8. Cerebrovascular Disease Flashcards

(51 cards)

1
Q

what are the 4 types of stroke

A

subarachnoid haemorrhage
primary intracerebral haemorrhage
ischaemic stroke
transient ischaemic attack

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2
Q

which is the most common type of stroke

A

ischaemic stroke (80% of cases)

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3
Q

what normally causes a subarachnoid haemorrhage

A

occurs when an aneurysm on the surface of the brain bursts and leaks

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4
Q

where does the bleeding occur in the subarachnoid haemorrhage

A

bleeding occurs in the space that surrounds the brain

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5
Q

where does the bleeding evolve from in a primary intracerebral haemorrhage

A

evolves from within the tissue of a brain

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6
Q

what normally causes primary intracerebral haemorrhage

A

hypertension or amyloid angiopathy

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7
Q

what happens in ischaemic stroke

A

a blockage prevents the flow of blood and oxygen to the brain

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8
Q

describe transient iscahemic attacks

A

also known as a mini stroke - symptoms only last for a short amount of time as the blockage preventing blood flow is only temporary

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9
Q

what structure ensures constant blood flow to the brain

A

the circle of Willis

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10
Q

what does NIHSS stand for

A

the national institute of health stroke scale

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11
Q

what does the NIHSS assess

A

the level of disability and neurological impairments on. scale from 0-42 0 with 42 the equivalent of death

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12
Q

on a CT scan, what is the white structure encasing the brain called

A

the cranial vault

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13
Q

how can a brain bleed be identified on a CT

A

the presence of a faint white line

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14
Q

what does infarction mean

A

the term for tissue injury that happens following reduced blood flow

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15
Q

what does ischaemia mean

A

reduced blood flow

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16
Q

how many strokes every year in the EU

A

1 million per year

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17
Q

give me a striking statistic on strokes

A

stroke is the second most common cause of death worldwide

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18
Q

name the 4 long-term complications associated with strong

A

increased long term mortality
physical, cognitive and behavioural impairments
chronic disability
recurrent stroke
increased risk of further vascular events

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19
Q

what is the biggest cause of stroke (what %)

A

atherothromboembolism = 50% of strokes

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20
Q

describe the Oxford vascular study as evidence for age as a risk factor

A

difficult to assess incidence of strokes. however, a longitudinal study directed by Oxford University found 75% of cerebrovascular diseases occurred in those aged 65+

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21
Q

what is a limitation of the Oxford vascular study

A

limited as numbers do not include possible, recurrent or suspected cerebrovascular events

22
Q

name 3 races with an increased risk for stroke

A

black populations
maori and pacific islands
south asian populations living in the UK

23
Q

why do black populations have an increased risk of stroke

A

due to comorbidities: increased risk of diabetes mellitus and hypertension

24
Q

who do NZ people have a higher risk of stroke than

A

higher risk than europeans

25
why do south asian populations in the UK have a high risk factor for stroke
high prevalence of vascular disease due to genetic susceptibility, dietary and lifestyle factors
26
stroke as a result of atherosclerosis is high in rural china, what does incidence grow by each year?
stroke incidence rises annually at a rate of 8.7%
27
what factors make pregnant and postpartum females more prone to stroke
gestational hypertension caesarean delivery pre-eclampsia - can all lead to aneurysm rupture as blood volume and cardiac output increase
28
women with gestational diabetes are how much more likely to have a stroke
6-9 fold
29
what does pre-eclampsia cause
endothelial dysfunction and impaired cerebral autoregulation
30
why is it interesting that the risk of perpiartuqm stroke is associated with caesarean delivery
perhaps this is because women at risk of stroke are encouraged to have a C-section. this would explain why incidence is higher in this group.
31
how many times more likely to suffer a stroke are people who take cocaine
6 x more likely
32
how does cocaine cause stroke
increases BP = could burst an aneurysm cocaine promotes thrombotic strokes by causing hypercoagulable states
33
what evidence is there for a role of infections in preceding stroke
seasonal variation in stroke incidence and the fact that 10-35% of patients have an infection in the week preceding stroke
34
what chronic infections are associated with increased stroke risk
chlamydia pneumoniae helicobacter pylori
35
name some modifiable risk factors for stroke
hypertension psychosocial stress smoking
36
how do these risk factors increase propensity to stroke
- promote the formation of atherosclerotic plaques - these plaques in the brain compromise endothelial ability to regulate microvascular flow
37
why is it important that the brain is able to regulate microvascular flow
ensures that the brains energy supply matches demand - this can be mismatched when atherosclerotic plaques compromise this process
38
some of these risk factors can increase production of reactive oxygen species (ROS), what does this mean?
free radical superoxide inactivates nitric oxide resulting in a loss of vasoregulatory and loss of anti-aggregant effects
39
what are the two main zones of an ischaemic stroke
the core zone the penumbra
40
what occurs in the core zone
rapid neuronal death and the death of supporting cellular elements e.g. glial cells
41
how do neurons and glial cells die in the core zone
the loss of oxygen and glucose results in an energy deficit. this facilitates ionic imbalance and mitochondrial failure. activation of a series of enzymes results in the fast breakdown of cell structures and the loss of cellular integrity
42
what happens to the neurons in the penumbra
they remain viable for several hours. they will die if reperfusion is not established
43
what supplies neurons in the penumbra with their blood supply
collateral arteries
44
how can neurons in the penumbra be damaged even if blood flow is restored
they can face excitotoxicity = excess glutamate = calcium influx and production of free radicals.
45
what breaks down after ischaemic stroke and contributes to the oedema and bleeding into the infarcted area
the blood brain barrier
46
what molecule is involved in BBB breakdown
matrix metalloproteinases
47
what percentage of stroke patients go on to develop dementia in the months following stroke
~ 25%
48
what facilitates dementia formation post stroke
white matter lesions which interrupt neural pathways involved in cogntion
49
what is the term given for these small white matter lesions
leukoaraiosis
50
what happens when these white matter lesions form
they facilitate demyelination, axonal loss and microglial activation = neuronal loss involved in cognition
51
what is the development of dementia dependent on
the location and volume of the stroke and the presence of other cerebral pathologies