Week 3 - Stroke 2 Flashcards
What causes symptoms of stroke?
loss of brain function
What are common symptoms of stroke?
speech, feeling, weak limbs, vision, gaze palsy,
What are common symptoms if cerebellum and brainstem are effected?
- ataxia,
- nystagmus of eyes,
- lack of coordination,
- dizziness
- pons damage
What are common symptoms if anterior cerebral arteries are effected?
affects frontal lobe. paralysis of lower limbs, no sensory input.
What are common symptoms if middle cerebral arteries are effected?
paralysis of face, arms and legs.
occipital lobe damage
if its on dominant side (left), you get aphasia. if its on non-dominant side (right), you develop neglect - unawareness of external space (only notice things on right)
What are common symptoms if small vessel/lacunar arteries are effected?
deep matter small area affected. can have huge impact if its in the internal capsule - area with many neurons running together.
They can cause deficits including pure sensory, pure motor, sensorimotor or ataxic hemiparesis.
What are common symptoms if posterior cerebral arteries are effected?
cerebellum and brainstem. can cause coma.
pons damage can lead to full paralysis except for eye.
temporal affected - hearing
occipital affected - vision
What are the 4 kinds of stroke?
TACS - total anterior (and middle) cerebral stroke
PACS - partial anterior (and middle) cerebral stroke
LACS - lacunar stroke
POCS - posterior cerebral stroke
Which kind of stroke has the highest mortality and recurrence rates?
Highest mortality is TACS. Highest recurrence is POCS
What is the survival rate of stroke?
1/3 die in a year
What damage is done after stroke?
50% dependant
60% unable to walk
40% unable to lift both arms
40% confused
30% unable to talk
What are non-modifiable risk factors for stroke?
co-morbidities.
- BP,
- previous stroke,
- heart issues,
- peripheral vascular disease,
- reno-vascular disease,
- carotid disease,
- hyper-coagulable state
- diabetes
What are modifiable risk factors for stroke?
- smoking,
- hypertension,
- diet,
- high LDL,
- alcohol,
- oral contraceptives,
What are the aims of treatment? (3)
- protect brain before necrosis,
- remove clot,
- prevent clot occuring in first place
What is the purpose of acute stroke therapy?
restore blood supply, prevent extension of damage and prevents re-perfusion injury
What thrombolysis drug is used? what time frame?
alteplase - no more than 4.5 hrs
Whats the pattern with how soon to give thrombolysis and the benefit?
sooner its given the more benefit outweighs the harm. after 4.5hrs, harm to patient (bleeding out) outweighs benefit so not given
What other treatments aside from thrombolysis should be given to prevent/manage stroke?
anti-platelets, statins, blood pressure management (ACE’s, CCB’s)
How do you treat a primary intercerebral haemorrhage?
no treatment - just get blood pressure down
What scanning methods are used for detecting stroke and which is the best?
CT, MRI, Perfusion CT, CT angiogram
CT used over MRI as its faster and time is of the essence, MRI is more specific and perfusion CT is advanced and very helpful - take 30 mins compared to 5.
What are issues with scanning techniques?
CT radiation - can lead to hair loss
MRI takes a while and is highly magnetic - dangerous
What does a perfusion CT show?
highlights dead area and hypoxic areas to show degree of damage.
What does a CT angiogram show? Do we use these?
vessel occlusion. quite fast so done often.
Are strokes painful?
most strokes are painless. Haemorrhagic strokes are more likely to be painful, as blood is highly irritant to the meninges.
What are 2 different types of dysphagia?
expressive dysphagia - brocas area damaged. knows what they want to say but cant get the words out
receptive dysphagia - wernickes area. speaks well but cant understand language
What vision loss can be found in middle cerebral artery stroke?
homonymous hemianopia - half visual field in both eyes (2 left halves e.g.)
What is dysarthria?
slurred speech due to motor deficit - weakening of muscle
hemiplegia vs paraplegia?
- hemiplegia is paralysis in one side of the body
- paraplegia is paralysis in the lower limbs
What vision loss does MCA lead to?
homonymous hemianopia
