Stroke

Question 1

Ischemia pathology- lack of blood

Answer 1

• 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

Question 2

Pathology Haemorrhagic stroke- bleeding

Answer 2

• 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)

Question 3

Pathology Ischaemic transient attack

Answer 3

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

Question 4

Signs of stroke

Answer 4

• 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

Question 5

Diagnosis

Answer 5

• 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

Question 6

Diagnosis of stroke in neurological exam

Answer 6

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

Question 7

Clinical features

Answer 7

• 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

Question 8

Aphasia

Answer 8

• 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

Question 9

Hemispatial neglect

Answer 9

• 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

Question 10

Management of acute stroke

Answer 10

• 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

Question 11

Physiotherapy management

Answer 11

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

Question 12

Treatment in rehab

Answer 12

• 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

Question 13

SOAP notes

Answer 13

• 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