stroke

Question 1

Stroke/CVA

Answer 1

brain attack
A stroke, also known as a cerebrovascular accident (CVA), is the rapid loss of brain function(s) due to disturbance in the blood supply to the brain. This can be due to ischemia (lack of blood flow) caused by blockage (thrombosis, arterial embolism), or a haemorrhage (leakage of blood).

Question 2

Classification

Answer 2

Haemorrhagic stroke

Ischaemia stroke

Question 3

Haemorrhagic stroke

Answer 3

bleeding from a cerebral artery

Question 4

Subarachniod haemorrhage

Answer 4

bleeding into subarachnoid space
due to rupture of congenital anerysm or trauma
sudden intense headache, vomiting, neck stiffness and loss of consciousness
10% die within two hours
40% die within two weeks

Question 5

Aneurysm

Answer 5

saccular
fusiform
ruptured

treated by surgical clipping

Question 6

Intracerebral haemorhage

Answer 6

bleeding in deeper part of brain
longstanding hypertension
arterial wall weaken
micro-aneurysm develop 
rupture and bleed
sever headache and vomitting

Question 7

Ischaemic stroke

Answer 7

80% strokes due to occulsion
atherom of cerecral artery
emboli from atheromatous plaque in hear/neck vessel

Most common vessel: MCA > PCA > ACA> brainstem (more serious)

Question 8

Embolic stroke

Answer 8

completed stroke -tia-
sudden onset

blood clot that forms elsewhere in the body (embolus) breaks loose and travels to the brain via the bloodstream.
lodges in cerebral artery distruptiung the flow of blood

Question 9

artrial fibrilation

Answer 9

Atrial fibrillation is irregular heartbeat,blood clots are more likely to form in your heart, increasing stroke risk

Question 10

thrombotic stroke

Answer 10

completed stroke-tia-
 overnight
develops over several days
early full recovery
20% risk of full CVA with a month

Question 11

Bamford classification

Answer 11

TACS – Total anterior circulation stroke
PACS – Partial anterior circulation stroke
POCS– Posterior circulation stroke
LACS – Lacunar stroke(deep penetrating arteries)
(TAC)S=stroke
(TAC)I=infarct
(TAC)H=haemorrhage

Question 12

Tramatic brain injury

Answer 12

injury to the brain caused by external physical force,
altered state of consciousness
impairment of cognitive or physical abilities
disturbances of behaviour or emotional functioning

temporary or permanent

Question 13

Mechanism of injury

Answer 13

Penetrating injury-risk of infection

Compression - inner cerebral traume

Deceleration- outer cerebral injury discrete cognitive deficit

Diffuse axonal injury– poor communication between brain structures, reduces processing speed, global impairment

Question 14

Extradural haemorrhage

Answer 14

bleeding into extradural space

cause by severe trauma

Question 15

subadural haemorrhage

Answer 15

bleeding in subdural space
usually cause by severe trauma
maybe be delayed symptons

headache
drowsiness 
stupor- altered state of conciousness
hemiparesis
coma

Question 16

Secondary damage of TBI

Answer 16

raised ICP (intercranial pressure)
infection
ischaemic changes
vasospasm
complication of systemic dysfunction

Question 17

Transient ischaemic attack TIA

Answer 17

A TIA is a sign that part of the brain is not getting enough blood, and there is a risk of a more serious stroke in future

Question 18

Hemiplegia

Answer 18

paralysis at one side of the body

Question 19

Clinical features of stroke

MOTOR

Answer 19

Alterations in tone
Low tone - flaccidity
High tone – spasticity

Ataxia
Weakness 
Asymmetry
Loss of normal movement patterns,postural adjustments and balance	
Compensations

Question 20

Pattern of spasticity

Answer 20

Flexor pattern in upper limb
Shoulder elevation & retraction
Internal rotation & adduction
forearm pronation
elbow worst and and finger flexion

Extensor pattern in lower limb
Hip retraction
Hip extension
Knee extension
Ankle plantarflexion & inversion

Question 21

Clinical features of stroke

SENSORY

Answer 21

impaired cutaneous sensation
stereognosis
proprioceptive impairment
Visual field loss- Homonymous Hemianopia

Question 22

Clinical features of stroke

SPEECH

Answer 22

Expressive dysphasia
Damage to Brocas area
Loose ability to produce speech

Receptive dysphasia
Damage to Wernikes area in temporal lobe
Lose ability to understand speech

global aphasia

Question 23

Clinical features of stroke

COGNITIVE

Answer 23

Perceptual Problems

Astereognosis
Visual Agnosia
Auditory Agnosia
Depth perception
Apraxia
Anosagnosia 
Inattention/neglect

Question 24

Agnosia

Answer 24

Inability to recognise

Question 25

Neglet

Answer 25

more common with left hemiplegia patients fails to attend to stimuli from the one side poor prognosis if persists results in many functional problems

Question 26

Clinical features of stroke

Answer 26

``` Disorders of emotion Delay / absent swallow reflex Incontinence Secondary musculoskeletal problems Gait problems Functional difficulties Social problems ```

Question 27

Physiotherapy treatment

Answer 27

prevent complications, minimise impairments and to maximise function ``` Assessment Identification of problems Clinical reasoning Goal setting Objective outcomes Choice of Rx method Interdisciplinary input ```

Question 28

Factors affecting recovery

Answer 28

Extent and nature of lesion Integrity of collateral circulation Capacity of Nervous System to re-organise ``` Environment Pre-morbid status Age Co-exisiting conditions Nutrition/Hydration Medication ``` Motivation participation and Attitude of patient

Question 29

Medical management

Answer 29

``` Treat as medical emergency MRI/CT scan Ischaemic stroke (80%)– aspirin, anticoagulants - thrombolysis SAH – surgery or endoplastic procedures SDH/EDH/ICH – treat hypertension TIA – aspirin, prevention work Other tests – Blood tests, angiography, echocardiology Other medication – osmotic agents Surgery – carotid endarterectomy ```

Question 30

National Stroke startergy

Answer 30

Treat Stroke as a medical emergency Effective assessment and treatment of vascular risk factors TIAs assessed and scanned within 24hrs Suspected stroke transferred to specialist stroke unit with MDT treatment and assessment Range of services available locally to support long-term needs Opportunity to return to work

Question 31

lacunar stroke

Answer 31

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