B2W3 Trans Phys Stroke

Question 1

Ischemic Stroke

Answer 1

When cerebral blood flow is insufficient to meet the brains metabolic demands

Question 2

Causes of ischemic Stroke

Answer 2

Thrombosis
Embolism
Hemodynamic

Question 3

Thrombosis

Answer 3

Intracranial Large Artery disease
Penetrating large artery disease

Question 4

Embolism

Answer 4

Extracranial disease (artery to artery emboli or flow-limiting stenosis)

Question 5

Hemodynamic

Answer 5

Aortic arch plaque, Afib, Valve disease, and cardiomyopathy

Question 6

Law of Poiseuille

Answer 6

CBF = (CPP)(PiR^4)/(n)(i)

Decreasing R or radius causes ischemia from the center outward

Decrease in P or pressure causes ischemia between vascular territories, increases risk of developing infarcts

Question 7

Ischemic Penumbra

Answer 7

Territory where dead tissue radiates outwardly within a few minutes of blockage

Surrounding area may still be viable but is stunned

Question 8

Occlusion of Ophthalmic Artery

Answer 8

Opthalmic artery is one of the first branches off of the carotid artery
- Supplies the Central Retina Artery
- Causes Amaurosis Fugax or Transient Mono-Ocular Blindness
- Transient attack meaning symptoms resolve spontaneously
- STILL AN EMERGENCY

Question 9

Occlusion of the Anterior Cerebral Artery

Answer 9

Branch of the internal carotid artery
- Causes weakness to the opposite foot/leg, and shoulder/arm
- Does not affect the face and hands
- Involves frontal lobe
- - Causes patient slowness

Question 10

Occlusion of Middle Cerebral Artery

Answer 10

Other branch of internal carotid artery
- Covers more territory of the brain and more common than ACA
- Weakness/numbness in the opposite face and hands
- Further symptoms associated with location of the occlusion

Question 11

MCA Occlusion Location Dependency in the Artery (Left side of brain)

Answer 11

1st row
- Trouble Speaking and understanding
- Blocks both offshoots of the artery

2nd Row
- Trouble Speaking
- Broca’s Aphasia
- Distal superior division

3rd Row
- Trouble understanding
- Wernicke’s Aphasia
- Distal inferior division

Question 12

Broca’s Aphasia

Answer 12

Trouble Speaking
“Broca” “Broken” “Broken Vocal Chords

Question 13

Wernicke’s Aphasia

Answer 13

Trouble understanding
“Wernicke’s” “Is that even english”

Question 14

Lacunar Syndromes

Answer 14

Small Vessel Disease

Question 15

Lateral Lenticulostriate Arteries

Answer 15

Vessels that branch from the MCA and supply the putamen, posterior limb of the internal capsule and corona radiata

Question 16

Occlusion of the Vertebral Artery

Answer 16

Major artery of the head/neck
- Posterior Inferior Cerebellar Artery (PICA)

Question 17

Occlusion of PICA

Answer 17

• Causes Wallenberg Syndrome

Question 18

Wallenberg Syndrome

Answer 18

Loss of sensation in the face and limbs

Question 19

Treatment for Ischemic Stroke

Answer 19

Increase Blood flow
Increase Blood Pressure
Increase Radius

Question 20

Method to increase blood flow

Answer 20

remove clot via IV tPA (<3-4.5 hrs) or mechanical thrombectomy (<6 hrs from onset)

Question 21

Method to increase blood pressure

Answer 21

Sweet Spot of BP = Systolic 140 - 180mmHg
Provide Vasopressors to augment blood flow by constricting blood vessels to increase blood pressure

Question 22

Increase Radius

Answer 22

Angioplasty or stent

Question 23

Intracerebral Hemorrhage

Answer 23

15% of Strokes

Question 24

Atrio-Venous Malformation

Answer 24

2nd cause of hemorrhagic stroke
-Seen in frontal lobe

Question 25

Hypertensive Hemmorhage

Answer 25

Hypertension is the main cause of hemorrhagic stroke

Question 26

Most common location of hypertensive hemorrhagic stroke

Answer 26

Putamina

Question 27

Hemorrhagic Intracranial Volume Equation

Answer 27

ABC/2
ABC indicates different slices of the brain along the Z axis and the area of blood in each is multiplied and divided by 2

Question 28

Ideal BP for Hemorrhagic Stroke victims

Answer 28

< 160 mmHg