Stroke Flashcards

(13 cards)

1
Q

Ischemia pathology- lack of blood

A
  • 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
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2
Q

Pathology Haemorrhagic stroke- bleeding

A
  • Weakened vessels rupture, leading to bleeding into surrounding brain
  • Pressure may lead to loss of blood supply&raquo_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)
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3
Q

Pathology Ischaemic transient attack

A
  • Caused by blood clot, but blockage is temporary
  • Symptoms occur rapidly and last for short time
  • Usually no permanent damage
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4
Q

Signs of stroke

A
  • 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
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5
Q

Diagnosis

A
  • 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
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6
Q

Diagnosis of stroke in neurological exam

A
o	Medical history
o	Muscle strength
o	Sensation
o	Coordination
o	Proprioception
o	Reflexes
o	Vision
o	Neglect
o	Spasticity
o	Gait
o	Transfers
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7
Q

Clinical features

A
  • 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
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8
Q

Aphasia

A
  • 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
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9
Q

Hemispatial neglect

A
  • 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
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10
Q

Management of acute stroke

A
  • 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
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11
Q

Physiotherapy management

A
  • Mobilisation should begin ASAP to reduce complications- pneumonia, DVT, pulmonary embolus, pressure sores
  • Rehab to restore neurological function
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12
Q

Treatment in rehab

A

• 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

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13
Q

SOAP notes

A
  • 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
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