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neuro 210 finallll > Brain Circulation and Stroke > Flashcards

Brain Circulation and Stroke Flashcards

1
Q

how common is stroke?

A

every 10 minutes someone in canada suffers a brain attack aka stroke

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2
Q

what is the number one cause of disability and number three cause of death?

A

stroke

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3
Q

what does ‘stroke; mean?

A

apoplexy = struck down with violence .. this is the word that stroke stemmed from… stroke first used in 1599 to describe the apoplectic seizure

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4
Q

What is a stroke defined by world health organization?

A

world health organization define it as a neurological deficit of cerebrovascular cause that persists beyond 24 hours or is interrupted by death within 24 hours

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5
Q

What are two types of strokes described by Wepfer?

A
  1. ischemic stroke –> isn’t really visible, its when theres low blood to certain area of the brain due to occlusion in the artery … the cortical ribbon surrounding the right hemisphere is pale and white
  2. hemorrhagic stroke –> this is visible in post mortum brain because its a visible huge blood clot in the brain due to blood leaking
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6
Q

what is an acute ischemic stroke? what percentage of strokes comprises of this?

A

ischemia in general is lack of blood flow

acute ischemic stroke is caused by occlusion of a blood vessel usually via thrombosis (blood clot) in that artery or a thrombo-emobolism which is a blood clot somewhere else in the body that moves upwards towards the brain

this accounts for 80% of stroke

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7
Q

What is spontaneous intracranial hemorrhage?

A

when microscopic vessels rupture and cause macroscopic bleeding (bruising but with bleeding)

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8
Q

what are two types of spontaneous intracranial hemorrhage?

A
  1. aneurysmal subarchanoid hemorrhage (5-10% of strokes) –> rupture of blood vessel and bleeding outside of the brain
  2. intracerebral hemorrhage (10-15% of stroke) [second common cause of stroke]
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9
Q

How do we visual stroke?

A

using CT scans or angiograms that take slices of the brain

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10
Q

What are symptoms of stroke?

A

when subarchanoid hemorrhage touches your meninges, it gives you the worst headache of your life

signs:

  • unilateral weakness on one side or numbness
  • trouble speaking and understanding
  • loss or change in vision
  • sudden onset of dizziness and loss of balance
  • sudden onset of first and worst headache
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11
Q

what is aphasia/dysphasia? which hemisphere does it occur and what are two types?

A

its when people have trouble understanding or producing speech

brook’s aphasia is also called non-fluent aphasia which is characterized by slow, halting, effortful speech, frustrated, relatively good comprehension

wernicke’s aphasia is characterized as empty, speech, word salad and poor comprehension

dysarthria is slurring of words

this usually occurs in the left hemispheres

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12
Q

what is neglect/ heme-inattention?

A

right parietal lobe lesion that causes person to not see their left side

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13
Q

what is hemiplegia?

A

stroke that affects the internal capsule of white matter

symptoms include contralateral weakness

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14
Q

what are the two main arterial supply to the brain?

A

vertebral artery and internal carotid artery

they join up at the circle of willis in the brain and are connected by basilar artery

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15
Q

which arteries innervate the anterior circulation?

A

The internal carotid artery supplies the anterior circulation and its composed of anterior cerebral artery and middle cerebral artery

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16
Q

which arteries innervate the posterior circulation?

A

posterior cerebral artery and basilar artery

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17
Q

why do we have the circle of willis?

A

for evolutionary protection so if any other blood got clot then we have another blood circulation going to the same spots

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18
Q

What is the middle cerebral artery (MCA)?

A

its the one that goes through the deep structures like basal ganglia, and subcortical white matter and supplies blood to the LATERAL surface of the hemisphere

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19
Q

what happens if theres a clot in the MCA?

A

you get contralateral face and arm weakness and aphasia in the left hemisphere and neglect in the right hemisphere

20
Q

Where does the Anterior Cerebral Artery supply blood to?

A

it supplies blood to the medial surface of the hemisphere and causes contralateral leg weakness or numbness

21
Q

What is a large artery/cortical stroke?

A

can be proximal (over a small area) or distal (spread over larger area)

  • symptoms include: contralateral weakness, neglect (right hemisphere), aphasia/dysphasia (left hemisphere) and contralateral visual loss
22
Q

what are sub-cortical/lacunar strokes?

A

occlusions of small artery that penetrates deep into the brain
- harder to detect on CT scans and MRI is often used

most common symptom of this is contralateral weakness

23
Q

What is a sub cortical stroke affecting the white matter?

A

this affects the internal capsule of the legs, arms, and face

symptoms can include contralateral weakness affecting the face, arm and leg and even a small stroke can be debilitating

24
Q

What composes of the posterior circulation?

A

vertebral and basilar arteries supply posterior and medial regions of the hemispheres, brainstem, diencephalon, and cerebellum

25
Q

what are the two major branches of the posterior circulation?

A
  1. posterior cerebral artery

2. cerebellar arteries

26
Q

what is a brainstem stroke?

A

a brainstem stroke is a stroke in the brain stem and the brain stem contains more wiring downstream from the internal capsule white matter that controls the movement of legs, face and arm

symptoms of this include lacunar syndrome which is weak and ataxic on the contralateral side

can lead to hemipalegia

27
Q

what is a posterior cerebral artery stroke?

A

its a contralateral hemianopsia (blindness on one side of the visual field)

28
Q

What is Locked In Syndrome?

A

its a stroke in the pons.

it is the ONLY stroke with bilateral symptoms

its an occlusion of the basal artery and shows differences in consciousness and leaves you quadriplegic … you are awake but you can’t move

29
Q

what is transient ischemic attack (TIA)?

A
  • these are mini strokes
  • symptoms of stroke that resolve within 24 hours of onset (stroke and TIA are a continuum)
  • this is a warning sign for a major stroke
    these are NOT benign and 50 percent of TIA’s are associated with permanent damaged particularly if symptoms last over an hour

its a little occlusion but resolves spontaneously however can lead to permanent damage

30
Q

Where do thromboembolism clots come from?

A

magnetic resonance angiograms are used to spot out clots in the artery

  1. the heart (cardioemobolic)
  2. arteries in the neck
  3. arteries in the brain
31
Q

what is the major stroke mechanism?

A

major mechanism for stroke is unknown but 20% is from cardioembolic (travelled from heart), 20% is from large vessel atheromatous (in the neck or arteries of clotting), 25% is from small vessels and 5% from other

32
Q

What is the number one cause of stroke?

A

irregular heartbeat via atriofibrillation (most clots go up the brain) and will end up in the left hemisphere (dominant side) and cause aphasias mostly

33
Q

what is carotid artery atherosclerosis?

A

its when theres a plaque in the internal carotid artery and that plaque travels to the brain … can be viewed under angiogram

34
Q

what is intracranial atheroscelotic disease?

A

arteries get stiff and non compliant and occlude

35
Q

what are 4 ways to prevent stroke?

A
  1. high blood pressure treatment (drugs)
  2. smoking cessation
  3. aspirin (low dose)
  4. anticoagulation (warfarin or other newer drugs) only for patients with atrial fibrillation
36
Q

what is cerebral schema?

A

insufficient blood supply (therefore low oxygen and low glucose) to meet the metabolic demands of the brain

37
Q

What is the Ischmic Penumbra done by Astrup et al (1981)

A

studied how the brain responds to low blood in baboons

    1. blood flow stopped and no protein was made
      1. EEG became silent in that part of the brain
      2. blood flow is so low, you can’t bring neurons back…

after its 50% low of blood flow, neurons are not dormant anymore, they just die and can’t be revived

38
Q

what is the penumbric tissue?

A

its an area where theres an intermediate between non-functioning but still alive neurons and capable of recovery (not at 50% yet).. .kind of dormant

39
Q

What are some treatment options for acute thrombus?

A

thrombolysis activating drug (breaks down blood clots) called tPA (tissue plasminogen activator) which activates enzymes to break down blood clot

40
Q

how does tPA work?

A

it opens arteries and restore blood flow to the brain

41
Q

What is a Hemorrhagic stroke or Intracranial hemorrhage (ICH)?

A

its the second most common stroke type (10-20% varies with population) and occurs mainly in african and asian populations

42
Q

what is the prognosis in ICH and what does it matter on?

A

early 30 day case fatality is 40% and its double that of ischemic stroke
- initial level of consciousness + hematoma volume predicts death (swelling of clotted blood in the tissue)
- drowsy/coma + hematoma cause a more than 60% mortality rate
- being alert + hematoma (that is less than 30mL) cause 17% mortality rate
Initial level of consciousness + hematoma volume of more than 60mL is 91% predicts death

43
Q

What are risk factors for developmental aneurysms?

A

aneurysms are ruptures that cause subarchanoid hemmorage

  1. hypertension
  2. smoking
  3. family history
44
Q

How are aneurysms typically treated?

A

using a aneurysm coil (endovascular coil) or a surgical clip

45
Q

What is the intracererbral hemorrhage treatment?

A

no proven therapy

neuro 210 finallll (12 decks)

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