.
Age - increase risk of age
Gender - male have higher risk as set age but as females live longer have a greater risk overall.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What genetic conditions increase the risk of a stroke?

A

Sickle cell disease - ischemic
Small vessel vasculopathies - ischemic
Marfan syndrome - connective tissue disorder, results in heart murmus.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How common is an ischemic stroke?
What are the different categorise of an ischemic stroke?

A

85% of stroke are ischemic in origin.
Thrombosis - narrowing/plaque in the place of blockafe
Embolism - plaque formation elsewhere breaks off and blocks bv at a secondary location

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What blood vessel is most commonly occluded by stroke?

A

Middle cerebral artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How common is a hemorrhagic stroke?
What are the different classifications of a hemorrhagic stroke?

A

15% of strokes
Subarachnoid - between arachnoid and pia mater
Intracerebral - within the brain tissue itself.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the four different categorise of stroke in the Bamford classification criteria?

A

Partial Anterior Circulation Stroke (PACS)
Total Anterior Circulation Stroke (TACS)
Lacunar stroke (LACS)
Posterior circulation stroke (POCS)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the features of a partial anterior circulation stroke?

A

Affects regions of the brain effected by the middle of the anterior cerebral arteries.
Two of the following
- unilateral weakness of sensory deficit in limbs or face
- higher cerebral dysfunction
- homonymous hemianopia (visual loss)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the features of a total anterior circulation stroke?

A

Affects regions of the brain supplied by the middle and the anterior cerebral arteries.
Will have:
- unilateral weakness and loss of sensation in the face and limbs
- homonymous hemianopia (vision loss)
- higher cerebral dysfunction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the key features of a lacunar stroke?

A

Subcortical stroke meaning there is no damage to higher cerebral functions.
Effects deep white matter such as basal ganglia or pons.
Blockage tends to be in a small artery.
Leads to one of the following
- sensory deficit
- motor deficit
- sensorimotor deficit
- ataxia hemiparesis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are some key features of a posterior circulation stroke?

A

Blockage in the posterior cerebral artery
Results in the following
- cranial nerve palsy
- contrlateral motor/sensory deficit
- conjugate eye movement disorder
- cerebralar dysfunction
- isolated homoymous hemianopia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are transcient ischemic attacks?

A

Also known as mini strokes
Blood supply is temporarly interrupred lasting less than 24 hours (normally last less than an hour).
No permanent brain damaged
20% of TIA patients will later suffer from a stroke

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How does a stroke patient present in clinic?

A
  • Rapid onset of symptoms
  • Lasting longer than 24 hours
    Often facial drooping, limb weakness (unable to lift their arms up), slurred speach and vision loss or unsteadiness.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the purpose of a Rosier Score?

A

A rosier score identifies the likelihood of stroke, allowing rapid treatment to take place if necessary.
Scored between -2 to 5, a score below zero means a stroke is unlikley.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

How do you calculate a ROSIER score?

A

Has there been loss of consciousness/syncope? (-1)
Has there been seizure like activity (-1)
Asymetrical facial weakness (1)
Asymmetrical leg weakness (1)
Asymmetrical arm weakness (1)
Speach disturbance (1)
Visual field defect (1)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What test might be done to help diagnose a stroke patient?

A
  • ROSIER score
  • brain imaging
  • blood test
22
Q

How does a diffusion weighted MRI indicate stroke?

A

highlights white areas of reduced water movement (odema), this highlights ischemic stroke.

23
Q

How does a functional MRI identify areas of stroke?

A

Measures change in oxygenated blood flow.
Detect neural activity in the brain by evaluating the proportion of blood flow to certain areas
Can identify the region of the brain affected but not the type of stroke

24
Q

How is an MR angiography useful in stroke imaging?

A

Creates a map of blood vessels, can identify aneurysms or occlusions of blood flow.

25
Q

How does an MRI help in the diagnosis of a stroke?

A

84% accuracy, less available and more expensive
Coloured - red tends to be a lack of blood flow
Ischemic - tends to go grey brain tissue when damaged
Hemorrhagic tends to go white when brain tissue is damaged.

26
Q

How does a CT help diagnose a stroke?

A

54% accuracy but less expensive and lore widely available.
Can take 12-18hours after a stroke for brain tissue changes to appear on scan. Will later appear grey (less dense
Ischemic - blockage in artery is hyperdense, appears white
Hemorrhagic - tissue appears white, hyperdense blood.

27
Q

In CT and MRI what are the signs of stroke damage on the brain tissue?

A

Loss of symmetry in the brain
Loss of clear sulci and gyrus
Loss of midline in the brain
Occlusion in the ventricles.

28
Q

How does a doppler scan aid in stroke diagnosis?

A

A doppler scan is a type of ultrasound, changes soundwaves into colours related to the different speed and direction of blood flow.
Slower speed of blood flow is more likley to indicate a stroke

29
Q

What are the NICE guidelines for a suspected stroke patient?

A

Use FAST to screen hospital patients for a potential stroke
Measure blood glucose to exclude hypoglycaemia as a cause of stroke.
In the emergency department establish with a ROSIER score.

30
Q

What treatment should be given to all TIA patients or suspected patients?

A

300mg aspirin daily, unless contradicted, to be started immediatly.
Refer to a specialist assessment and investigation to determin likelihood of a stoke within 24 hours of symptoms onset
Offer secondary prevention advice.

31
Q

Why might a blood test be done in patients suspected of a stroke?

A

Blood glucose - exlcude hypoglycemia as the cause, high bg may damaged bv indicate hemorrhage
Anemia - increase blood loss
Electrolyte distribution - changed by stroke, early warning sign for cerebral odema
Inflammatory response marker
Clotting abnormalities
Full blood count - sickle cell, higher RBC can indiacte risk of clot
Erthrocyte Sedimentation rate - high means inflamation
Creatine - indicate risk of a secondary heart attack
Cholesterol - ischemic
INR - higher INR indicates slower clotting of blood

32
Q

What common medication is given to reduce the risk of a secondary stroke?

A
  1. Aspirin - blood thinner (for Ishcemic stroke ONLY0
  2. Statins - reduce cholesterol (ischemic)
  3. Beta blockers - reduce blood pressure (hemmorrhagic stroke)
33
Q

How is cloridogel used in stroke treatment?

A

Is an antiplatelet, may be given instead of aspirin in the long term.
Is not given immediatly due to higer risk of sdverse cardiovascular events.

34
Q

What is thrombolysis?

A

A treatment used after an ischemic stroke, if patient present in less than 4.5 hours after the stroke.
Medication such as alteplase to degrade the blood clots, helps return blood supply and prevent further necrosis of tissue.

35
Q

What are some of the complication of thrombolysis, hence what are its contradictions?

A

Increase risk of hemorrhage, hypotension, allergic reactions, bleeding, angioedema and reperfusion arryhtmias.
Not given if have bleeding disorders, previous hemorrhage, severe uncontrolled hypertension, redcent significant head or facial injury

36
Q

What is thrmobectomy?

A

A surgical procedure, often aided by an angiogram, uses a catheter to grab and remove clots, only used for occlusion in large blood vessels

37
Q

What is a hemicraniectomy?

A

Brain surgery to remove a portion of the skull, to relieve pressure inside the cranial cavity, reduce the risk of severe brain damage from inflammation or increased intracranial pressure

38
Q

What facilities are available on a stroke ward?

A

RVI Newcastle has 34/7 access to thromobolysis and mechanical thrombectomy.
Staff members include a stroke liason sister (adivce and support to family/patient, aid in discharge plans and assessing capacity) and a specialist stroke nurse (to arrange referalls, secondary prevention and aid monitoring of patients)
Facilities to allow acute monitoring including blood pressure, temperature for 72 hours after the onset of a stroke.

39
Q

Who should be admitted to an acute stroke ward?

A

All people with a suspected stroke should be admitted directly to an acute stroke ward following an initial assessment or after visiting to A&E department.
High risk TIA patients may also be admitted onto the ward for monitoring.

40
Q

What is recommended for the care of stroke patients in recovery in hospital?

A

Early mobilisation - including sitting, standing or walking
Physiotherapy
Speach and language therapy

41
Q

What needs to be considered for nutrition and hydration in stroke patients?

A

Is most important in patients who have long term dysphagia so struggle to swallow.
Must ensure swallowing is checked before given solid food within 72 hours of admission
Patients may require tube feeding or diet modification including fluid thickening to prevent aspiration, potentially causing pneumonia.
Oral medication may need to be changed to IV or IM
Meetings with a dietitian.
May need IV fluids to prevent dehydration.
Recommend small and regular meals.

42
Q

What is the impact of depression in stroke recovery?

A

16% of stroke sufferers develop depression as a consequence.
Biologically this is due to the damage of seratonin and noradrenergic neurones involved in emotional regulation, and inflammation in the brain (SSRI’s decrease inflammation in the brain).
Emotional impact - sudden change in lifestyle and opportunities, major impact on patient wellbeing and perpspecitve

43
Q

Describe the global prevalence of stroke.

A

Highest in Mongolia, China, Brazil and Indonesia
Lowest in Canada, Austrialia and New Zealand.

44
Q

What is the prevalence of stroke like in the UK?

A

Stoke causes 38,000 deaths a year
Mean age of onset in 68.2 for males and 73 for females.
1 in 6 people will have a stroke.

45
Q

What long term impact does stroke have on a patients daily life activities?

A

Urinary incontinence - anxiety to leave the house, encourage pelvic floor exercises and incontinence products
Medications can decrease libido, may have erectile dysfunction
Cannot drive for 1 month, many people will not be able to drive again, must be reassessed by a doctor.

46
Q

What is goal-centred rehabilitation?

A

Where the patient works with the MDT to design indivudialised therapy based on SMART goals, this help tailor treatment to what the patients deems to be most important.
Specific
Measurable
Achievable
Result Focused
Time specific

47
Q

What is involved in physiotherapy of a stroke patient?

A

Physiotherapy involves balance, position, gait and limb movements.
New methods involve - electromechanical assisted gait training, where robotic technology is used to move the limbs and support some of the weight of the patient
Rhytmic cueing - auditory rhythm can help improve timing of motor actions such as walking, aids time keeping in the brain.
Constraint indiced Movement therapy - preventing the patient from using their functional limb to encourage retraining of the affected limb.
May be offered orthotics.

48
Q

What is involved in a neurological history taking?

A

Includes assessing mental status, cranial nerve function, motor function, sensory function, co-ordination, reflexes, speech, stance and gait.
History to indicate the onset and frequency of these symptoms.
May include a mini mental state examination but this is not common as requires too long for a stroke patient.

49
Q

What is the role of a speech and language therapist?

A

Assess the patient fro problems with speech or swallowing
Create a therapy porgramme
Help develop communication skills, adivse family/medical staff on how best to communicate with the patient.
Work with patients who suffer
Dysphasia - language comprehencsion
Dysarthria - speech production
Dysphagia - difficult swallowing

50
Q

What are the different components of ageism?

A

Ageism messages: insulting comments and actions
Ageism in interpersonal interactions: presumptions of diminished capabilities in older individuals
Internalised ageism: older peope undervaluing themselves.

PBL (23 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions