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Stroke

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Bodhisattva Jedi

on 18 September 2016

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Transcript of Stroke

Aetiology
Caused by thickening or narrowing of the arteries that carry blood to the brain
Risk Factors
1. Ischemic: caused by blockages (clots) in one of the arteries or blood vessels supplying the brain. Build up of fatty deposits ie. Cholesterol on innner walls - atherosclerosis
Epidemiology
Stroke
Disruption of blood supply to the brain
Presentation
Physical problems in one side of the body - numbness or weakness
Most strokes are caused by blockages (usually blood clots) disrupting the brain’s blood supply. These are called
Ischaemic
strokes.

Some strokes are caused by bleeds.
These are called
Haemorrhagic
strokes.
What is a Stroke?
TIA: Transient Ischemia Attack: partial bloackagae that quickly dissipates
Also arterial occlusions or stenosis. Stenosis is leakage or rupture of an artery.
Stroke is also more common in South Asian, African or Carribean partly because diabetes is more common in these populations
Risk Groups:

People with high blood pressure
People with high cholesterol
People with heart disease or
Diabetes
Smokers
Heavy Drinkers
People that don't exercise
2. Haemorrhagic: One of the blood vessels bursting causing a bleed by high blood pressure
3. Diabetes
4. Heart disease
5. Brain aneurysms or arteriovenous malformations (AVMs)
Drooping on 1 side of the face
Slurred speech muddled words
Visual problems - blurred or loss of vision
Confusion and severe headache
In more serious events: psychological problems including depression and anxiety.

Bowel or bladder problems, incontinence
TIA's last 1-24 hours
Aggravating Factors
Recovery
Alleviating Factors
Examination
CT Scan or MRI to determine the type of stroke you've had

It's important to know the type of stroke as the treatment differs:
Ultrasound to check for any blockages in the main arteries.
Blood pressure checks and
Blood tests to check glucose and cholesterol levels and other tests to check heart
Management
Thrombolysis dissolves the clot in the artery - given within 4hrs of symptoms appearing

Carotid endartectomy: surgery to cut/clear the artery

Anti-coagulant treatment ie. Warfarin, Vitamin K, O2 therapy

Statins for high blood pressure

Stopping smoking and eating a healthy balanced diet are two strategies you can implement immediately to improve blood pressure and cholesterol levels

People that have had a stroke are at increased risk of having further strokes - so taking all preventative measures is seriously important.
Stress
Lack of exercise
Smoking
Poor Diet
Obesity
Alcohol / Drug use
Reducing stress - increasing relaxation, stroking pets, spending quality time with friends

Increase of exercise

Quit smoking

Balanced diet

Losing weight

Cessation of alcohol / drug use
Benefit from Physiotherapy; to improve balance and vestibular function

Speech and Language therapy; helps recovery of communication skills and can help improve problems with eating and swallowing

May also benefit from Occupational Therapy; to redevelop skills you need to perform everyday activities - washing, cooking

Assistive/Adaptive Technologies; to make life easier ie. stair lift

A review should take place every 6 months
Evidence
"Treatment and secondary prevention of stroke: evidence costs and effects on individuals and populations".
Lancet 1998.

Acute ischaemic stroke patients should immediately start on Aspirin 300mg a day, reduced to a lower dose of 75mg after the acute phase. Smoking discouraged. High Blood pressure treated with diuretics. And co-agulated with Warfarin, Statins, Aspirin.

"Collaborative Meta-analysis of randomised trails of anti-platelets therapy for prevention of deaths, myocardial infarction, and stroke in high risk patients".
BMJ 2002.


Aspirin (now reduced by half for acute stroke). For acute stroke 150mg, followed by 75-150mg daily is effective anti-platelet regime for long term use.


Presented by Michael, Jen and Paul. Musculoskeletal Medicine Sept 2016
Full transcript