6 Cerebral Vasclar Disease Stroke And Hemorrhage

Question 1

Strokes:

It’s a _____ of blood supply to an area of the brain, resulting in loss of neurological function.

Reduction of the flow rate by __% causes neurons to stop signaling. Reduction to about __% for more than a few minutes initiates necrosis of involved brain tissue.

A necrotic region of tissue is called an ______

An abrupt indecent of vascular insufficiency is called a _____

Bleeding into or around the brain can have stroke-like effects.

Answer 1

Loss

60%. 20%

Infarct

Stroke

Question 2

Are strokes are more common in men than women?

_______ with age.

Two types of strokes:

_________(ischemic) (70-80% of cases)
Thrombotic and _______

Hemorrhagic (not due to trauma)
Intracerebral hemorrhage and ____________ hemorrhage

Answer 2

Men!

Increases (peak around 80-84yrs)

Occlusive. Embolic

Subarachnoid

Question 3

Time is of the essence in a stroke!

A ________ is the region surrounding the area of permanent tissue damage. It will survive is you treat rapidly and appropriately. You have up to _hrs to treat!

Answer 3

Penumbra. 3hrs

Question 4

Occlusive/ischemic strokes:

__________:
Clot forms locally, over an atherosclerotic region. Often has prodromes and transient ischemic attacks (TIA).

_______:
Blockage by thrombi formed elsewhere. Thrombus detaches, and lodges in artery. Often no prodromes.

Watershed _______:
Hypoxia due to insufficient blood supply. Hypotension. Affects vulnerable sites

Answer 4

Thrombotic

Embolic

Watershed infarct

Question 5

Hemorrhagic strokes:

___________ hemorrhage:
Most commonly caused by ANEURYSM RUPTURE and arteriovenous malformation

____________ hemorrhage:
Most commonly caused by HYPERTENSION and arteriovenous malformation

Answer 5

Subarachnoid hemorrhage

Intracerebral Hemorrhage

Question 6

Ischemia and hemorrhage lead to virtually the same clinical presentation, the only difference is the _________.

Ischemic (reduced ______ supply): leads to decreased oxygenation of brain tissue (hypoxia) which can progress to tissue necrosis (________)

Hemorrhagic- ________ of a blood vessel. If a severe headache is associated with a stroke, symptoms indicate this kind of stroke

Answer 6

Mechanism

Blood. Infarction

Rupture

Question 7

A ________ ischemic attack is a vascular event similar to a stroke’s symptoms.

The crucial difference is that the deficits of a TIA persist for only a few minutes to hours and have a ________ recovery.

Transient monocular blindness or amaurosis fugax, is a classic example of ___ syndrome. Caused by emboli detaching from internal carotid artery and enter the ________ artery thus rendering the retina temporarily ischemic.

Often precede a stroke!

Answer 7

Transient

Complete

TIA. Ophthalmic.

Question 8

Ischemic stroke:

What’s the most common location where an ischemic stroke could occur?

_________ of the brain is the biggest immediate danger (herniation). The main symptoms are contralateral hemiparesis and sensory loss predominately in the ____ and ______ extremity. ***

______ strokes involve the MCA. Pure motor, sensory, isolated symptoms of MONOPARESIS and ISOLATED ________ LOSS**

Answer 8

MCA

Swelling. Face and upper extremity **

Lacunar. Sensory

Question 9

Strokes involving the anterior cerebral artery

Main symptoms include:

Contralateral hemiparesis in _____ extremity. Contralateral sensory loss in _____ extremity.

The give-away would be the _______ incontinence.

Answer 9

Lower. Lower

Urinary

Question 10

Strokes involving vertebral-basilar system

Main symptoms:

Ipsilateral ______ loss in the face

The main give away point is _______, ataxia!

The posterior inferior cerebellar artery supplies the lateral ______. It’s occlusion can cause Wallenberg Syndrome.

Answer 10

Sensory

Vertigo

Medulla

Question 11

The main symptoms involving a posterior cerebral artery include:

Gaze _______.

______ fields defects. Hemianopsia-where the eye deviates towards the side of the lesion to compensate. ‘Eye looks towards the lesion”

Answer 11

Paralysis

Visual

Question 12

Locations and causes of an intracranial hematoma:

________-rupture of a meningeal artery from blow to head.

________-rupture of a bridging vein. Accident where head hits hard surface.

__________-most often aneurysm rupture. “Worst headache of my life”

Answer 12

Epidural

Subdural

Subarachnoid

Question 13

What hematoma is caused when an arterial bleed creates a blood-filled space between the bone and dura matter? Caused from a blow to the head.

Diagnosis:
Head CT scan is best choice. It is ____ shaped.

Which hematoma is a subdural rupture of bridging veins between dura and arachnoid matter? Often seen in shaking baby syndrome, alcoholics, and the elderly

Which hematoma is caused by a ruptured berry aneurysm? Old age, smoking, and higher rates in African Americans. Presents as “worst headache of my life” and CN ___ paralysis.

Diagnosis:
Bloody spinal tap. CT scan crescent shaped. Removed by craniotomy

Answer 13

Epidural hematoma

Lens

Subdural hematoma

Subarachnoid. CN III oculomotor

Question 14

(LO) Describe how a subarachnoid hemorrhage starts. What types of vessels rupture?
What are some typical causes or risk factors?

Answer 14

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Question 15

(LO) What type of vessel ruptures in a subdural hemorrhage? What are some typical causes? Describe which tissues that contain the hematoma. What is the shape of the hematoma as seen in a CT or MRI scan? Why does this shape occur?

Answer 15

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Question 16

(LO) Where anatomically does an epidural hematoma occur? Describe how an epidural hemorrhage starts. What is the main cause? What vessels bleed? Describe which tissues that contain the hematoma. What is the shape of the hematoma as seen in a CT or MRI scan? Why does this shape occur?

Answer 16

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Question 17

(LO) What area(s) of the brain will be affected if the PCA gets occluded right the bifurcation of the lateral and the medial and the lateral occipital branches?

Answer 17

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Question 18

(LO) What area(s) of the brain will be affected if the ACA gets occluded at a point just distal to the anterior communicating artery?

Answer 18

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Question 19

(LO) What area(s) of the brain will be affected if the MCA gets occluded at a point just distal to origin of the ACA branch?

Answer 19

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Question 20

(LO) Why is that “time is of the essence” in diagnosing and treating stroke?

Answer 20

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Question 21

(LO) What does the term infarct mean? What does the term penumbra mean?

Answer 21

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Question 22

(LO) What is the main difference in definitions of a transient ischemic attack and a stroke?

Answer 22

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Question 23

(LO) What is a subarachnoid hemorrhage? Can it result in stroke?

Answer 23

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Question 24

(LO) What is the difference between a stroke and a brain hemorrhage?

Answer 24

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Question 25

What is a major anatomical source of embolism causing an embolic stroke? What is a “paradoxic” embolus?

Answer 25

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Question 26

What is the difference between an embolic and a thrombotic stroke? Explain what is the traditional definition of a stroke? What are some different causes?

Answer 26

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