Stroke Flashcards
(13 cards)
Ischemia pathology- lack of blood
- Most common type of stroke affecting all ages
- Usually caused by embolism with thrombus originating elsewhere- usually heart
- Thrombotic stroke accounts for ~50% of all strokes- clot originates in brain, limiting blood flow
- Brain tissue fails to function if deprived of oxygen for 60-90+ seconds
- Irreversible injury after ~3 hours, possible infarction
Pathology Haemorrhagic stroke- bleeding
- Weakened vessels rupture, leading to bleeding into surrounding brain
- Pressure may lead to loss of blood supply»_space; infarction
- Blood appears to have toxic effects on brain tissue
- Inflammation contributes to secondary brain injury
- Aneurysm (excessive swelling of vessel wall) or AVM (cluster of abnormally formed vessels) may cause blood vessel weakening
- Blood accumulates and compresses surrounding brain tissue
- 2 types: intracerebral (within brain); subarachnoid, (bleed into subarachnoid space)
Pathology Ischaemic transient attack
- Caused by blood clot, but blockage is temporary
- Symptoms occur rapidly and last for short time
- Usually no permanent damage
Signs of stroke
- Weakness, numbness or paralysis of face, arm or leg on either side
- Difficulty speaking or understanding
- Dizziness, loss of balance or unexplained fall
- Loss, blurred or decreased vision in 1 or both eyes
- Severe headache
- Difficulty swallowing
Diagnosis
- FAST- Face, arm, speech, time
- Neurological examination
- Imaging- ischemic stroke appears black, haemorrhagic stroke appears white; angiogram also specifies where blockage is
- Goals of imaging- differentiation of type and irreversibly affected/reversibly impaired tissue; identify stenosis or occlusion of arteries
Diagnosis of stroke in neurological exam
o Medical history o Muscle strength o Sensation o Coordination o Proprioception o Reflexes o Vision o Neglect o Spasticity o Gait o Transfers
Clinical features
- Deficits dependant on area affected by stroke- include: strength, coordination, sensation, vision and cognition
- If middle cerebral artery is affected, severe sensorimotor deficit in contralateral face and upper limb occurs
- Dominant hemisphere involvement may = global aphasia
- Non-dominant hemisphere involvement may = neglect syndrome
- Anterior cerebral artery = contralateral leg weakness and sensory loss
- Posterior cerebral artery = vision
- Basilar artery = cerebellum (incoordination, vertigo, nausea
Aphasia
- Damage to portion of brain responsible for language
- Left hemisphere for most people
- Difficulty expressing oneself when speaking or writing = expressive aphasia
- Trouble understanding speech or writing = receptive aphasia
Hemispatial neglect
- Reduced awareness of stimuli on one side of space despite no sensory loss
- Common during unilateral injury, particularly on right hemisphere
- Patients aren’t aware or acknowledge items on contralateral side
Management of acute stroke
- Likely pathology and cause
- Area of loss of blood
- Improve blood flow to ischaemic region- intravenous thrombolysis
- Time from onset of symptoms to treatment is critical
- Manage acute medical or neurological complications
- Manage risk of recurrent stroke
Physiotherapy management
- Mobilisation should begin ASAP to reduce complications- pneumonia, DVT, pulmonary embolus, pressure sores
- Rehab to restore neurological function
Treatment in rehab
• Neuroplasticity = underlying mechanism for stroke rehabilitation
• Requires learning of new task or skill and should be functionally relevant and engaging for patient
• Various techniques:
o Constraint induced movement therapy
o Bobath therapy
o Motor/mental imagery
o Mirror therapy
• Compensation strategies
• Initial severity of impairments and individual characteristics key predictors of stroke recovery outcomes
SOAP notes
- Subjective- history, home situation, previous level of mobility
- Objective
- Assessment- summarise major issues, relate to current function, progress or goals achieved
- Plan- short or long term goals