Strokes: progressive stroke pathway

The progressive stroke pathway, produced by the National Advisory Committee for Stroke (NACS), sets out a vision of what progressive stroke care in Scotland should comprise.

13. Glossary

ACTATS (Acute CTA for Thrombectomy in Stroke): An online training package aimed at stroke clinicians and radiologists to help them interpret CT (see computerized tomography) & CTA (see computed tomography angiography) in the context of thrombectomy.

Acute Stroke Centre: A hospital which has staffing and facilities to acute assess acute stroke patients, carry out an early CT brain scan and deliver thrombolysis. They will also have a stroke unit, or equivalent facility for ongoing care of stroke patients.

AF: Atrial Fibrillation is an irregular and often very rapid heart rhythm (arrhythmia) that can lead to blood clots in the heart. AF increases the risk of stroke.

AFO: Ankle Foot Orthoses are external biomechanical devices utilized on lower limbs to stabilize the joints, improve the gait and physical functioning of the affected lower limb.

AI: Artificial intelligence: In the context of stroke services this term refers to digital systems which provide a rapid interpretation of brain imaging, and communication of the images and its interpretation to those involved in delivering time sensitive stroke treatments.

Aneurysm coiling: a procedure performed to block blood flow into an aneurysm (a weakened area in the wall of an artery).

Aphasia: a disorder of language which can affect speech, reading and writing. It's usually caused by damage to the left side of the brain.

Botulinum toxin injections: Botulinum toxin can help to relax overactive muscles for a short period of time. During this time a therapy programme can be implemented to stretch shortened muscles and stiff joints. This may help improve function e.g., walking or grip, or could help care staff manage personal hygiene.

Carotid endarterectomy: An operation to remove the narrowing in a carotid artery to reduce the risk of future stroke.

Carotid Ultrasound: Carotid ultrasound is an imaging test that uses high-frequency sound waves to create pictures of the inside of carotid arteries. It is used to identify patients who may benefit from carotid endarterectomy or angioplasty and stenting

CHI number: Community Health Index number is a unique patient identifier used across Scotland. The first 6 digits include the patient's date of birth.

CSC: A Comprehensive Stroke Centre is a hospital which in addition to the facilities of the ASC can also provide thrombectomy and neurosurgery with associated critical care support.

CT: A computerized tomography (CT) scan combines a series of X-ray images taken from different angles around your body and uses computer processing to create cross-sectional images (slices) of the inside of the body.

CTA: Computed tomography angiography (CTA) uses an injection of contrast material into your blood vessels and CT scanning to help diagnose and evaluate blood vessel disease or related conditions.

CTP: Computed tomographic perfusion (CTP) imaging is an advanced modality that can aid in diagnosis, management, and prognosis of acute stroke patients by clarifying acute cerebral physiology.

Decompressive hemicraniectomy: A surgical treatment for cerebral oedema (when the brain swells, causing an increase in pressure). Has been performed for several different pathologies, including malignant middle cerebral artery syndrome, one of the most widely recognized large vessel strokes.

Door In, Door Out time: The delay between a patient's arrival at an Acute Stroke Centre (ASC) and their departure from that hospital to go to a Comprehensive Stroke Centre (CSC) for thrombectomy.

DTN: Door-to-Needle Time is the delay between arrival at a hospital and the administration of a bolus of thrombolysis medication.

Dysarthria: Slurred speech caused by disturbance of muscular control.

Dysphagia: Medical term for swallowing difficulties.

Endovascular therapy: Minimally invasive procedures that are done inside the blood vessels.

ESD: Early supported discharge services comprise a stroke specific interdisciplinary team and sufficient care staff to allow hospital admitted stroke patients to be discharged home earlier than otherwise to continue their rehabilitation in the community

Flexible endoscopic evaluation of swallowing (FEES): FEES is a procedure designed to assess swallowing function through visualization of the pharyngeal and laryngeal (throat) structures.

FLORENCE: Flo or Florence is a simple telehealth system that uses text messages to support patients to manage their high blood pressure and related aspects of health.

FES: Functional Electrical Stimulation is a treatment that uses small electrical charges to produce muscle activity or a muscle contraction.

Hydrocephalus: a build-up of fluid around the brain, which increases pressure and can cause brain damage.

Integrated Joint Boards: Bodies that lead the planning of health and social care services. IJB's commissions the local authority and health board to deliver services in line with a strategic plan.

Interdisciplinary team: a group of professionals from a range of disciplines who work in a coordinated manner toward the same goal for the patient

Intermittent pneumatic compression comprises sleeves wrapped around the legs which are inflated regularly to squeeze the legs, increasing blood flow to reduce the risk of blood clots in the legs).

Interventional Neuroradiologists: doctors who specialise in minimally

invasive treatment of neurovascular disease including thrombectomy

Interventional Radiologists: Doctors who performs image guided procedures, fully interpret the imaging required to guide and monitor response of those procedures, as well as provides the pre and post procedural care for those patients receiving procedures including thrombectomy.

LDL: Low density lipoprotein (LDL) cholesterol is often referred to as "bad cholesterol" because too much is unhealthy.

Large Vessel Occlusion a blockage in one of the major arteries of the brain which may be opened up with thrombectomy.

Managed Clinical Networks: linked groups of health professionals and organisations from primary, secondary and tertiary care, working in a co-ordinated manner to ensure equitable provision of clinically effective services throughout Scotland.

MRA: Magnetic resonance angiography (MRA) uses a powerful magnetic field, radio waves and a computer to evaluate blood vessels and help identify abnormalities.

MRI: Magnetic resonance imaging (MRI) is a type of scan that uses strong magnetic fields and radio waves to produce detailed images of the inside of the body.

Musculoskeletal pain is pain which affects the muscles, ligaments, tendons, and bones.

Mirror-box therapy: a rehabilitation therapy in which a mirror is placed between the arms or legs so that the image of a moving non-affected limb gives the illusion of normal movement in the affected limb.

Multi-disciplinary team: a group of professionals from one or more clinical disciplines who together make decisions regarding recommended treatment of individual

Near Me: A secure form of video consulting approved for use by the Scottish Government and NHS Scotland.

Neuropathic pain: Neuropathic pain is often described as a shooting or burning pain. It often is the result of nerve damage or a malfunctioning nervous system.

Neurosurgery: Specialty concerned with the diagnosis and treatment of patients with injury to, or diseases/disorders of the brain, spinal cord and spinal column, and peripheral nerves within all parts of the body.

Nocturia: The medical term for excessive urination at night.

Orthoptics: Allied health professionals who specialise in the diagnosis and non-surgical management of eye problems that affect eye movement and the development of vision.

Orthotics: Allied health professionals who make and fit braces and splints (orthoses) for people who need added support for body parts that have been weakened by injury, disease, or disorders of the nerves, muscles, or bones.

Patent Foramen Ovale: A hole in the heart that didn't close the way it should after

Post stroke spasticity: Following stroke, muscles may become stiff, tighten up and resist stretching. This is called spasticity.

SCI Gateway: Scottish Care Information (SCI) Gateway is a national system that integrates primary and secondary care systems using highly secure Internet technology. SCI Gateway enables GPs to access SCI services on-line.

Scottish Stroke Care Audit: An audit coordinated by Public Health Scotland. Measures the performance of stroke services against national standards

STAT+, STARS Advanced Modules: Professional training:

STAT+: Stroke and Transient Ischaemic Attack (TIA) Assessment Training (STAT) and STAT+. Training incorporates simulated scenarios to improve the emergency response to stroke and TIA.

STARS: Stroke Training and Awareness Resources. An e-learning resource providing a learning tool for health and social care staff to enable them to become more knowledgeable and skilful in the area of stroke care.

Stroke: Occurs when the blood supply to part of the brain is interrupted and brain cells are starved of oxygen. Ischaemic strokes occur when a blood clot blocks the flow of blood. A haemorrhagic stroke can happen when blood from an artery begins bleeding into the brain after a blood vessel bursts.

Subluxation: Shoulder subluxation happens when the upper arm bone, called the humerus, becomes partially dislocated from the shoulder socket. This condition starts when the muscles around the shoulder become weak or paralyzed after stroke.

Telestroke: A service which uses telephone, video conferencing and access to Picture Archiving and Communication System (PACS) to allow clinicians to remotely assess patients to enable the clinician to advise on management.

Thrombectomy: The physical removal of a thrombus (clot) which is blocking an artery causing a stroke.

Thrombolysis: The use of medicine which dissolves blood clots and restores blood flow to the brain.

Transient Ischaemic Attack (TIA): A temporary disruption in the blood supply to part of the brain. The symptoms last only minutes or hours.

TRAKCare: An electronic health record management system which is available in all NHS Boards.

Treadmill training: Used to aidwalking rehabilitation with or without the use of body weight support

Transthoracic echocardiogram: The most common type of echocardiogram, which provides a moving image of the internal parts of the heart using ultrasound.

Transoesophageal Echocardiography: A type of echocardiogram

where a small probe is passed down the throat into the gullet and stomach.

Transcranial Doppler: A test that uses sound waves to detect medical problems that affect blood flow in the brain.

Triage: The assignment of degrees of urgency to illnesses to decide the order of treatment of a large number of patients.

Vascular surgery: Vascular surgeonsare trained in the diagnosis and management of conditions affecting the circulation, including disease of the arteries, veins and lymphatic vessels.

Venous thromboembolism: Blood clots that can develop in the deep veins in the legs or pelvis and can travel to the lungs to cause pulmonary embolism.

Videofluoroscopy: Assesses swallowing ability. It takes place in the X-ray department and provides a moving image of swallowing in real time.



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