Fichas
Stroke, Cerebral Palsy and Epilepsy
Fichas del conjunto (44)
- 13 main types?Thromb-embolic
Cerebral and celebellar haemorrhage
Subarachnoid haemorrhage
Hemiplegia following middle cerebral arterial thromboembolism is the typical example - 2DefinitionA syndrome of rapid onset of cerebral defecit (usually focal) lasting > 24hours or leading to death, with no cause apparent other than a vascular one
- 3Completed StrokeThe defecit has become maximal – usually within 6 hours
- 4Stroke in evolutionDescribes progression during initial 24 hours
- 5Minor StrokePatients normally recover within 7 days, with no significant defecit
- 6Transient Ischaemic AttackA sudden focal deficit lasting from seconds to 24 hours with complete recovery
- 7Causes (3)Arterial embolism
Arterial thrombosis
Both classified as “Ischaemic”
Haemorrhage - 8Thromboembolic Strokes are the most common and account for what %?80%
- 9ThrombusA thrombus is a blood clot that forms in a vessel and remains there
- 10EmbolismAn embolism is a clot that travels from the site where it formed to another location in the body.
- 11Risk FactorsHypertension
Smoking
Lifestyle
Alcohol
High Cholesterol
Raised haemocrit
Atrial fibrillation
Obesity
Diabetes
Severe carotid stenosis
Sleep apnoea - 12Hypertensionincreased pressure in arteries – tunica intima damage – atherosclerosis – thrombus – embolism risk
Managed by anti hypertensive drugs - 13Diagnosis 7Physical symptoms
CT Scan or MRI
Catheter ultrasound – carotid arteries
Swallow Test
Blood Tests
Chest X-Ray
ECG - 14Physical symptoms 6speech, limb weakness, hemiplegia, hemiparesis , facial problems. Limbs initially flacid and are flexic – over time – several days – reflexes return – spastic muscle paralysis
- 15Hemiplegia(paralysis of arm/leg one body side)
- 16hemiparesis(weakening – less severe than hemiplegia),
- 17Ct and MRIshow type of stroke – area of brain – extent of damage
Very important for – those who would benefit from thrombyolytic treatment – already on anti-coags – low level of consciousness - 18Swallow1/3 stroke victims difficulty swallowing
- 19Immediate managementAdmit to multidisciplinary stroke unit
General medical measures
Airway: confirm patency and monitor
Continue care of the unconscious or stuporose patient
Oxygen by mask
Monitor BP
Look for source of emboli
Assess swallowing - 20Is thrombolysis appropriate?If so immediate brain imaging is essential.
- 21Further management (4) drugsAnti-hypertensives
Anti-platelet agents
Endartectomy
Possible anticoagulants - 22Further management 5Speech therapy
Dysphagia care
Physiotherapy
Occupational therapy
Specific issues
Epilepsy
Pain
Incontinence - 23Treatment - Haemorrhagic Stroke 4 H,T,H,RHaematoma evacuation
Thrombolysis
Haemostatic therapies
Reducing inter-cranial pressure - 24Prognosis Ischaemic? Haemorrhagic?Ischaemic
Early mortality – 20%
Independent @ 6mths – 60%
Recurrance @ 1 mth – 10%
Recurrance @ 3 mths – 18%
Haemorrhagic
Early mortality – 60%
Independent @ 6mths – 20%
Recurrance – 2% per annum - 25Cerebral PalsyChronic disorder of posture and movement caused by a non progressive lesion sustained by the developing brain.
The damage is irreversible and produces life long disabilities which can be progressive - 26It is not one single entity but is a collection of disorders with a common presentation Often linked with ........ incapacity (?%) and seizures Prevalence is 2 per 1000 childrenMental (35%)
- 27Risk factors – pre-natal (5) S, A, M, P, GSmoking
Alcohol and drugs
Maternal infection
Placental insufficiency
Genetic issues - 28Risk factors – peri-natal (4) P,F,H,IPremature and low birth weight babies
Foetal distress
Hypoglycaemia
Infections - meningitis - 29Risk factors – post-natal 2 T, ITrauma – intra-ventricular haemorrhage
Infection – meningitis
10 % of all CP cases - 30Cerebral Palsy - classification (3)Spastic
Athetoid
Ataxic - 31Spastic - 4 further classificationsTopographically – by the area affected
Hemiplegia
Diplegia
Quadriplegia - 32The most common form of CP is spastic, where the muscles are? There is ..........muscle tone and..........reflexes. It is usually detected after? What may occur?Tense and contracted
Increased muscle tone and spinal reflexes
Usually detected after the 1st year
Spasticity does not resolve
Tremors may occur - 33Athetoid CP Coordination for ............... is poor Worse during periods of ?constant, uncontrolled movement of the limbs, head and eyes.
Coordination for speech is poor
Worse during periods of stress - 34Ataxic CP - 4Affects balance and depth perception
Poor coordination, often causing falls
Intention tremor
Difficulty with quick or precise movements - 35CP common features - 4Half are of normal or above average intelligence
One third have epilepsy
25 – 80% have speech problems
A quarter will be fully independent adults - 36Outcomes 4Almost all hemiplegic children walk
75% of diplegic children walk
Children who can sit at 2 years will probably walk
Not walking by 7 years is a poor prognosis. - 37Equinus Gait in CPPatient walks on tip toes.
- 38Epileptic seizureAn intermittent convulsion or transient event due to sudden activity of cerebral neurones.
All cease spontaneously
Epilepsy is a continuing
tendency to have such
seizures – even if long
time intervals occur - 39Seizures occur because of a disturbance in the brain that gives rise to: 4 M, S, B,Caltered movement
disturbance of sensory function
altered behaviour
altered consciousness - 40Aetiology - 8Birth injury
Cerebral tumours
Trauma
Cerebral Malformation
HIV encephalopathy
CVI
Infection
Metabolic disorder
Idiopathic - 41Classification Partial - 2 Generalised - 3Partial:
Simple partial (Jacksonian motor epilepsy)
Complex partial
Generalised:
Typical absence (Petit Mal)
Tonic-clonic (Grand Mal)
Atonic (Drop attacks) - 42Management 2Long term anticonvulsant drugs
E.g. Phenytonin, Carbamazepine, Sodium valproate, Vigabatrin, Gabapentin
Surgical management is sometimes possible:
Removal of the anterior temporal lobe - 43Emergency TreatmentStay calm & reassure
Ensure the patient harms themselves as little as possible.
Maintain an open airway if possible
Cushion the head
Loosen restrictive clothing around the neck
Place in the recovery position when possible
If hypoglycaemia is suspected give glucose
If possible let them sleep - 44Status EpilepticusChain of seizures following one another without recovery
Epileptic attack maintained for more than 60 mins in an adult and 30 min in a child
Medical emergency
Mortality 10 – 15%
(cardio-respiratory failure)
Información
- Descripción
- University Medicine, Surgery & Radiology Fichas sobre Stroke, Cerebral Palsy and Epilepsy, creado por Morgan Morgan el 28/12/2014.
- Creado por
- Morgan Morgan
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