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Sc 25 David's weakness > Intro lecture > Flashcards

Intro lecture Flashcards

1
Q

who does stroke generally occur in?

A

Older population

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2
Q

Speech can play an important role in helping identify where the stroke is

A
  • located in the left hemisphere of brain in 90% of people even if they are left handed
  • If speech is slurred then one knows that pathology is likely located in the left hemisphere
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3
Q

What is the Acute Thrombolytic/clot busting time window?

A

< 3 hours for the best effect

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4
Q

Why has it happened?

A

Wall irregularities; cause of thrombus

e.g. as a result of one of the many risk factors

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5
Q

Stroke Epidemiology

A

Incidence:

  • 114/100 000
  • 75% > 65 years

Results of Stroke :

1/3 recover well

1/3 significant disability - these ppl have life changed immensely

1/3 die

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6
Q

Total annual cost of stroke

A

£7000 million

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7
Q

Single most important risk factor

A

HIGH BLOOD PRESSURE

increased b.p. leads to increased risk of stroke

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8
Q

R.F #2

A

Diabetes

Increases risk of stroke

relative risk is roughly x2

Diabetics MORE LIKELY TO DIE than non-diabetics

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9
Q

R.F #3

A

Cigarette smoking

males and females equally affected

RR = x1.5

Risk declines after cessation of smoking

Association btwn carotid diease and smoking

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10
Q

R.F #4

A

High Cholesterol

deposition of cholesterol in vessel wall occurs as one gets older

this narrows vessels; makes blood flow IRREGULAR

STATINS: lower cholesterol

Hard to lower cholesterol via diet alone, pts are put on statins

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11
Q

Summary of risk factors

A
  • High B.P
  • Diabetes
  • Smoking
  • High cholesterol
  • Alcohol (not independently but goes along with the others)
  • Lifestyle
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12
Q

Blood supply to the Brain:

Anterior & posterior circulation

A

Anterior Circulation (+middle):

  • made up of the Right and Left Common Carotid Arteries

Posterior Circulation:

  • ​Right and left Vertebral arteries
    • these form the Basilar artery
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13
Q

Posterior circulation event

involves problems with:

A
  • Vision
  • Co-ordination (due to cerebellum affected)
  • Breathing (brainstem affected)
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14
Q

Anterior Circulation Event:

Involves problems with:-

A
  • Parietal lobe
  • Motor cortex
  • Movement and Sensory problems
    • perhaps also speech depending on which hemisphere is involved (speech usually in the left)
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15
Q

Aphasia/dysphagia

Dysarthria

A

Aphasia: Lack of speech completely

Dysphagia: Difficulty getting words out; more left sided

Dysarthria: slurred speech

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16
Q

Function of Motor Cortex

A

movement

17
Q

Function of Frontal lobe

A
  • Judgement
  • Foresight
  • voluntary movement
18
Q

Function of Broca’s area

A

speech

19
Q

Function of Frontal lobe

A

smell

20
Q

Function of Temporal lobe

A

Intellectual and emotional functions

21
Q

Function of Brainstem

A
  • swallowing
  • breathing
  • heartbeat
  • wakefullness centre
  • other involuntary functions
22
Q

Carotid Bruit

A
  • systolicsound heard over the carotid artery area during ausculation in neck
  • May occur as a result of Carotid Artery Stenosis
  • narrowing of the vessel
23
Q

Sign of an UPPER MOTOR NEURON LEISON

A

Extensor Plantar

means that something has occured in the motor cortex to the anterior horn cell

e.g. stroke, M.S. etc

24
Q

sign of a LOWER MOTOR NEURON

A

Flexor Plantar

Anterior horn cell in spinal cord and down

e.g. Motor neurone disease, polio etc

N.b.: in babies toes are extensor for the first 3 months as the fibres are not myelinated yet. once they become myelinated they become flexor

25
Q

Diagnosis of Stroke

A

CLINICAL DIAGNOSIS!!

n.b. still need to do a CT scan ASAP to see if there is a clot or a bleed

FAST test - 93-95% accurate

Face, Arm , Speech test

26
Q

Blood on CT

What should you NOT do?

A

if there is blood on a CT it shows there is a Haemorrhage

appears bright white on a CT

CANNOT give thrombolytics - this will make the bleed worse otherwise

CT IMAGING IS DONE BEFORE THROMBOLYSIS TO EXCLUDE HAEMORRHAGE

27
Q

Management of Acute Ischaemic Stroke

A
  • recognise:
    • symptom recognition, call 999
  • react
    • paramedics diagnose stroke, priority transfter to hospital with ASU
  • respond
    • triage to stroke team, Urgent CT for <3hr, reduces LOC
  • reveal
    • confirm diagnosis, assess for thromobylsis
  • Rx/Reperfusion
    • thromobolysis, aspirin, optimise physiology
  • Rehabilitaion
    • MDT assessment and treatment
28
Q

where shoud all patients with ACUTE stroke be admitted to?

A

A hospital with a multidisciplinary stroke unit

29
Q

telemedicine

A

enables all hosptials to continue to provide hyperacute care

30
Q

Conclusions

A

Stroke is common

Prevention in terms of vascular risk factors = VERY IMPORTANT

Acute stroke therapies work well

Sc 25 David's weakness (8 decks)

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