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Elderly Stroke/TIA

Elderly Stroke/TIA PTM

The elderly may present a challenge due to: 1.Comorbidities 2. Polypharmacy 3. Blunted Compensatory Mechanisms. Heart less sensitive to catechlomines. Atherosclerotic vessels less responsive. Orthostatic Stress. Renal capacity to regulate pH and electrolytes.
Define Stroke: Focal Neurological deficit due to a disturbance in the blood vessels supplying the brain. A sudden vascular catastrophe in the brain leading to neuro deficit that lasts >24 hrs
2 Types of Stroke? Ischaemic - 87% Haemorrahgic - 13%
Unmodifiable Risk Factors for CVA Gender Race Age Fhx/Hederity Previous stroke or MI
Modifiable Risk factors for CVA Hypertension Hyperlipidaemia Smoking Diabetes Heart disease eg. AF Carotid Disease Coagulation disorders Obesity Heavy ETOH use Cocaine use
What type of stroke is the most common? Ischaemic Stroke
What are two common Ischaemic Stroke names? Thrombotic Stroke. Embolic Stroke.
What type of Ischaemic Stroke is the most common? Thrombotic Stroke.
What conditions is Thrombotic stroke associated with? Atherosclerosis. Hypertension. Ischaemic Heart Disease (IHD). Coronary Artery Disease (CAD). Peripheral Vascular Disease (PVD)
Is Thrombotic stroke's development fast or slow? Slow
Is it possible to occur while at rest or asleep? Yes
Where are atherosclerotic plagues most common? At bifurcations.
Infarcts of the Cortex often causes: Aphasia. Neglect. Visual field disturbances. Transient Monocular Blindness.
Small vessel infarcts in the brain often affects deep tissues in the brainstem causing: Motor hemiplegia. Sensory hemiplegia. Dysarthia. Transient Monocular Blindness.
Define cardiogenic emboli: A clot that was created inside the heart - normally large.
Cardiogenic emboli originates from the heart and? Carotids
What is the onset for cardiogenic emboli? Sudden.
What is dramatic symptom is cardiogenic emboli often associated with? Seizure.
Disruption of the mid cerebral artery often affects what and what? Speech and comprehension.
Disruption of the motor speech area or Broca's area causes? Expressive Aphasia.
Disruption of the auditory association are (comprehension) or Wernickes area causes? Receptive Aphasia.
Where are Broca's and Wernicke's areas usually located? Left Hemisphere.
Define Dysarthia: Imperfect articulation. Pitch and tone issues. Paralysis of the muscles of the pharynx and larynx.
Define Dysphasia: Normal speech but difficulty in finding single words. Difficulty in naming common objects.
Define Expressive aphasia: Cant relate thoughts into words or written form. Speech is limited, takes effort, halting, anger, frustration. Motor speech area affected - Broca's area.
Define Receptive apahasia: Auditory association area affected. Wernick's aphasia: inability to comprehend spoken speech or written material. Conductive aphasia - repetition and letter substitution dispite good comprehension.
What is the onset of haemorrhagic stroke? Sudden.
What are two associated signs of haemorrhagic stroke? Sever headache. Neck stiffness.
Where may haemorrhagic stroke commonly occur? During exercise.
What is haemorrhagic stroke's leading cause? Hypertension.
Five warning signs of stroke are? Sudden confusion, trouble speaking or understanding. Sudden trouble seeing in one or both eyes. Sudden trouble walking, dizziness, loss of balance or coordination. Sudden severe headache with no known cause. Sudden numbness or weakness.
What does FAST stand for? Face. Arm. Speech. Time.
What is the management for stroke? Stabilize ventilation and support ABC's. Exclude hypoglycemia. Exclude head trauma. Manage seizures.
What does TIA stand for? Transient Ischaemic Attack.
Define Transient Ischaemic Attack. Stroke symptoms and signs that resolve within 24 hours.
Is TIA important? Yes - 25% of strokes are preceded by TIA.
How fast does most TIA's resolve? 30 min
Define diplopia: Double vision.
Define dysphagia: Difficulty swallowing.
Define dysarthia: Difficulty speaking.
Define Dyspraxia: Loss of coordination.
Define hemianopia: Blindness in one half of the visual field of one or both eyes.
Differential Diagnosis of TIA. Migrain. Hypotension/syncope. Pheripheral vestibular disorder. Partial epileptic seizure. Anxiety/hyperventilation. Transient global amnesia. Drug reactions. Peripheral nerve lesion. eg. Bell palsy. Hypoglycemia.
Treatment Guidelines for TIA. Assess BSL. Perform 12 lead. 300mg asprin, if pt recovered unless contraindicated. 99% of strokes after TIA are ischaemic. Intracerebral haemorrhage rarely cause TIA. Short term use of asprin in stroke patient with ICH- not shown to cause harm.
Created by: boermedic



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