Stroke Flashcards
(48 cards)
What is a stroke?
Acute neurological dysfunction of a vascular cause
What are the main risk factors for stroke?
▪️ Hypertension
▪️ Diabetes
▪️ Alcohol
▪️ Cardiac disease
▪️ TIA
▪️ Older age
▪️ Male
▪️ Smoking
▪️ Obesity
▪️ Hyperlipidaemia
▪️ Physical inactivity
How can atherosclerosis lead to ischaemic stroke?
▪️ Narrowing and hardening of blood vessels with plaque build up
▪️ Substances in plaque attract platelets
▪️ This builds until a blood clot is formed which blocks the vessel
What are the current major issues surrounding stroke in the UK?
▪️ One every 5 minutes
▪️ Large proportion have depression or disability
▪️ Increased likelihood of unemployment
▪️ Only 8 out of 10 people eligible receive thrombolysis
▪️ Lack of psychologist access
How does stroke incidence change as we age?
It increases
What are the two main types of stroke?
▪️ Ischaemic
▪️ Haemorrhagic
What is FAST?
▪️ Face, Arm, Speech, Time to call 999
▪️ Rapid ambulance protocol to triage patients for thrombolysis
▪️ ~82% sensitivity and specificity
What speech problems may be apparent in someone who is having a stroke?
▪️ Dysphasia (expressive/receptive/conductive)
▪️ Dysarthria (muscle weakness)
▪️ Dyspraxia of speech (difficulty coordinating movements for speech)
▪️ Cognitive communication disorder
What are the main categories of stroke mimics?
▪️ Systemic problems with CNS effects (e.g., hypoglycaemia, delirium, ‘decompensation’)
▪️ Primary CNS problems (e.g., focal epilepsy, MS, functional presentations)
▪️ ENT (e.g., labyrinthine disturbances with nausea and vertigo)
How can you typically differentiate stroke from partial (focal) epilepsy?
The former usually causes negative phenomena (e.g., weakness) whilst the latter often produces positive phenomena (e.g., clonus)
What can be used to treat acute ischaemic stroke or pulmonary embolism?
IV alteplase as soon as possible, ideally within 3-4.5 hours of symptoms (thrombectomy)
What is tissue Plasminogen activator (tPa)?
An enzyme involved in breaking down blood clots so can be used for intravenous thrombolysis
Alteplase = biosynthetic form
What is tPa use in stroke associated wiht?
▪️ Better outcome
▪️ 12% increase in minimal/no disability
▪️ Benefit in all subgroups
Damage to what brain area may present with Broca’s aphasia?
Motor speech area in frontal lobe of dominant hemisphere (left), particularly inferior frontal gyrus
Damage to what brain area may present with Wernicke’s aphasia?
The superior temporal lobe, typically also of the dominant hemisphere
What is a phonemic paraphasia?
Sound substitution or rearrangement but still resembles intended word (e.g., “bap” for “map”)
What is semantic paraphasia?
Entire word is substituted for one of similar meaning (e.g., “knife” for “fork”)
What are the characteristic symptoms of Gerstmann syndrome?
▪️ Finger agnosia
▪️ Dyscalculia
▪️ Dysgraphia
▪️ R-L disorientation
How can you test for language deficits following stroke?
▪️ Understanding (e.g., multiple stage commands)
▪️ Expression (just listen)
▪️ Naming
▪️ Repetition
▪️ Reading
▪️ Writing
▪️ Talk about a scene - can also see emotive features and safety awareness
What is the most common visual problem following stroke?
Homonymous hemianopia (visual field loss in same half of both eyes)
Damage to which area may result in Gerstmann syndrome?
Inferior parietal lobe of the dominant hemisphere, specifically around the angular gyrus
What is visual neglect?
Disorder of attention whereby the individual shows a lack of response to one half of their visual field, unexplained by primary damage to the visual system
How can neglect be subdivided/described?
▪️ Affected space (peripersonal, personal, extrapersonal)
▪️ Mode of output (sensory or motor)
▪️ Sensory modality (visual, somatosensory, auditory)
When does partial or complete recovery from neglect after stroke typically occur?
In the first month
