PBL 44 Flashcards
(37 cards)
What are the two main types of stroke?
ischaemic & haemorrhagic
Give some causes of ischaemic strokes
Thrombosis
Embolism
Systemic hypoperfusion
Cerebral venous sinus thrombosis
Give some causes of haemorrhagic stroke
Cerebral haemorrhage
Subarachnoid haemorrhage
What is the right hemisphere involved in?
Creativity, imagination, recognition and emotion
What is the left hemisphere involved in?
Logic, number skills, language and analytical skills
Effects of stroke in the cerebellum
VANISH’D
- Dizziness
- Headache
- Nausea and vomiting
Effects of stroke in the brainstem
- Breathing and heart functions
- Body temperature control
- Balance and coordination
- Weakness or paralysis
- Chewing, swallowing, and speaking
- Vision
- Coma
- Death
Signs and symptoms of stroke
- Sudden weakness or paralysis on one side of the body
- Sudden loss of sensation or abnormal sensations on one side of the body
- Sudden difficulty speaking, including difficulty coming up with words and sometimes slurred speech
- Sudden confusion, with difficulty understanding speech
- Sudden dimness, blurring, or loss of vision, particularly in one eye
- Sudden dizziness or loss of balance and coordination, leading to falls
Difference between stroke and TIA
TIA symptoms usually disappear within minutes and rarely last more than 1 hour
Risk factors for stroke (modifiable and non-modifiable)
- Non-modifiable
1. Age: older
2. Gender: male
3. Race
4. FHx
5. Previous strokes - Modifiable
1. Hypertension
2. Diabetes
3. AF
4. Smoking
5. Hyperlipidaemia
6. Obesity
Treatments of ischaemic stroke
Antiplatelets - CLOPIDOGREL
Anticoagulants - DABIGATRAN (II), APIXABAN(Xa), WARFARIN
Hypertension drugs (Acei, ARB, CCblocker)
Thrombolysis = clot buster
Thromboectomy = widen a narrowed artery
Treatments of haemorrhagic stroke
Treatments that help blood clot = Vit K & transfusions of fresh frozen plasma or platelets
Hypertension drugs if needed
Surgery to remove large areas of accumulated blood or shunt to relieve increased ICP
Dysarthria vs dysphasia
Dysarthria is caused by UMN lesions of the cerebral hemispheres, or LMN lesions of the brainstem. Affects the bulbar muscles which are used in forming words, so it is a disorder of SPEECH
Dysphasia is a disorder of LANGUAGE. It is the impaired ability to understand or use the spoken word, caused by a lesion in the dominant hemisphere.
Causes of aphasia
Stroke
Severe head injury
Brain tumour
Progressive neurological conditions e.g. dementia
Give some means of primary stroke prevention
MANAGE THE RISK FACTORS WHEN THERE IS NO PREV. HISTORY
- Hypertension
- Smoking cessation
- Diabetes
- Dyslipidaemia
- AF
- Postmenopausal HRT
- Diet and exercise
- Weight
- Alcohol consumption
Explain secondary stroke prevention
WHEN IS PREV. STROKE HISTORY = ABCDE A - Antiplatelets and anticoagulants B - Blood pressure C - Cessation of smoking, cholesterol lowering medications and carotid revascularisation D - Diet E - Exercise
Mechanism of clopidogrel
ADP receptor inhibitor
ADP causes platelet aggregation
Anticoagulants vs antiplatelet function
Anticoagulants slow down clotting by reducing fibrin formation (DABIGATRAN, WARFARIN)
Antiplatelets prevent platelets clumping and prevent clots from forming and growing (CLOPIDOGREL/ASPIRIN)
How do anterior cerebral infarct symptoms compare to middle cerebral and posterior cerebral?
Anterior cerebral = contralateral limb weakness and contralateral sensory deficit where the LOWER LIMB IS MORE IMPACTED
Middle cerebral = contralateral limb weakness and contralateral sensory loss where the UPPER LIMB IS MORE IMPACTED
Posterior cerebral = contralateral problems with vision (homonymous hemianopsia) and also contralateral hemiparesis and sensory deficits
Clinical response to brain injury
- Altered conscious level
- Loss of consciousness
- Post traumatic amnesia - Symptoms
- Vomiting
- Pain
- Dizziness
Difference between primary and secondary brain injury?
Primary = occurs at the moment of trauma
Secondary = occurs immediately after and produces effects which last for a long time
Brain injury can be classified as focal or diffuse, what is the difference?
Focal = specific location: contusion or haemorrhage
Diffuse = over a widespread area: diffuse axonal injury, hypoxic brain injury, diffuse brain swelling
Symptoms of primary brain injury
Mechanoporation
Calcium influx
Oxygen free radical formation and lipid peroxidation
Axotomy
Cytokine-mediated inflammatory response
Symptoms of secondary brain injury
- Raised ICP
- Hypoxic brain injury
- Ischaemic brain injury
- Seizures
- Infection
- Hydrocephalus (>fluid in the brain)
- Cerebral oedema
- Excitatory amino acids (EAAs) - Can cause swelling, vacuolization and neuronal death
- Endogenous opioid peptides - Modulate the presynaptic release of EAA neurotransmitters