OSCE AND LEARNING POINTS.

OSCE:
 1)Therapeutic window of stroke
                  The main treatment for an ischemic stroke is a tissue plasminogen activator (tPA). It breaks up the blood clots that block blood flow to your brain. A healthcare provider will inject tPA into a vein in your arm. This type of medicine must be given within 3 hours after stroke symptoms start.
Drugs like alteplase, reteplase, and tenecteplase can be used.


2)Fibronolytic therapy:

       streptokinase, anisoylated plasminogen-streptokinase activator complex, urokinase, and recombinant human tissue-type plasminogen activator. All 4 of these drugs activate the fibrinolytic system by converting plasminogen to the active enzyme, plasmin.


3) Dual antiplatelet therapy vs aspirin therapy:
 
 https://www.ahajournals.org/doi/full/10.1161/STROKEAHA.120.033033


4)Frontal lobe functions parietal lobe functional tests
Parietal lobe:
   

5)UMN LESION:

- Pyramidal & Extra-Pyramidal descending tracts are involved.

- conditions-Occurs in vascular accidents & space occupying lesions.

- Nutrition-Group of muscles affected

- tone-Increased

- power-No loss of power.

- reflexes : superficial and deep exaggerated

- babinski sign : positive

- clonus : present

- paralysis: spastic

- clasp knife reflex: present 



6) LMN LESION

- a and v motor neurons of spinal cord and of cranial nerve nuclei are involved

- Conditions-Occurs in poliomyelitis

- Nutrition - Single muscles are affected..

- Tone-lost

- Power-Lost

- reflexes - Superficial & deep Reflexes - Lost

- Babinski's sign- Negative

- Clonus-Absent

- Paralysis-Flaccid.

- Clasp Knife Reflex- Absent.


7)Cushings triad:
     Cushing's triad refers to a set of signs that are indicative of increased intracranial pressure (ICP), or increased pressure in the brain. 
Cushing's triad consists of bradycardia (also known as a low heart rate), irregular respirations, and a widened pulse pressure.

8)Motor homonculus:
              The motor homunculus is a topographic representation of the body parts and its correspondents along the precentral gyrus of the frontal lobe. While the sensory homunculus is a topographic representation of the body parts along the postcentral gyrus of the parietal lobe.
   



Learning points: 

1)Sudden onset of weakness or neurological deficit suggests - CEREBRO VASCULAR ACCIDENT.

2) Importance of proper clinical evaluation.
 
3) How to determine whether it is embolic or haemorrhagic or thrombotic stroke ?

    •Ischemic stroke : onset of symptoms usually noticed immediately after waking up from sleep 

    •Embolic or haemorrhagic stroke: onset of symptoms during activities

    •Embolic stroke : history of cardiac diseases like RHD or Atrial fibrillation is present

    • Haemorrhagic stroke: history of raised ICT - headache, nausea,vomiting etc.

4) Use of CIMT:
     Constraint induced movement therapy or CIMT is a physiotherapy technique used to improve a person's upper limb function following neurological damage.


    

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