510: stroke presentation

blockage of BF to brain

usually caused by a blood clot that forms elsewhere in the body (embolus) and travels through the bloodstream to the brain -> goes up carotid artery, right side more common

results from a blockage or narrowing of the carotid arteries due to plaque buildup

can cause stroke

a transient (doesn't last long) neurologic dysfunction, caused by focal brain, spinal cord or retinal ischemia

risk of recurrent stroke after TIA

should be evaluated urgently so that optimal stroke prevention measures can be implemented early to prevent disabling stroke

middle cerebral artery -> motor + sensory function

hemiparesis (weakness or the inability to move on one side of the body) + balance deficits

aphasia + dysarthria (unclear articulation)

- broca's aphasia (speech diminished, grammatical errors)

- wenike's aphasia (impaired language comprehension)

- mixed + global aphasia (speech + comprehension)

proprioceptive deficits

visual-spatial deficits

dysphagia

spasticity

seizures

pain

incontinence

language problem that results in difficulty using language to communicate thoughts verbally or in writing and/or difficulty understanding language

NOT cognitive dysfunction (often misunderstood)

unable to return to previous level of functioning (work)

may not be able to do ADL (phone, reading, ATM..)

frustration + feeling of isolation

risk factor for depression

assess communications strengths + limitations

provide education

assistance w/learning adaptive communication strategies

provide rehab to improve

determine if patient is candidate for alternate augmentative means of communication (ex: pics, alphabet board)

give time to respond

acknowledge your patient knows more than they can say

never pretend you understood smth you haven't

always address patient directly, ask permission to ask caregiver questions

short simple sentences

tone of voice

gestures

pictures

eliminating distractions

observe facial expression

write down keywords/topics

follow advice from SPL

head CT and CTA w/perfusion study

angiogram

MRI

TIME IS BRAIN

powerful thrombolytic agent (dissolve blood clots)

dose titrated to patient's weight

multiple exclusion criteria

monitor for signs of intracranial/systemic hemorrhage

monitor for orolingual angioedema reaction (acute swelling of the lips and the tongue that spontaneously resolves, but may be life threatening because of the risk of upper airways obstruction)

a surgery to remove a blood clot from a blood vessel (artery or vein)

miraculous procedure but 30k

evaluation of stroke severity

investigation of etiology

PT, OT, SLP, nutrition assessment for discharge

maintain homeostais + avoid complications

Cincinnati scale (FAST)

canadian neurological scale

ASSIST and STAND dysphagia (swallowing difficulties) screening tools

spatial hemi-neglect (reduced awareness of stimuli on one side of space, even though there may be no sensory loss.)

shoulder pain

aphasia

depression

maintain homeostasis:

- intracranial pressure

- brain perfusion

- blood pressure

- blood glucose

- body temp

- protect airways, screen for dysphagia

- support nutritional status

prevent complications:

- recurrent strokes

- hemorrhagic transformation

- falls

- pneumonia

- DVT

- muscle mass loss

- pressure ulcers

- shoulder pain

- UTI

the ability of the nervous system to change its activity in response to intrinsic or extrinsic stimuli by reorganizing its structure, functions, or connections after injuries

- promotes autonomy

- supporting communication

- promoting rapid transfer to rehab

- promote neuronal stimulation as appropriate

public awareness

prevention

hyper acute stroke management

acute stroke management

rehab

community reintegration

intensive rehab centres -> goals to improve:

- mobility

- communication

- balance

- function

community reintegration centers -> goals to adapt

- driving

- work

- assistive technology

- self-management programs

- administer meds, assist w/daily care

- promote practice of skills learnt in therapy

- provide teaching

- participate in goal setting

- participate in transition planning

- discuss stroke prevention, ensure follow-up

visual aids

clear, short, at right time

try to have family present at much as possible

basic pathophysiology

signs+symptoms (FAST)

management of vascular risk factors

new meds

follow up appts

what resources are available

sense of shock

grief

shame

loneliness

communication + cognitive issues

stress

caregiver burnout

listen

provide info according to their interests

promote healthy behaviours related to prevention

provide info on community organizations

plan transitions from 1 phase of care to next

make referrals to support groups

provide instructions on skills required

post stroke depression -> symptom onset usually within 3 months, but can be within year, linked to life changes, ALL patients screened

cognitive changes -> linked to progressive microvascular change, ALL patients screened

fatigue -> common but not well studied

interrelated -> if screen for one screen for ALL, screen at various points, may go unrecognized in acute phase

reducing risk of recurrent vascular events in individuals who have already had a stroke/TIA

anti platelet therapy (unless indication of anticoagulation)

management of modifiable risk factors (BP meds)

surgical intervention (carotid endarterectomy)

older age

sex

family history

ethnicity

previous stroke

TIA

atrial fibrillation

carotid stenosis

high BP

high cholesterol

smoking

diabetes

sleep apnea

overweight

birth control pills

pregnancy

- pre-eclampsia

- gestational diabetes

- cardiomyopathy

menopause

- hormone replacement therapy

- cholesterol

- triglycerides

older age

- atrial fibrillation

Face

Arms

Speech

Time

limit alcohol

be physically active

eat healthy

smoke + drug free

reduce stress

availability and affordability of healthy food

walkability of neighborhood

policies

health behaviours of those in social network