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Neurology - Sem 3 > Case 5 - Stroke > Flashcards

Case 5 - Stroke Flashcards

1
Q

What are the driving requirments for people who have had a stroke?

A
  • Must NOT drive
  • Dont need to notify the DVLA
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2
Q

When must the DVLA be notified?

A
  • After 1 month of:
    • Visual field defect
    • Cognitive defects
    • Impaired limb function
    • Residual neurological deficit continues
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3
Q

What are the requirements for a person who has a:

  • Single ischaemic attack
  • v
  • Multiple transient ischaemic attack
A

SIA

  • Must not drive for 1 month
  • No need to notify DVLA

MTIA

  • Must not drive for 3 months min.
  • Must notify DVLA
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4
Q

What are phonemes?

A

Fundamental sounds that a language uses to communicate

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5
Q

How many words can children understand at 18 months?

A

150 words

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6
Q
  1. What is the multistore theory?
  2. What is memory in this theory?
  3. When does short term memory become long term memory?
  4. What happens if there is no rehearsal?
  5. What is the capacity of long term memory?
A
  1. Memory consists of perception - storage - retrieval
  2. Memory is made of a series of stores
  3. If it is rehearsed
  4. It is forgotten
  5. Unlimited
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7
Q
  1. What is the working model of memory?
  2. What is the central executive?
  3. What are the 2 subsystems?
  4. What does the phonological loop deal with?
  5. What are the 2 parts of it?
  6. What is the visuo-spatial sketchpad?
A
  1. Not just 1 store, but different systems for different types of information
  2. controls and coordinates the operation of the 2 subsystems, and decides what to pay attention to and memorise
  3. Phonological loop & Visuo-spatial sketchpad
  4. spoken and written material
  5. Phonological store and articulatory control process
  6. Processes visual and spatial information
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8
Q
  1. What is the levels of processing model? What is memory?
  2. What are schema?
  3. What are the 2 ways we process information?
  4. What are the 2 forms of shallow processing?
  5. What is semantic processing?
  6. Which information is easier to recall?
A
  1. Concentrates on processes involved in memory, memory is the processing of information
  2. template for learning and remembering things
  3. Shallow processing & Deep processing (Semantic processing)
  4. Structural processing (Physical qualities) & Phonemic processing (Sound)
  5. We encode meaning of word etc.
  6. Information that has been through deeper processing
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9
Q

What is aphasia?

A

Partial or complete loss of language abilities post. brain damage

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10
Q

Which part of the brain usually controls language expression?

A

Left cerebral hemisphere

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11
Q

Identify:

  • Broca’s area
  • Wernickes area

Where on the brain are these found? Which lobe?

What is their function?

A

Broca:

  • Left frontal lobe
  • Articulation of speech

Wernicke’s:

  • Superior temporal lobe, between auditory area and angular gyrus
  • Comprehension of speech
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12
Q

What is Broca’s aphasia?

What is Wernicke’s aphasia?

A
  • Also called motor aphasia. Difficulty speaking, comprehension is good. Anomia (Inability to find words)
  • Speech is fluent, comprehension is poor.
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13
Q

Which 2 arteries supply the brain? Where do they originate?

A
  • Internal carotid artery — Common carotid artery
  • Vertebral arteries —Subclavian artery
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14
Q

Where does the internal carotid artery enter the cranial cavity?

A
  • Through carotid canal into the middle cranial fossa
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15
Q

Identify the arteries (Under black boxes):

  • Internal carotid artery
  • Vertebral artery
  • External carotid
  • Common carotid
  • Subclavian artery
    *
A
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16
Q

What does the ICA divide into (Terminal branches)?

What do these 2 branches supply (2+3)?

A
  1. Anterior cerebral artery – Frontal & Parietal lobes
  2. Middle cerebral artery – Lateral surface of frontal lobe + Parietal + Temporal lobes
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17
Q

Where does the vertebral artery pass through from its origin?

Where does it enter the cranial cavity?

What do the 2 vessels unite to form? & Where?

A
  • Transverse foramina of the cervical vertebrae
  • Enters through the foramen magnum
  • Basilar artery, at junction of medulla and pons
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18
Q

What arteries are given off by the vertebral artery? (x7)

A
  • Anterior & Posterior spinal arteries
  • Posterior interior cerebellar artery
  • Pontine branches
  • Anterior inferior cerebellar artery
  • Labyrinthine artery
  • Superior cerebellar arteries
  • Posterior cerebellar arteries
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19
Q

What does the Posterior cerebral artery supply?

A
  • Occipital lobe (Visual cortex)
  • Infero-medial temporal lobe
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20
Q

Identify which area of the brain is supplied by which of the following arteries:

  • Anterior cerebral artery
  • Middle cerebral artery
  • Posterior cerebral artery
A
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21
Q

On the circle of willis identify:

  • Basilar artery
  • Vertebral artery
  • Spinal arteries
  • Labyrinthine artery
  • Pontine arteries
  • Posterior cerebral artery
  • Posterior communicating artery
  • Anterior communicating artery
  • Internal carotid artery
  • Anterior cerebral artery
  • Opthalmic artery
  • Posterior inferior cerebellar artery
  • Anterior inferior cerebellar artery
A
22
Q

What is a carotid bruit?

What does it indicate?

A
  • Whooshing sound heard from carotid arteries
  • Indicates that there is a change in blood flow or reduction.
23
Q

What is Pareisis?

What is Plegia?

What is a fasciculation?

What is spasticity?

A
  • Weakness
  • Paralysis
  • Spontaneous contractions of muscles
  • Resistance to passive limb moveements
24
Q

What would a lower motor neuron lesion lead to?

A
  • Symptoms ipsilateral to the lesion - affecting 1 muscle or group of muscles
    • Plegia or Pareisis
    • Loss of reflex or diminished reflexes (Areflexia or Hyporeflexia)
    • Fasciculation
25
Q

What is the result of an upper motor neuron lesion?

A
  • Symptoms contralateral to the lesion
    • Hyperflexia (Overactive reflex)
    • Spastictiy
    • +ive Babinski response
    • NO atrophy
26
Q

What are the functions of these areas of the brain?

  • Motor cortex - where is it?
  • Sensory cortex - Where is it?
  • Temporal lobe
  • Occipital lobe
  • Wernicke’s area
  • Cerebellum
  • Brainstem
  • Frontal lobe
  • Broca’s area
  • Pituitary
A
  • Movement (Higher function) - Pre central gyrus/Parietal lobe
  • Sensations - Post central gyrus/Parietal lobe
  • Hearing
  • Vision
  • Speech comprehension
  • Coordination
  • Heartrate, breathing etc.
  • Smell & Judgement, voluntary movement
  • Motor aspects of speech
  • Homeostatic regulation
27
Q

What are the un-modifiable risk factors of vascular disease?

What are the modfiable risk factors of CVD?

A
  1. Family history

Older age

Male

Hispanic or black

  1. Smoking, Diabetes, hypertension, Atrial fibrillation, atherosclerosis
28
Q

What are the following BMI values?

  • Normal
  • Overweight
  • Obese
A
  • 18.5 – 24.9
  • 25 – 29.9
  • 30 – 39.9
29
Q

What are the normal cholesterol values?

Total

HDL

LDL

A
  • Total = <5mmol per L
  • HDL = >1mmol per L
  • LDL/Non-LDL = <4mmol per L
30
Q

What is the FAST test?

What is its function?

A
  • F - Facial weakness
  • A - Arm weakness
  • S - Speech problems
  • T - Time

In order to assess signs of stroke

31
Q

What is the NIH stroke scale assessment?

What are the components of the test?

What score would a person who hasnt had a stroke get?

A

Assesment to evaulate and document the neurological status in stroke patients

  1. Level of consciousness - noxious stimuli, questions, and commands
  2. Best gaze - eye movements
  3. Visual fields
  4. Facial palsy
  5. Motor arm & Leg testing
  6. Limb ataxia
  7. Sensory deficit testing
  8. Dysarthria
  9. Inattention

Min score - 0

32
Q

What is the MRC grade?

What is MRC grade 5?

Grade 2?

Grade 0?

A
  • To determine the power or strength of a patient
  • Grade 5 = normal power
  • Grade 2 = Active movement w/o gravity
  • Grade 0 = No contraction
33
Q

What are tendon reflexes?

What is used to test them?

What is a normal tendon reflex score?

What does 5+ mean?

What does 0 mean?

What does clonus mean?

What is the normal plantar response?

A
  • Used to test lower motor neurons, by eliciting the tendon reflex
  • Tendon hammer is used to test them
  • Normal is 2+
  • 5+ = Sustained clonus
  • 0 = Absent reflex

Clonus = continuous rhythmic muscle spasm

  • Normal response - plantarflexion of the toes or absent sign
    • Abnormal response - dorsiflexion of the toes
34
Q

What are the following tests?

  • CT scan
  • Carotid doppler ultrasound
  • PET scan
    *
A
  • Series of X-rays to build 3D image of body
  • Sound imaging of blood vessels, show blood flow
  • Imaging of glucose metabolism of brain
35
Q

How do risk factors affect cerebral blood vessels?

What is the effect of NO on the vessels?

A
  • Increase in production of reactive O2 species – promotion of inflammation
  • Inactivation of NO – Vasoconstriction & Less control of microvascular flow
  • Platelet & leukocyte adhesion

NO causes vasodilation of blood vessels – more blood flow

36
Q

What are the sources of Reactive oxygen species in ischaemia?

A
  • Increase in cytostolic Ca+ – activation of superoxide producing enzyme - NADH oxidase
  • ROS produced by mitochondria
  • Release from the cell
37
Q

What are the 4 components of neurological repair?

A
  1. Neuroplasticity/Neurogenesis
  2. Angiogenesis
  3. Microglial repair
  4. Glial scarring
38
Q
  1. Where are the neuronal stem cells found in the adult brain? (2)
  2. What is believed to be the function of the subgranular zone?
  3. Which colour does each correspond to?
A
  1. Lateral ventricle - Subventricular zone & Hippocampus - Subgranular zone of dentate gyrus
  2. How we improve our memory
  3. SZ - Yellow, SZDG - Blue
39
Q
  1. What is angiogenesis?
  2. What factors are required for it?
A
  1. Growth of new blood vessels from pre-existing vessels
  2. VEGFR2, Ang1 & Tie 2
40
Q
  1. What do astrocytes do during injury?
  2. What is gliosis?
A
  1. Form a glial scar which is a deposit of soft tissue after activation of astrocytes in brain
  2. Hypertrophy and hyperplasia of astrocytes
41
Q
  1. What do microglia do in response to injury?
  2. What are the 2 types of microglia formed when activated?
  3. When do they appear?
  4. What is their function?
A
  1. Proliferate, form aggregates, and congregate around cell bodies of dying neurons
  2. M1 & M2
  3. M1 - Acute phase, M2 - recovery phase
  4. M1 - Neurotoxic, M2 - Phagocytic
42
Q
  1. What is a transient ischaemic attack?
  2. What are the 2 ways to get a stroke?
  3. What are the 2 ways of ischaemic stroke?
  4. What are the 2 types of haemorrhagic stroke?
A
  1. Blood flow to part of the brain is blocked or reduced, disappears after short time - blood flow restored
  2. Ischaemia or haemorrhage
  3. Embolic stroke (Outside brain and travels there) or Thrombotic stroke (Within artery)
  4. Intracerebral or Subarachnoid or Extradural
43
Q
  1. What 3 factors does the survival of tissue depend on?
  2. What determines the clinical deficit that results?
A
  1. Collateral circulation, duration of ischaemia, and magnitude and rapidity of reduction in blood flow
  2. Anatomical area of the lesion
44
Q
  1. What happens in ischaemia?
  2. What does the high Ca+ level lead to?
A
  1. Depletion of ATP & Elevation of Ca+
  2. Apoptosis
45
Q
  1. What do the neurons release which is toxic?
  2. What does this lead to?
  3. What is the penumbra?
  4. What is the ischaemic core?
A
  1. Glutamate, in excess
  2. Excessive influx of Ca+ via NMDA receptors
  3. At risk tissue which can be rescued with reperfusion
  4. Irreversible tissue damage distal to occluded vessel
46
Q
  1. What is global cerebral ischaemia?
  2. What is the result?
  3. What is the prognosis?
A
  1. Generalised reduction of cerebral perfusion
  2. Confusional state, with widespread neuronal damage
  3. Usually brain death, with autolysis of tissue
47
Q
  1. What is focal cerebral ischaemia?
A
  1. Reduction or cessation of blood flow to localised area of brain
48
Q
  1. What are the 4 effects of hypertension on the brain?
  2. What is a Lacunar infarct?
  3. What is a slit haemorrhage?
  4. What is Hypertensive Encephalopathy?
    5.
A
  1. Lacunar infarcts, Slit haemorrhages, Hypertensive Encephalopathy, Hypertensive intracerebral haemorrhage
  2. Occlusion of deep penetrating arteries, leading to lacunar infarcts in subcortical areas
  3. Rupture in small penetrating vessels
  4. Increased intercranial pressure
49
Q
  1. What are the events that lead to brain damage in stroke? (3)
  2. What are cortical spreading depolarisations?
  3. What is released from RBC’s which is toxic in the brain?
A
  1. Excitotoxicity, Oxidative stress, and Post-ischaemic inflammation
  2. High levels of K+ and glutamate cause massive depolarisation of neurons which causes further damage
  3. Hb
50
Q
  1. What is normal anxiety?
  2. What is the result?
  3. What is Generalised anxiety disorder?
  4. What is a phobia?
A
  1. Response to threatening situations, prepares for fight or flight response
  2. Increased SNS activity
  3. Anxiety response that is out of proportion to theat, or occurs when there is no threat
  4. Abnormal anxiety in specific situations
51
Q
  1. Which part of the brain is key in this disorder?
  2. What are the DSM 4 diagnostic criteria?
  3. What are the treatments for it? (3)
A
  1. Amygdala
  2. Excessive anxiety and worry on most days for approx 6 months, restlessness, irritability etc.
  3. Benzodiazepines, SSRI, CBT

Neurology - Sem 3 (15 decks)

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