Stroke Week Flashcards
If we’re considering thrombolysis for a stroke patient, what are 3 things we need to have?
- Imaging
- <4.5 hours after onset
- No contraindications
What are the 4 different types of stroke in the oxford stroke classification and what are the clinical features of each?
Total Anterior Circulation Stroke - TACs
Occlusion of a large cerebral artery (Internal carotid or middle cerebral)
All three of:
- Hemiplegia contralateral to the cerebral lesion, usually with ipsilateral hemi sensory loss
- Hemianopia Contralateral to cerebral lesion
- New disturbance of higher cerebral function (aphasia, visuospatial problems - neglect)
Lacunar Stroke - LACs
Occlusion of a single deep perforating artery
High recurrence rate and often missed
Pure motor loss, OR pure sensory loss, OR ataxic hemiparesis i.e. a single deficit
Partial Anterior Circulation Stroke - PACs
Occlusion of a branch of the middle cerebral artery
High recurrence rate
Diagnosis requires 2 out of 3 TACS deficits, OR higher cerebral dysfunction alone, OR monoparesis, for example:
- Motor/sensory deficit + Hemianopia
- Motor/sensory deficit + new higher cerebral dysfunction - New higher cerebral dysfunction alone
Posterior Circulation Stroke - POCs
Occlusion of a posterior vessel (basilar/ vertebral/posterior cerebral) leading to cerebella/ brainstem/ occipital infarcts
Complex presentation due if brainstem involved due to decussation of various tracts e.g.
- Ipsilateral cranial nerve palsy (single/multiple) with contralateral motor and /or sensory deficit
- Disorders of conjugate eye movement (horizontal/vertical)
- Cerebellar dysfunction without ipsilateral long tract sign
- Isolated hemianopia or cortical blindness
What is the primary choice of imaging for a stroke patient? Why is this carried out?
CT head
- Rule out bleeding
- Rule out alternative diagnoses
- Assess suitability for reperfusion therapy
For patients with an acute ischaemic stroke who present within 6 hours of symptom onset are most likely to receive ‘reperfusion therapy’. What does this aim to achieve and how is it carried out?
Reperfusion therapy:
Aims:
- Unblock occluded artery
- Restore blood flow
How?:
- Intravenous thrombolysis- plasminogen activator
- +/- mechanical thrombectomy (interventional radiologist to visualise and pull out thrombus)
Thrombolysis= most effective within 3 hours but safe up to 6 hours
Out of those receiving thrombolysis for a stroke, how many make a complete recovery and how many improve compared to if they had not received it?
1 in 8= complete recovery
1 in 3= improve compared to if they had not received it
What % of stroke patients are usually eligible for thrombolysis?
15-20% of patients
What is the most serious risk when carrying out thrombolysis with a stroke?
Risk: Haemorrhage (1 in 20)
Mechanical thrombectomy can be used to treat strokes in patients with a clot in which arteries?
Larger blood vessels;
Internal carotid
Middle cerebral artery
Basilar artery
Can be used alongside thrombolysis or when it is contraindicated
For a mechanical thrombectomy following a stroke, what is the number needed to treat to have reduced disability?
Number needed to treat to reduce disability= 2.6 people
Can be of benefit up to 24hrs post symptom onset
What should a patient have to be considered for a referral for mechanical thrombectomy following a stroke?
- Onset < 6hours
- NIHSS (National Institutes of Health Stroke Scale) >4
- Large vessels occlusion on CT angiogram
What are the 3 main goals of the initial management of an intracerebral haemorrhage?
- Identify and reverse any coagulopathy
- Control BP (aim systolic <150mmHg)
- Consider neurosurgery in selected patients
What is a stroke?
Rapidly developing clinical syndrome
of
acute focal or global impairment of brain function
Lasting >24hours
Of vascular origin
For a TAC stroke, what is the mortality at 1 year?
Mortality at 1 year= 60%
What is the mortality rate for a PAC stroke at 1 year?
16% mortality at 1 year
State some of the modifiable and non-modifiable risk factors for strokes.
What imaging is done following a TIA?
- CT head
- Check for areas of ischaemic brain tissue
- Bloods
- Check for clotting disorder
- ECG
- Check for AF
(MRI takes too long?)
What % of those with a TIA will go on to have a stroke?
33%
How is stroke severity graded? (Good for management choices and to review outcomes)
National institute of health stroke scale
List the members of a stroke multidisciplinary team.
Stroke physicians
Stroke nurse
OT
Social worker
Speech and Language therapist
Physio
Radiographer
Radiologist
HCAs
Dieticians
Stroke co-ordinators
List some of the common complications that follow on from a stroke:
Dysphagia (swallowing)
Dysphasia (speech)
Another stroke
Mobility issues
Mood disorders
Incontinence
Pressure sores
List some causes of stroke should be considered in a younger stroke patient.
Clotting disorder
Trauma
Diabetes
Pill/medication
Familial hyperlipidaemia
Hypertension- due to eg kidney problem
AV malformation
What types of stroke usually cause headaches and why?
Haemorrhagic-
–> irritates meninges
–> increase ICP
Describe the role of a physiotherapist in the stroke MDT.
- Restore movement and function
- Manage pain
- Prevent disease and disability
- Enable people to remain as independent as possible
- Reduce risk of stroke complications and help prevent further strokes
Techniques:
Movement and exercise
Manual therapy
Education and advice
Specialist equipment
Hydrotherapy
Describe the role of a occupational therapist in the stroke MDT.
Promote health and wellbeing through occupation
- Enable person to take part in daily activites of life -maximise independence
- Occupation= any activity person wishes/needs to complete
- Assessment and intervention in: cognition, vision etc
