10 - Stroke Rehabilitation Flashcards
(25 cards)
What is special about a comprehensive stroke centre?
They do everything including thrombectomy, hyperacute and acute stroke
How does HASU differ from comprehensive stroke centres?
HASU = doesn’t do mechanical thrombectomy - does do everything else
Which Ps does ASU take?
Stroke Ps after initial interventions
Who is involved in stroke Ps rehab?
Everyone
What are potential obstacles to successful rehabilitation?
How should you respond to challenges in rehabilitation?
Be truthful with Ps
Consistent & flexible approach
What are potential complications of stroke?
Why should you be careful about hemiplegic shoulder injury?
Can easily dislocate shoulder - have to be very careful with this. If dislocated can cause long term pain
What do you need to do for secondary prevention of stoke?
Unequivocal evidence that statins reduce the chance of repeat stroke
What anti-thrombotic agents can be given to Ps post stroke?
Aspirin
Clopidogren
DAPT
Anticoagulants - Warfarin or DOAC
What Rx is given for large stroke or low risk of TIA?
Aspirin (300mg OD 2w) then 75mg OD or clopidogrel 75mg OD
What Rs is given for a smaller stroke or high risk of TIA?
DAPT (Aspirin 75mg OD + Clopidogrel 75mg OD) for 3 w
Then Clopidogrel 75mg OD
What is a TIA defined as?
Transient neurological dysfunction secondary to ischaemia without infarction.
What is a crescendo TIA?
When 2 or more TIAs occur within a risk - high risk of progression to a full stroke
What are the sudden onset Sx of a stroke?
Sudden
- weakness of limbs
- facial weakness
- onset dysphagia
- onset visual or sensory loss
What are the RF for a stroke?
CVD or PVD
Previous stroke or TIA
AF
Carotid artery disease
HT
DM
Smoking
Vasculitis
Thrombophilia
Combined oral contraceptive pill
How should a stroke be managed?
Admit to specialist stroke centre
Exclude hypoglycaemia
Immediate CT (exclude intracerebral haemorrhage)
Aspirin 300mg stat post CT
If intracerebral haemorrhage excluded - can give alteplase (window 4.5 hrs). Monitor for complications after.
Dont lower BP during a stroke - risks reducing perfusion to the brain.
How should TIAs be managed?
Start aspirin 300mg daily
Start secondary measures for CVD
If crescendo TIA - seek specialist
What is the gold standard imaging for stroke?
Diffusion-weighted MRI
What imaging can detect carotid stenosis?
Carotid ultrasound
What technique can be used to remove plaques in the carotids?
Endarterectomy
What is standard secondary prevention of stroke?
Atorvastatin 80mg - although dont start immediately
Aspirin 300mg OD or DAPT (clopidogrel) = both for 2-3w
If sinus rhythm - then clopidogrel
If AF - DOAC
When is anticoagulation for AF given
- after a TIA
- after a very small stroke
- after a moderate stroke
- after a large stroke
- Immediately
- Immediately
- 3-7 days after moderate stroke
- 14 days after a large stroke - provided repeat brain imaging has been done
What investigations should be done after a stroke or TIA?
