Week 3 Flashcards
What is diaschisis
sudden inhibition of function secondary to neurophysiological changes that occur distant to the focal brain lesion
What is tPA stand for
tissue plasminogen activator
what is the penumbra
moderately ischaemic tissue that surrounds the ischaemic core
is viable for up to 6 hours
What is the leading treatment for ischaemic stroke
tPA: thrombolysis
What is the time frame that tPA can be delivered in
up to 4.5 hours post symptom onset
neurointervention involves
intra-arterial thrombolysis and mechanical clot removal
Antithrombotic therapy involves
ingestion of aspirin orally/NGT/suppository within 48 hours after onset of stroke
-only if imaging excludes haemorrhage
If patients have received thrombolysis, how long do they have to wait until they can take aspirin
should be deferred for 24 hours and only prescribed if follow up imaging has excluded haemorrhage
Acute phase blood pressure lowering therapy can be used in ischaemic stroke id
BP is >220/120
no reductions past 10-20%
in acute primary intracerebral haemorrhage, with severe hypertension observed, Acute phase BP lowering therapy can be used
to maintain SBP <180mmHg
If the patient is already on antihypertensive therapy, what should you do
continue provided there is no symptomatic hypotension or any other reason to withhold
What are the current recommendations for patients with large MCA infarcts in terms of cerebral oedema
patients should urgently referred for consideration of decompressive hemicranectomy, due to the increased intra cranial pressure
Are corticosteroids recommended for management of brain oedema and raised ICP
no
Main focus of management in intracerebral haemorrhage management
rapid assessment
routine investigations
prevention of complications
Current recommendations in intracerebral haemorrhage management include
haemostatic drug treatment with rFVlla is experimental and not recommended for use
for patients receiving anticoagulation therapy prior to stroke and who have elevated INR, therapy to reverse anticoagulation should be initiated rapidly
surgical evacuation may be undertaken for cerebellar hemisphere haematomas >3cm in selected patients
Current recommendations involving physiological monitoring include
check of neurological status (GCS), Vital signs (HR, BP, Temp, Spo2, and glucose levels) and respiratory pattern monitored and documented regularly during the acute phase
frequency of observations should be determined by the patient’s status
Current recommendations for oxygen therapy includes
patients who are hypoxic (<95% oxygens sats) should be given supplemental oxygen
The routine use of supplemental oxygen is not recommended in acute stroke patients who are not hypoxic
prevalence of hyperglycemia in patients following stroke is
1/3
Current recommendations for glycaemic control includes
blood glucose monitoring (on admission) and appropriate glycaemic therapy instituted
Pyrexia is
“fancy word for fever” increased body temperature
pyrexia is associated with
poorer outcomes after stroke
common causes of pyrexia include
Respiratory or urinary infections
Current recommendations for pyrexia
antipyretic therapy, comprising regular paracetamol and / or physical cooling measures should be used routinely where fever occurs
Current recommendations for seizure management are
anticonvulsant meds to be used for patients with recurrent seizures post stroke
What is spasticity
motor disorder characterised by a velocity dependant increase in tonic stretch reflexes (muscle tone) with exaggerated tendon jerks resulting from hyper-excitability of the stretch reflex as one component of the upper motor neurone syndrome
When should interventions to reduce spasticity be undertaken
when the level of spasticity interferes with activity or the ability to care to the patient
what can be used as an intervention to decrease level of spasticity
botulinum toxin A - should be trialled in conjunction with rehab
electrical stimualtion and or EMG biofeedback can be used
What is a contracture
shortening of soft tissue that results in reduced joint ROM due to impairments (weakness or spasticity)
What can be used to prevent contracture
conventional therapy for those at risk of contracture `
the routine use of splints or prolonged positioning of muscles in lengthened positions is not recommended
Usual position of hemiplegic limbs following ABI
Upper limb -Shx : abd/IR Elb, Wrx and fingers : F Forearm : pronation Thumb : adduction
Lower limb - Supine Hip: ER Knee: E Ankle: PF
Sitting position
Hip : F/ER
Knee : F
Ankle : slight PF
Conventional therapy for contracture includes
Encouraging active movement
target muscles most at risk of shortening
Implement a positioning program for UL/LL between therapy times and during rest periods
Joints at risk of contracture should be positioned >20-30 minutes in outer range
Passive positioning should be routine ward protocol
Aim to keep humerus in the plane of the scapula
Teach patients to attend to their own arm
Subluxation definition
partial or incomplete dislocation that usually stems from changes in the mechanical integrity of the joint
head of humerus is lowered relative to the glenoid cavity (anterior and inferior)
What causes subluxation
Weakness (especially supraspinatus and deltoid)
Overextensibility of capsular structures
Spasticity
When is a subluxation most likely to happen
in the first three weeks
