The Language of Stroke
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1 The Language of Stroke Examination / Imaging / Diagnosis / Treatment Dr Suzanne Busch
2
3 A lot of letters! CBF CVA ICH CVD CBV DWI US MRI/MRA CAA CTA CTP ICA MCA SAH WMD TIA MCA
4 Agnosia A lot of big words! Neglect/Inattention Ipsilateral Homonymous Hemianopia Dysarthria Dyspaghia Anosagnosia Endarterectomy CT Perfusion Embolectomy Apraxia Ataxia Visuospatial loss Aphasia/Dysphasi Apraxia Contralateral Dysdiadokinesis Ischemic Penumbra
5 Understanding the language of stroke Effects of a stroke Type of stroke Investigations Management
6
7 Beyond weakness Homonymous Hemianopia/Visual inattention Don t see to the left Don t notice the left when something is happening to the Right
8 Beyond weakness Homonymous Hemianopia + Visuospatial neglect (don t realise there is a left to look to)
9 Apraxia Beyond weakness
10 Beyond weakness Apraxia Inability to execute planned movement despite desire and physical capacity.
11 Apraxia Gait apraxia Cant walk despite normal power and sensation Can reproduce movement required lying down but not when standing
12 Beyond weakness Agnosia The inability to process sensory information e.g. Can see but don t recognise what is being seen
13 Beyond Weakness Anosagnosia Incapable of perceiving your impairment Weakness Blindness Perceptual difficulties
14 Can t see but don t know you cant see Cortical blindness
15 Beyond weakness Aphasia/Dysphasia Dysarthria Dysphagia
16 Beyond weakness Aphasia Dysarthria Dysphagia
17 Beyond weakness Aphasia Dysarthria Dysphagia
18 Beyond weakness Aphasia - Language Dysarthria Dysphagia
19 Beyond weakness Aphasia - Language Dysarthria - Voice Dysphagia
20 Beyond weakness Aphasia - Language Dysarthria - Voice Dysphagia - Swallow
21 Talking about weakness Ipsi-lateral Same side Contra-lateral Opposite side
22 Types of Stroke
23 Types of Stroke CVA Cerebrovascular Accident
24 Types of Stroke L CVA Cerebrovascular Accident
25 Types of Stroke L CVA Cerebrovascular Accident
26 Types of Stroke What sort of stroke Infarct vs Bleed Where is the stroke Side/Lobes Affect of the stroke Symptoms/signs What caused the stroke AF/HT/DM
27 Types of Stroke WMD White matter disease
28 Investigations
29 CT Investigations
30 CT Investigations
31 CT Investigations
32 CT Investigations
33 Investigations CTA - CT angiogram
34 Investigations CTP - CT perfusion
35 Investigations CTP - CT perfusion CTP measures brain tissue blood perfusion. Differentiates salvageable ischaemic brain tissue (the penumbra) from irrevocably damaged infarcted brain (the infarct core).
36 Investigations CTP - CT perfusion
37 Investigations CTP CBV (Cerebral blood volume) = mls of blood per 100 g of brain The volume of flowing blood for a given volume of brain. MTT ( Mean Transit Time) = seconds The average amount of time it takes blood to transit through a given volume of brain. CBF (Cerebral Blood Flow) = mls of blood /100 g of brain tissue /minute The volume of flowing blood moving through a given volume of brain in a specific amount of time.
38 Investigations CTP The Ischemic Penumbra It is possible to have regions of tissue that show decreased CBF with maintained CBV indicating potentially salvageable tissue or penumbra.
39 CTP A. Normal CT B. CBF shows a region of perfusion. D. MTT shows a corresponding prolongation within this same region. C. CBV map demonstrates no abnormality, -representing a CBV/MTT -mismatch or ischemic penumbra.
40 Investigations MRI Magnetic Resonance Imaging
41 Investigations MRI Magnetic Resonance Imaging Sees small strokes better Sees brainstem strokes better Sees acute strokes better Harder to access and take longer to do
42 MRI/MRA Investigations
43 MRI Investigations
44 Treatment Embolectomy Thrombectomy Clot retrieval
45 What can I do tomorrow?
46 What can I do tomorrow?
47 What can I do tomorrow? Use every day language more
48 Everyday Language As a result of her CVA on the background of WMD Mary has a moderate Hemiplegia with hemianopia. Complicating this she has visuospatial inattention, anosagnosia and apraxia. She has dysarthria and dysphagia. As a result of a stroke secondary to a bleed Mary has moderate weakness of her left arm and leg. She is unable to see to the left and when she is distracted will not remember to look to the left. She is unable to complete complex motor tasks even when strength is ok. She is unable to understand the nature of her disability. Her speech is slurred when she is tired and she has some difficulty swallowing thin liquids.
49
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