Stroke Flashcards
(19 cards)
What are some risk factors for a stroke? State which ones B had.
Modifiable
Smoking
Hypertension (B)
Diabetes (B)
Hypercholestermia
Alcohol intake
Atherosclerosis
Taking certain drugs
Obesity
Non-modifiable
Family history
Age (B)
Physiological abnormalities
Ethnicity
Male sex (B)
Previous stroke/TIA (B)
Patent foramen ovale (hole in heart)
What are the more common symptoms that are not usually seen with an ischemic stroke?
Nausea
Vomiting
What is the FAST acronym used for?
Identifying signs of a stroke
F - Face - droop/eye crooked
A - Arms - difficulty lifting arms, drift?
S - Speech - words slurred, unable to speak, can understand you?
T - Time - last time they were without symptoms
What type of stroke did B have and explain what the characteristics of this are
Ischemic Stroke
Cause: This type occurs when a blood vessel supplying blood to the brain is blocked, usually by a clot. The blockage can result from atherosclerosis (narrowing of the arteries) or an embolism (a clot that travels from another part of the body). Most common 80-85%
Symptoms: Symptoms may include sudden weakness or numbness, difficulty speaking, vision problems, and loss of balance or coordination.
What parts of B’s brain were involved? And what was the result of this?
Left cerebrum, temporal lobe = sight
Left cerebrum, occipital lobe = speech
Cerebellum = coordination
Cranial nerves V, VI & VII, as well as some impact on cranial nerve X = movement/sensation especially face
What is the range of score for the neurological assessment Glasgow Coma Scale?
3-15
Eye Opening (1-4)
Verbal Response (1-5)
Motor Response (1-6)
Severe impairment: GCS of 3-8
Moderate impairment: GCS of 9-12 (B=10)
Mild impairment: GCS of 13-15
What diagnostic tests were done for Patient B initally and why?
- CT Scan
Speed: CT scans are quick, making them ideal for emergency situations where time is critical.
Detection of Hemorrhage: CT is particularly effective in identifying hemorrhagic strokes (bleeding in the brain) as it can reveal blood within the cranial cavity immediately.
Acute Changes: In the early stages of an ischemic stroke, CT can show signs of tissue damage and swelling, although these changes may take a few hours to appear.
Later on B had an MRI - why?
MRI (Magnetic Resonance Imaging)
Detailed Imaging: MRI provides more detailed images of brain tissue and can identify smaller strokes or subtle changes in brain structure that a CT may miss.
Ischemic Stroke Detection: MRI is more sensitive in detecting ischemic strokes, particularly in the early stages. It can show areas of restricted blood flow and subtle infarcts.
Assessment of Brain Tissue: MRI can help assess the extent of brain damage and can be useful in evaluating other conditions that may mimic stroke symptoms.
What were some of the other impacts for the patient B?
*Dysarthria
*Dysphagia
*Truncal ataxia
*Poor short term memory & impulse control
*severe visuospatial impairments
What are the two types of asphasia?
Expressive aphasia is an inability to put thought into words (damage to Broca’s speech area).
Receptive aphasia is an inability to understand the spoken word (damage to Wernicke’s speech area).
What cranial nerves (5) are associated with muscles of speech?
Trigeminal nerve (V)
The facial nerve (VII)
The glossopharyngeal nerve (IX)
The vagus nerve (X)
The hypoglossal nerve (XII)
Explain what hemiparesis is? And what did B have?
A weakness or an inability to move on one side of the body
B has obvious right side hemiparesis due to infarction in his left cerebral hemisphere, cerebellum, brainstem and the affected cranial nerves involved in facial movement
B experienced homonymous hemianopia - which is what?
Hemianopic visual field loss on the same side in both eyes. For B it was the right side
What other impacts does a stroke have? B exhibited two -
Fatigue and Depression
What is an immediate treatment option for ischemic strokes?
Immediate treatment (within a few hours) of ischemic stroke most commonly involves using rtPA. Tissue plasminogen activator (tPA) is a naturally occurring human protease enzyme that activates plasmin (converts plasminogen into plasmin). rtPA (recombinant tPA or Alteplase) is made in a lab using recombinant DNA technology
The main goal of treatment with rtPA is reperfusion of the cerebral vessels
What is another treatment option for ischemic strokes?
Anti-coagulation is another common treatment for ischemic stroke.
Antiplatelets:
*Aspirin: blocks prostaglandin synthetase action
*Clopidogrel: inhibits receptor P2Y12, a chemoreceptor on platelet cell membranes
*Dipyridamole: inhibits the phosphodiesterase enzyme
Anticoagulants:
*Dabigatran: competitive direct inhibitor of thrombin (factor IIa)
*Heparin: inhibits antithrombin III, which ultimately inactivates blood clotting factor Xa and inhibits blood clotting
*Warfarin or Rivaroxaban: inhibits vitamin K-epoxide reductase
What is the main goal for treatment for ischemic strokes?
Restore Blood Flow: Quickly restore blood flow to the affected area of the brain to minimize damage. This is often done using thrombolytic (clot-dissolving) medications, such as tPA (tissue plasminogen activator), or mechanical thrombectomy (removal of the clot).
Prevent Further Damage: Manage risk factors and complications to prevent additional strokes or further brain injury. This includes controlling blood pressure, blood sugar, and cholesterol levels.
Support Recovery: Facilitate rehabilitation and recovery of function, including physical, occupational, and speech therapy, to help patients regain lost abilities and improve their quality of life. Example: SLT/PT/OT/Psychology/nursing and social work
What was the specific cause for B’s ischemic stroke?
B had an embolic stroke - blood clot or a shower of blood clots that break off from a thrombus, float downstream through arteries and lodge there blocking a smaller artery.
Therefore ischemia occured; neurons became hypoxic, brain develops inflammation, neurons die!
What neuro tests were part of B’s assessment?
- visual field test
- facial movement
- facial sensation
- corneal reflex
- leg movement/lift
- arm movement/lift
