Understanding Stroke
Diagnosis, Treatment and Complications of Stroke
Diagnosis Stroke
Patients with stroke-related symptoms need detailed medical assessment, including obtaining a detailed medical history, and performing a physical examination. These assessments can support the diagnosis of stroke or other medical conditions that resemble stroke.
CT Brain
-
CT Brain: An early assessment for suspected stroke
-
Scan time <5 minutes
-
Quickly diagnose and distinguish ischaemic or haemorrhagic stroke to determine appropriate medical treatment
CT Scanner
CT Scan of a patient with ischaemic stroke
CT Scan of a patient with haemorrhagic stroke
Medical Assessment
Blood tests
-
Complete blood count, clotting profile
-
Liver and renal function tests
-
Fasting glucose
-
Lipid profile
ECG
-
Diagnose atrial fibrillation
Normal heart rhythm
Atrial fibrillation (AF)
To evaluate brain health
MRI Brain
-
MRI is sensitive and specific in distinguishing ischaemic lesions and identifying pathologies that resemble stroke
-
MRI Brain is less readily available in public hospitals
-
May not be suitable for patients with a non-MRI compatible pacemaker, patients with recent surgeries with metallic implants e.g. hip replacement, or patients who are claustrophobic
MRI scanner
MRI scan of the brain and its supplying blood vessels
To evaluate neck & brain arteries condition
Carotid Duplex Ultrasound
(Ultrasound of the neck arteries suppluing the brain)
Transcranial Ultrasound (Ultrasound of the arteries within the brain)
-
Ultrasound as a non-invasive assessment that can visualise cerebral blood flow
CT Angiogram
MR Angiogram
Digital subtraction angiogram
To evaluate heart condition
Holter monitoring
-
Electrodes of the Holter monitor are attached to the patient's body. It can generate continuous ECGs and stays in place for 1-7 days on average.
-
Compared with a typical ECG examination, Holter monitoring is more sensitive in detecting paroxysmal atrial fibrillation, which can be the cause of the TIA or ischaemic stroke.
-
Applicable to both an in-patient or out-patient setting. Patients can still continue their daily activities during Holter monitoring.
Cardiac echocardiogram (ECHO)
& Trans-esophageal echocardiogram (TEE)
-
Visualises the heart structure and functionality and aids in the diagnosis of heart valve disease and congenital heart defects
配圖由いらすとや和看護師🎨イラスト集提供
Treatment of Stroke
Acute Stage: Treatment and examination in the emergency ward
Ischaemic stroke patients:
-
Intravenous thrombolytic therapy (tPA)
-
Administration of tPA to unblock the blood vessels, save brain cells that have not been ischaemic or necrotic, and reduce the risk of consequent disability or death
-
Treatment within 4.5 hours of symptom onset is vital
-
Approximately 7% of patients are at risk of intracerebral haemorrhage
-
tPA treatment is available in all HA hospitals with an Emergency Department and several private hospitals in Hong Kong
-
-
Mechanical thrombectomy
-
During mechanical thrombectomy, the thrombus that blocks the arteries in the brain is removed. This prevents damage to brain cells that are not ischaemic or necrotic and minimises the chance of disability and death after stroke
-
Usually provided within 6 hours of symptom onset
-
!
Patients who arrive too late at the hospital may not be eligible for these treatments since the risk of a poor outcome from tPA or mechanical thrombectomy (most often life-threatening bleeding in the brain), may outweigh any potential treatment benefits.
!
For patients who suffer a severe ischaemic stroke, surgery may be required to relieve pressure in the brain.
!
It should also be noted that for every minute that an acute ischaemic stroke is not treated, approximately 1.9 million neurons in the brain are lost. Anyone with sudden onset of stroke symptoms should immediately attend their nearest Accident and Emergency Department so that appropriate treatment can be given within the effective treatment time window.
For haemorrhagic stroke:
-
Treatment normally depends on the underlying cause.
-
Monitor blood pressure and coagulation index and reduce the risk of further cerebral bleeding
-
If coagulation function and index are abnormal, transfusion of blood products may be required
-
If aneurysm or malformation of blood vessels is found, neurosurgical intervention may be required
-
Neurosurgical operation may be performed to extract the blood clot within the brain
-
In-patient Stage: Rehabilitation in Hospital
Doctors
Nurses
Physiotherapists
Occupational therapists
Speech therapists
Medical social workers
Chinese medical physicans
Dietitians
Prosthetic orthopedists
Clinical psychologist
Podiatrists
配圖由いらすとや提供
-
Physiotherapist
-
Provides advice about different techniques including use of tools and mechanics as well as exercises to strengthen muscles, improve gait and mobilisation and relieve pain
-
Educate patients about bladder control
-
Provide chest physiotherapy for patients with pulmonary conditions
-
-
Occupational therapist
-
Teaches patient how to relearn daily activities e.g. getting out of bed, washing clothes, eating, cooking etc. and improve mobility
-
May provide aids and equipment
-
May provide home visits and advice about disability after stroke
-
-
Speech therapist
-
Provides assessment and training to maximise speech and swallowing ability to minimise the risk of aspiration pneumonia
-
Performs bedside swallowing screening assessments and referral for endoscopy if indicated
-
Patients who present with acute stroke symptoms are usually directly admitted to an acute medical ward or acute stroke unit and managed by a multidisciplinary team.
配圖由看護師🎨イラスト集提供
Acute Stroke Unit staff include doctors, nurses, physiotherapists, occupational therapists, speech therapists, medical social workers, dietitians, clinical psychologist, prosthetic orthopedists and podiatrists.
-
Exercise/Physical Rehabilitation
-
Prevent complications and improve the patient's limb function and self-care ability. This includes management of limb pain or deformity, prevention of muscle atrophy, fall prevention and balance exercises and physical activity training
-
-
Healthy diet
-
For malnutrition and constipation due to dysphagia
-
-
Swallowing and Communication Disorders Rehabilitation
-
Swallowing and communication difficulties may occur after stroke as mobility of the mouth, tongue, face and throat may be compromised
-
Patients may learn swallowing skills and eat foods of various textures to reduce the risk of aspiration pneumonia
-
Patients may encounter difficulties in listening, speaking, reading, writing and cognition, and require help to improve communication skills
-
-
Cognitive and Psychological Rehabilitation
-
Up to 30% of patients will suffer depression. Through physical and mental relaxation training, patients can set reasonable goals, seek support from family, friends and the community, and maintain a positive outlook
-
Stroke may affect memory, concentration, organization, judgment, and sensory perception
-
Cognitive rehabilitation includes exercises to improve memory, minimize environmental noise or distractions, and use of assistive devices to compensate for affected functions. Caregivers should check the situation, pay attention to the environment using the saccade method/turning method, or use touch/sound to hold the patient’s attention
-
-
Foot care
-
Includes prevention of foot pressure ulcers, dealing with thick calluses and corns, caring for skin and nails, and choosing the right shoes and socks
-
Outpatient: Regular assessment and management in acute and convalescent hospitals
Complications of Stroke
Infections: the lungs and urinary system
Deep vein thrombosis
Pain
Spasticity of the limbs and contractures
Seizures
Bed sores
Depression
Cognitive impairment
Heart attack
配圖由いらすとや提供