Stroke Lec. 3 PDF

Stroke Lec.3 Dr.Sarkawt S.Kakai KHCMS (Ortho. & Trauma) Clinical Scenario • Mrs. LM was a 29-year-old married woman who lived with her husband and 2-year-old daughter. At the time of the incident, she was 37 weeks pregnant with a second child. She led a physically active life, looking after her fa...

Stroke Lec.3 Dr.Sarkawt S.Kakai KHCMS (Ortho. & Trauma) Clinical Scenario • Mrs. LM was a 29-year-old married woman who lived with her husband and 2-year-old daughter. At the time of the incident, she was 37 weeks pregnant with a second child. She led a physically active life, looking after her family and undertaking all household activities. She enjoyed an active social life and was involved in all her daughter’s activities. • Mrs. LM was found unconscious at home by her husband. She was admitted to a local hospital where an emergency caesarean section (of a healthy baby boy) was undertaken. Immediately following surgery Mrs. LM was transferred to the intensive care unit of a specialist neurological hospital. • Arterio-venous malformation (AVM) bleed. Large left frontotemporal bleed extending to the frontal basal ganglia, with minimal blood in the fourth ventricle. Introduction • A stroke, sometimes called a brain attack, occurs when something blocks blood supply to part of the brain or when a blood vessel in the brain bursts. • A stroke is a medical emergency, anyone suspected of having a stroke should be taken to Accident & Emergency immediately. • A stroke or cerebrovascular accident (CVA) is typically defined as an accident with ‘rapidly developing clinical signs of focal or global disturbance of cerebral function, with symptoms lasting 24 hours or longer or leading to death, with no apparent cause other than of vascular origin Classification Strokes are classified into two main categories: ischaemic or haemorrhagic . An ischemic stroke is caused by an interruption of the blood supply. A hemorrhagic stroke is caused by a ruptured blood vessel. The majority of strokes are ischemic accidents (approximately 80%). Etiology: Hypertension, diabetes mellitus, hypercholesterolemia, physical inactivity, obesity, genetics, and smoking. Ischemic stroke causes Thrombosis: obstruction of a blood vessel by a blood clot formed locally Embolism: obstruction of a blood vessel caused by blood clot (embolus) coming from somewhere else in the body Systemic hypoperfusion (e.g., when a person is in shock) Cerebral venous sinus thrombosis (caused by blood clot of the sinuses that drain blood from the brain). A haemorrhagic stroke can be an intracerebral or intracranial accident. An intracerebral haemorrhage is a stroke where blood is leaking directly into the brain tissue, building up a haematoma. An intracranial haemorrhage is the build-up of blood anywhere within the skull, typically somewhere between the skull and the meninges surrounding the brain and spinal cord. Diagnosis • The diagnosis of stroke is based on a clinical assessment and imaging techniques such as computed tomography (CT) or magnetic resonance imaging (MRI) scans. • For diagnosing an ischaemic stroke in the acute setting, an MRI scan is preferred, as sensitivity and specificity are higher in comparison with CT imaging Early treatment Acute Ischemic stroke • Medication (thrombolysis) or treatment is aimed at breaking down the blood • Mechanically removing the blood clot (thrombectomy). clot either by means of In case of a haemorrhagic • Patients sometimes do require neurosurgical stroke, being able to stop intervention to achieve this. the bleeding as early as • Drug interventions used in ischaemic stroke (such as anticoagulants and antithrombotics) can make bleeding possible is of paramount worse and therefore cannot be used in haemorrhagic stroke. importance Outcome Measure • The Functional Ambulation Category evaluates the degree of dependency during walking. There are six categories and the patient is assigned to one of them: • (0) Unable to walk • (1) Dependent Walker Level 2 – support from one person needed with carrying weight and balance • (2) Dependent Walker Level 1 – support from one person needed with balance or coordination • (3) Dependent Walker Supervision – requires only verbal supervision or stand-by help without physical contact • (4) Independent Walker on Level Ground – requires help on stairs, slopes or uneven surfaces • (5) Independent Walker – can walk anywhere. Prevent complications Minimise impairments Primary Goals of Rehabilitation Maximise function Optimising Post Stroke Rehabilitation • Early assessment with standardized evaluations and validated assessment tools • Early employment of evidence-based interventions relevant to individual patient needs • Patient access to an experienced multidisciplinary rehabilitation team • ongoing medical management of risk factors and comorbidities