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CR2 > 31 - Stroke > Flashcards

31 - Stroke Flashcards

1
Q

What is a stroke

A

Ischaemia and hypoxia due to cerebrovascular disease

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2
Q

What are causes of a stroke

A

Infarction

Haemorrhage

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3
Q

Parenchymal stroke

A

Stroke in brain tissue

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4
Q

Subarachnoid stroke

A

Into subarachnoid space

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5
Q

Where do most strokes occur and why

A

Branches of middle cerebral artery as highly tortuous

The branches from MCA form lenticulo-striate arteries which leave the MCA at 90 degree angle

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6
Q

What do the lenticulo-striate arteries supply blood to

A

Basal ganglia adn internal capsule

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7
Q

Symptoms of a stroke

A 
ALL SUDDEN 
Numbness, weakness of arm/face on one side of the body
Confusion
trouble seeing
trouble walking
severe headache
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8
Q

What does FAST stand for

A

F - Face
A - Arms
S - Speech
T - Time (quicker help means more brain function can be preserved)

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9
Q

What are the types of stroke

A 
TIA
Thrombotic
Ischaemic
Hemorrhagic
Lacunar
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10
Q

Which are the most common strokes

A

Thrombotic and embolic strokes make up 85% of all strokes

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11
Q

Transient Ischaemic Attack

A

Lasts less than 24 hours
Result of a small emboli
Mini-stroke

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12
Q

Thrombotic Stroke

A

Ischaemic stroke
The blood clot in cerebral artery, plaque opens and collagen and TF are exposed that produce a thrombus that blocks blood supply

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13
Q

What percentage of thrombotic strokes develop during sleep and what is the reason

A

60%

Due to obstructive sleep apnea that increases BP and ruptures the plaque

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14
Q

Embolic Stroke

A

Ischaemic
Can be blood broken from a thrombus or bacteria
Neurological signs develop rapidly
Usually occur during activity

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15
Q

What is the usual source for an embolic stroke

A

Left side of the heart - A Fib, MI, defective valves

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16
Q

Hemorrhagic stroke

A

Sudden neurological symptoms
Severe headache
Causes stupor or coma
Usually hypertensive

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17
Q

Lacunar stroke

A

Occlusion in one of the arteries that provides blood to the brain’s deep structures

18
Q

What are example of the brain’s deep structures

A

Basal ganglia, cerebral white matter, thalamus, pons,cerebellum

19
Q

What percentage of ischaemic strokes are lacunar strokes

A

15-25%

20
Q

Motor hemiparesis with dysarthria

A

33-55%(most common) infarct in posterior limb of internal capsule

21
Q

Ataxia & hemiparesis

A

infarct also in posterior limb of internal capsule

22
Q

Dysarthria & clumsy hand

A

infarct in anterior limb of internal capsule

23
Q

Risk factors

A 
Hypertension 
Heart disease (AFIB)
Hyperlipidaemia (use statins)
Diabetes
Smoking
Obstructive Sleep Apnea
Low potassium diet
24
Q

How do you diagnose a stroke

A 
Physical examination (BP)
Blood tests (Cholesterol, C-reactive protein)
CT Scan (Show haemorrhage, tumor, stroke)
MRI - Detect damaged brain tissue
25
Q

Why do nerve cells have a high ATP usage

A

To fuel a sodium pump

26
Q

What happens when a Na pump stops working bc of hypoxia

A

Na leaks into cells
Cell swelling
Swelling exerts pressure on the cells and EC space decreased
Cells contact each other - Raise in intercranial pressure

27
Q

By how much does the EC space decrease in a normal brain to hypoxic brain

A

20% to 5%

28
Q

What can a severe raise in ICP cause

A

Cerebellum extrudes through the foramen magnum

Compression on lower brainstem

29
Q

What removes the potassium that is released into ECS and what happens in a hypoxic brain

A

Glial cells

In a hypoxic brain - K+ not removed so excess NT release

30
Q

What is excitotoxicity

A

Follows a stroke
Hypoxic brain cells subjected to excessive NTS due to a smaller ECS and reduced reuptake
Lead to cell damage

31
Q

What is the main excitatory brain transmitter and what does it act on

A

Glutamate anion
Main excitatory brain transmitter
Acts on NMDA and AMPA receptors

32
Q

What does excess NMDA receptor stimulation and excess AMPA receptor stimulation cause

A

Excess NMDA receptor stimulation - Excess influx of Ca ions into nerve cells
Excess AMPA receptor stimulation - Slow excitotoxicity

33
Q

What happens to ATP-ase uptake sites for glutamate in hypoxia and what is the result of this

A

The ATP drops
reuptake fails
post synaptic glutamate receptors overstimulated
Leads to an influx of calcium and the excitotoxic loop

34
Q

What does an influx of calcium lead to

A

increased metabolic demand on the cell
Uses more oxygen
when no oxygen there is free radical formation which triggers apoptosis

35
Q

What is the penumbra region

A

neurons are hypoxic and /or damaged but survival is possible

36
Q

What happens to cells in the middle and outside in a stroke

A

Cells in the middle face inevitable death

Cells on the outside will survive

37
Q

What are the 3 main treatment strategies for a stroke

A

Restore blood flow
Combat excitotoxicity
Combat free radical damage

38
Q

How can you restore blood flow

A

Tissue plasminogen activators – thrombolysis

39
Q

How can you combat excitotoxicity?

A
  • NMDA antagonists e.g Cerestat – block NMDA receptors and fast excitotoxicity but has serious side effects
  • AMP antagonists e.g NBQX – reduce slow excitotoxicity
40
Q

How can you combat free radical damage?

A
  • Antioxidants e.g Vitamin C and E to boost brain’s antioxidant defences
  • Dietary vitamin C and E reduce risk in vulnerable populations
  • Free radical scavenging enzymes e.g superoxide dismutase low in in patients
  • Cool down the brain – reduces oxygen demand
41
Q

How do you reduce the primary risk of stroke

A

Treat hypertension - Diuretics, ACE inhibitors, AR antagonist, change diet
Treat A Fib - Give Aspirin
Statins - reduce LDL cholesterol

CR2 (34 decks)

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