Stroke Rehabilitation Flashcards

1
Q

What is a stroke?

A

Rapidly developing clinical symptoms and/or signs of loss of brain function with symptoms lasting >24hrs or leading to death with no other cause

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2
Q

What are important things to note when taking the history of a stroke?

A

Time of onset, symptoms, how did they progress

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3
Q

How common are stroke mimics?

A

1/3 of all stroke presentations are stroke mimics

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4
Q

What are some examples of stroke mimics?

A

Seizure, sepsis, toxins, SOL, syncope, delirium, vestibular dysfunction, dementia

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5
Q

What are the questions asked when generating a Rosier score?

A

Has there been loss of consciousness or syncope?
Has there been seizure activity?
New onset of = asymmetric facial weakness, asymmetric arm weakness, asymmetric leg weakness, speech disturbance, visual field defect

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6
Q

How is the Rosier Score graded?

A

Scores range from -2 to +5
Score >0 is likely to be stroke
Score <= 0 has low likelihood of being stroke

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7
Q

Is a stoke technically classed as a diagnosis?

A

No = it is an experience of persisting neurological complications of CV disease

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8
Q

What are the types of stroke?

A

Infarct = atheroembolic, small vessel, cardioembolic
Haemorrhage = structural abnormality, hypertensive, amyloid angiopathy
Subarachnoid haemorrhage

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9
Q

What is the limitation of using CT to image strokes?

A

Scans aren’t sensitive for blood after about 1 week

In hyperacute setting CT may appear normal

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10
Q

What is the management of stroke patients?

A

Thrombolysis/thrombectomy and imaging
Swallow assessment, nutrition and hydration
Antiplatelets and DVT prevention
Stroke unit care

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11
Q

What are some factors to consider when deciding whether to thrombolyse a patient?

A

Age, time since onset, previous intracerebral haemorrhage/infarct, atrophic changes, blood pressure, diabetes

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12
Q

What are the benefits of brain imaging?

A

Establishes diagnosis and indicates therapeutic decisions

Facilitates clinical management, patient flow and information for patient

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13
Q

How effective are stroke units in caring for patients?

A

Highly effective = for every 33 patients treated there is 1 extra survivor, for every 20 patients treated 1 extra patient is discharged back to their own home

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14
Q

What investigations should be done before prescribing antiplatelets after a stroke?

A

Do a CT first to exclude a bleed

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15
Q

What antiplatelet is prescribed after a stroke?

A

Aspirin 300mg prescribed ASAP = must wait 24hrs if patient was thrombolysed

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16
Q

What is the purpose of prescribing antiplatelets after a stroke?

A

Aim is to reduce further infarct = risk highest early on

17
Q

Why are stroke patients at higher risk of DVT?

A

Due to immobility

18
Q

What are some options for DVT prophylaxis?

A

Heparin reduces risk but benefit outweighed by bleeding risk
TED stockings don’t give overall benefit
Intermittent pneumatic compression can reduce risk

19
Q

How is dysphagia screened for in stroke patients?

A

Initial swallow screen takes place

20
Q

How is dysphagia managed in patients with an abnormal swallow screen result?

A

Assessment by speech and language therapists

May need NG tube placement or textured diet and thickened fluids depending on swallow

21
Q

What is a transient ischaemic attack (TIA)?

A

Brief episode of neurologic dysfunction caused by focal brain or retinal ischaemia without evidence of acute infarction

22
Q

How long do symptoms of a TIA usually last for?

A

Typically last for <1 hour

23
Q

What is done as part of the rapid assessment at the rapid access neurovascular clinic?

A

History, carotid imaging, ECG, blood tests

24
Q

What immediate therapies are offered following diagnosis at the rapid access neurovascular clinic?

A

Medication, carotid endarterectomy

25
Q

How should intracerebral haemorrhage patients who present <6hrs onset with systolic BP >150 be treated?

A

Treat urgently = lower systolic BP to 140 for at least 7 days

26
Q

What are some associations of intracerebral haemorrhages?

A

15% associated with anticoagulation = worst outcomes associated with vitamin K antagonists (warfarin)

27
Q

What can reduce the incidence and improve outcomes of intracerebral haemorrhages?

A

DOAC = still worse outcomes than if not anticoagulated

28
Q

What is the mortality of intracerebral haemorrhages?

A

Mortality rate of 30-50%

29
Q

What is the immediate management of intracerebral haemorrhages?

A

Anticoagulation reversal

30
Q

How is warfarin reversed?

A

Vitamin K/Prothrombin complex

31
Q

What are some specific anticoagulation antidotes?

A

Idarucizumab = reverses direct thrombin inhibitors

Andexanet alpha = reverses direct factor Xa inhibitors

32
Q

What are some methods of anticoagulation reversal when specific antidotes aren’t available?

A

Prothrombin complex advised

May also use tranexamic acid or rFVIIa