Week 1 & 2 - Stroke Management Flashcards
Posterior Circulation Syndrome (POCS)
- Ipsilateral cranial nerve palsies with contralateral sensory/motor loss
- Vestibular/occular signs
- Isolated cerebellar dysfunction
- Isolated homonymous hemianopia
- Brainstem and cerebellar deficits: vertigo, ataxia, CN signs
- 24%
Lacunar Syndrome (LACS)
- Pure motor stroke (posterior limb of internal capsule)
- Pure sensory stroke (infact to thalamus)
- Sensory motor stroke
- Ataxic hemiparesis
- Dysarthria (slurred speech), Clumsy hand syndrome
- 25%
Partial Anterior Circulation Infarct (PACI)
- 2/3 components from TACI
- Aphasia typically related to expressive (speak) or receptive (understand)
- Typically no drowsiness
- ACA/MCA - 34%
Total Anterior Circulation Infarct (TACI)
- Hemiparesis and/or hemisensory loss
- Homonymous hemianopia
- Global aphasia/visuospatial neglect (unaware of half the environment)
- ACA and MCA - 17%
What is a Transient Ischaemic Attack (TIA)?
- Rapidly developed clinical sign of focal or global disturbance in cerebral function
- Is a warning sign to stroke
- Last <24 hours
What are the subtypes of stroke?
- Ischemic (85%)
- Intracerebral Haemorrhage (10%)
- Subarachnoid Haemorrhage (5%)
What are the signs of an Upper Motor Neurone (UMN) syndrome?
- Weakness/paralysis of movement (corticospinal not working)
- No profound wasting (more generalised)
- Spasticity and hyperreflexia (no dscending output from brain to calm reflexes down)
- Primitive reflexes
- Cortex, cerebellum, basal ganglia, BS motor nuclei
Cell body lesion will be in the brain
What are signs of a Lower Motor Neurone (LMN) Syndrome?
- Weakness or paralysis of individual muscles
- Wasting (specific muscles)
- Fasiculation (spontaneous firing of neurones)
- Hypotonia & hyporeflexia/areflexia
- Anterior horn cells, motor cranial nerve, peripheral nerves
Cell lesion will be in spinal cord
What does the lateral corticospinal tract do?
Controls fine movement of ipsilateral limbs, innervate distal muscles
What does the anterior corticospinal tract do?
Controls axial and girdle muscles, innervates proximal muscles (eg. trunk)
What does the rubrospinal do?
Facilitates activity of flexor muscles, cells orignate in red nucleus (gross motor)
What are the descending tracts for tone, posture, and balance?
- Reticulospinal
- Tectospinal
- Vestibulospinal
What is the foramen magnum and tentorium?
- Foramen magnum separates brain and spinal cord
- The tentorium separates the cerebral lobes with the brainstem and cerebellum
What does glioma, meningioma, schwannoma, haemangioblastoma, and neuromas arise from?
Glioma - brain tissue
Meningiomas - surrounding meninges/membrane
Schwannomas - cranial nerves
Haemangioblastoma - blood vessels
Neuromas - nerve sheaths
What is a haemorrhagic stroke?
It is the bleeding into the brain by rupture of blood vessels of an intracerebral artery
- 10-15% of all strokes
What is an ischaemic stroke?
Inadequate blood supply to part of the brain as a result of:
- An embolosm: blood clot formation which travels via bloodstream to brain
- Thrombosis: narrowing of blood vessels
- 85% of all strokes, blockage of artery
What is thrombolysis (tPA - tissue plasminogen activator) and what does it do?
- It re-canalise blocked vessels, restore penumbra
- Restore blood supply to region within therapeutic time frame (~<5 hours)
What are some primary exclusion criteria for tPA?
- History of haemorrhage stroke (if bleed and give thrombolytic medication, patient will die)
- AVM or aneurysm, cancer
- Elevated BP
- Seizure at onsent
- Pregnancy
- Patient >85 years
What are the gradings of NIHSS? (The National Institute of Health Scale Stroke)
0: no stroke
1-4: minor stroke
5-15: moderate stroke
16-20: moedrate to severe stroke
What are the gradings for the Modified Rankin Scale (mRS)?
0 = no symptoms
1 = no significant symptoms
2 = slight disability, can look after themselves
3 = moderate requiring some help
4 = moderate disability; unable to walk without assistance
5 = severe disability; incontinent, requires nursing
6 = death
What is the function of the frontal lobe?
Motor function, problem solving, memory, language, planning, reasoning, social, personality, judgement (Broca’s aphasia)
What is the function of the parietal lobe and its deficits?
Function: sensory information
Deficits: contralateral neglect, aphasia (language), agnosia, anasognosia
Which lobe is responsible for processing auditory information from ears to understand meaningful speech and memory?
The temporal lobe
What are some deficits of the temporal lobe?
Wernicke’s aphasia (difficulty understanding words), prosopagnosia (diffucluty recognising face)
What does the occipital lobe do?
Processes visual information
What does the cerebellum do and its deficits?
Function: coordination of voluntary motor movements, balance, equilibrium, muscle tone
Deficits: vertigo, loss of coordination fine movements, walking, rapid movements, dysarthria (slurred speech), poor postural control
Function of basal ganglia and its deficits?
Function: voluntary motor control, procedural learning to routine behaviours/habits, cognitive and emotional functions
Deficits: difficulty initiating movements, increased muscle tone, posture
Which part of the brain relays motor and sensory signal to the cerebral cortex and receives signal as sensation which passes on to the cortex for interpretation?
Thalamus
What is the function of the brainstem (midbrain, pons, medulla) and its deficits?
Function: controls heart rate and lungs. Regulates vital body functions
Deficits: decreased breathing, dysphagia (swallow), balance & movement, vertigo, sleeping difficulty, ipsilateral CN findings, contralateral motor & sensory signs
Which artery supplies the medial part of the brain?
ACA - lower limbs
The MCA supplies the…
Lateral areas of the brain and face & upper limbs
Which artery supplies 80% of the brain and its anterior and posterior?
Internal carotid artery (ICA)
Anterior: optic nerves, frontal lobes, parietal & temporal lobes
Posterior: cerebellum, brainstem, thalamus, occipital lobe, medial temporal lobe
What is encephalitis?
Acute inflammation of brain tissue (viral or bacterial)
What happens if the ACA is damaged?
- Contralateral hemiplegia and sensory loss of lower limb
- Dysarthria and aphasia
- Prefrontal cortex: emotions, bevaiours, decision making
What happens if the MCA is damaged?
- Contralateral hemiparesis & sensory loss of upper limb and face
- Dominant: Broca’s aphasia (expressive, speech not fluent/not expressed), Wernicke’s aphasia (receptive, can’t understand words)
- Non-dominant: apraxia (willing to perform but can’t figure out), contralateral visual & sensory hemispatial neglect
What happens if the PCA is damaged?
Contralateral visual field deficits - homonymous hemianopia, visual agnosia
How would an occupational therapist help a stroke patient?
They help people regain function and re-learn how to perform everyday tasks that person needs or wants to do
Promotes health and wellbeing
Re-education
Cognition assessment
