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354: Pathobiology > 8. Cerebrovascular Disease > Flashcards

8. Cerebrovascular Disease Flashcards

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
Q

why do south asian populations in the UK have a high risk factor for stroke

A

high prevalence of vascular disease due to genetic susceptibility, dietary and lifestyle factors

26
Q

stroke as a result of atherosclerosis is high in rural china, what does incidence grow by each year?

A

stroke incidence rises annually at a rate of 8.7%

27
Q

what factors make pregnant and postpartum females more prone to stroke

A

gestational hypertension
caesarean delivery
pre-eclampsia
- can all lead to aneurysm rupture as blood volume and cardiac output increase

28
Q

women with gestational diabetes are how much more likely to have a stroke

A

6-9 fold

29
Q

what does pre-eclampsia cause

A

endothelial dysfunction and impaired cerebral autoregulation

30
Q

why is it interesting that the risk of perpiartuqm stroke is associated with caesarean delivery

A

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
Q

how many times more likely to suffer a stroke are people who take cocaine

A

6 x more likely

32
Q

how does cocaine cause stroke

A

increases BP = could burst an aneurysm

cocaine promotes thrombotic strokes by causing hypercoagulable states

33
Q

what evidence is there for a role of infections in preceding stroke

A

seasonal variation in stroke incidence and the fact that 10-35% of patients have an infection in the week preceding stroke

34
Q

what chronic infections are associated with increased stroke risk

A

chlamydia pneumoniae
helicobacter pylori

35
Q

name some modifiable risk factors for stroke

A

hypertension
psychosocial stress
smoking

36
Q

how do these risk factors increase propensity to stroke

A
  • promote the formation of atherosclerotic plaques
  • these plaques in the brain compromise endothelial ability to regulate microvascular flow
37
Q

why is it important that the brain is able to regulate microvascular flow

A

ensures that the brains energy supply matches demand - this can be mismatched when atherosclerotic plaques compromise this process

38
Q

some of these risk factors can increase production of reactive oxygen species (ROS), what does this mean?

A

free radical superoxide inactivates nitric oxide resulting in a loss of vasoregulatory and loss of anti-aggregant effects

39
Q

what are the two main zones of an ischaemic stroke

A

the core zone
the penumbra

40
Q

what occurs in the core zone

A

rapid neuronal death and the death of supporting cellular elements e.g. glial cells

41
Q

how do neurons and glial cells die in the core zone

A

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
Q

what happens to the neurons in the penumbra

A

they remain viable for several hours. they will die if reperfusion is not established

43
Q

what supplies neurons in the penumbra with their blood supply

A

collateral arteries

44
Q

how can neurons in the penumbra be damaged even if blood flow is restored

A

they can face excitotoxicity = excess glutamate = calcium influx and production of free radicals.

45
Q

what breaks down after ischaemic stroke and contributes to the oedema and bleeding into the infarcted area

A

the blood brain barrier

46
Q

what molecule is involved in BBB breakdown

A

matrix metalloproteinases

47
Q

what percentage of stroke patients go on to develop dementia in the months following stroke

A

~ 25%

48
Q

what facilitates dementia formation post stroke

A

white matter lesions which interrupt neural pathways involved in cogntion

49
Q

what is the term given for these small white matter lesions

A

leukoaraiosis

50
Q

what happens when these white matter lesions form

A

they facilitate demyelination, axonal loss and microglial activation = neuronal loss involved in cognition

51
Q

what is the development of dementia dependent on

A

the location and volume of the stroke and the presence of other cerebral pathologies

354: Pathobiology (10 decks)

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