Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

year 2 neuro - Robbie > Cerebral Infarction (Clinical) > Flashcards

Cerebral Infarction (Clinical) Flashcards

1
Q

What is the global burden of stroke?

A

5 million stroke deaths each year

2nd leading cause of death worldwide

>15 million non-fatal strokes each year

>50 million stroke/TIA survivors alive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the UK stroke burden?

A

>100,000 new strokes per year

~75% of strokes occur in people > age 65

~1/3 of patients die within 1 year of stroke

1.2 million stroke survivors

50% of survivors remain dependent on others

Stroke accounts for more hospital and nursing home bed-days than any other condition.

Annual cost of stroke £26 billion (set to triple by 2035)

(includes direct health care costs, productivity loses due to mortality and morbidity, and informal care costs)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Stroke Risk _________ with Age

A

Stroke Risk Increases with Age

It is a disese of ageing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Are all stroke presentations the same?

A

No all different

depends what area of the brain is affected

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is a stroke?

A

is the sudden onset of focal or global neurological symptoms caused by ischemia or hemorrhage and lasting more than 24 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the 2 different types of stroke?

A

85% are ischaemic strokes

15% haemorrhagic strokes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is a transient ischemic attack (TIA)?

A

the term used if the symptoms resolve within 24 hours

Most TIAs resolve within 1-60 min

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Ischemic strokes make up 85% of strokes, what are the different types of ischemic strokes?

A
  1. Large artery atherosclerosis (e.g. Carotid) 35%
  2. Cardioembolic (e.g. atrial fibrillation) 25%
  3. Small artery occlusion (Lacune) 25%
  4. Undetermined/Cryptogenic 10-15%
  5. Rare causes <5%
  • Arterial dissection
  • Venous sinus thrombosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Haemorrhagic strokes make up 15% of all strokes, what are the different types of haemorrhagic strokes?

A
  1. Primary intracerebral hemorrhage 70%
  2. Secondary hemorrhage 30%
  • Subarachnoid hemorrhage
  • Arteriovenous malformation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Wht are the 2 different types of risk factors for a stroke?

A

modifiable

non-modifiable

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the non-modefiable risk factors for a stroke

A

Previous stroke

Age

Male

Family history

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

WHat are modifiable risk factors of a stroke?

A

the pill

smoking

western diet

obesity

high blood pressure

drugs

lack of exercise

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the most important modifiable risk factor?

A

Hypertension

The most important modifiable risk factor

The risk of stroke is related to the level of blood pressure

Chronic hypertension exacerbates atheroma and increases involvement of smaller distal arteries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

WHat are small end arteries more at risk of?

A

Small end arteries coming directly off large arteries experience higher pressure and are at risk of lipohyalinosis causing:

I. Lacunar ischaemic stroke

II. Small vessel haemorrahges

Especially in:

  1. Brainstem
  2. Basal ganglia
  3. Subcortical areas
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How does smoking increase the risk of strokes?

A

·Smokers have:

  1. 2x increased risk of cerebral infarction
  2. 3x increased risk for sub-arachnoid hemorrhage

Some of the increased risk relates to the complications of cardiac problems

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How does diabetes and lipids affect the risk of a stroke?

A

Diabetes mellitus increases the incidence of strokes 3x

Hypertension, cigarette smoke, and diabetes contribute to LDL-C deposition in arterial walls

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How do lipids relate to the risk of a stroke?

A

The relationship between serum lipids and stroke is established

Risk related to development of atheroma in blood vessel walls

A high plasma level of low density lipoprotein (LDL) results in excessive amounts of LDL within the arterial wall

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How does alcohol increase the risk of stroke?

A

Complex relationship

Small amounts of alcohol may decrease stroke risk

Heavy drinking increases the risk 2.5 x

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

How does inactivity and obesity (especially abdominal/thigh) increase the risk of a stroke?

A

independent risk factor for vascular disease including stroke

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

How does AF affect a persons risk of a stroke?

A

Prevalence of AF doubles with age: 9% at 80-90 years

5x increased risk embolic stroke

More severe strokes

Higher mortality and morbidity, longer hospital stays, and lower rates of discharge to patients’ own homes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is used to help reduce the risk of ischemic strokes?

A

In patients with AF antiplatelets (e.g. Aspirin) have no benefit in reducing ischaemic stroke

Anticoagulants (warfarin and DOACS) reduce the risk of ischaemic stroke by 2/3rds

DOACS (e.g. Edoxaban and Apixaban) have less risk of causing bleeding than Warfarin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are some other risk factors of a stroke?

A

Other cardiac causes (recent heart attack, myxoma, PFO - patent foramen ovale)

Oral contraceptives (+ HRT) with a high estrogen content. Progesterone-only OK

Hyper-coagulable states:

- malignancy

- genetic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is the arterial circulation to the brain?

A

Anterior circulation:

2 x Internal carotid arteries

• 2 x Anterior Cerebral Artery (ACA)

• 2 x Middle Cerebral Artery (MCA)

Posterior circulation:

2 Vertebral arteries → 1 basilar

• 3 pairs of cerebellar arteries

• 2 Posterior cerebral arteries (PCA)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are the anastomoses of the arterial supply to the brain?

A

Circle of Willis - via anterior + posterior communicating arteries

Borderzone anastomoses - between peripheral branches of anterior, middle and posterior cerebral arteries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

image showing blood supply to the brain

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

The signs and symptoms the patient has should make _____: i.e. fit in with an _________ and an _____ of the brain

A

The signs and symptoms the patient has should make sense: i.e. fit in with an artery territory and an area of the brain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

When making a diagnosis of a stroke, the diagnosis should give you the answers to what questions?

A

What is the neurological deficit?

Where is the lesion?

What is the lesion?

Why has the lesion occurred?

What are the potential complications and prognosis?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What is the functions of the frontal lobe?

A

High level cognitive functions ie. abstraction, concentration, reasoning

Memory

Control of voluntary eye movement

Motor control of speech (dominant hemisphere) - expressive dysphasia/Broca’s aphasia, “non fluent aphasia”, Brocas area critical for language pronunciation and production and articulation

Brocas area usually left inferior frontal hemisphere

Motor cortex

Urinary continence

Emotion and personality

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What are the functions of the parietal lobe?

A

Sensory cortex

Sensation (identify modalities of touch, pressure, position)

Awareness of parts of the body

Spatial orientation and visuospatial information (non dominant hemisphere)

Ability to perform learned motor tasks (dominant)

30
Q

What are the functions of the temporal lobe?

A

Primary auditory receptive area

Comprehension of speech (dominant) – Wernicke’s

(Wernicke’s aphasia – usually left hemisphere. Deficit in language comprehension. Can speak fluently but has semantic errors and may sound nonsensical/jargon)

Visual, auditory and olfactory perception

Important role in learning, memory and emotional affect

31
Q

Where deos the anterior and middle cerebral arteries represent on the homonculus and what are the effects of them being blocked?

A
32
Q

Does the location of stroke matter?

A

Yes

a small storke in one place may have dramatic effects

33
Q

What is the function of the cerebellum?

A

balance and coordination

34
Q

What is the brainstem?

A

Midbrain, pons and medulla

10 of 12 cranial nerves arise in brainstem (ipsilateral signs)

Contralateral hemiparesis due to crossing of cortical tracts in lower medulla

Some major functions: eye movement, breathing, swallowing, heart beat, consciousness

35
Q

What are the functions of the occipital lobe?

A

Primary visual cortex

Visual perception

Involuntary smooth eye movement

36
Q

What are some visual field defects tha can effect visual pathways?

A
37
Q

What is the clinical presentation of a stroke?

A

Sudden onset loss of function:

Motor (clumsy or weak limb)

Sensory (loss of feeling)

Speech: Dysarthria/Dysphasia

Neglect/visuospatial problems

Vision: loss in one eye (amaurosis fugax) or hemianopia

Gaze palsy

Ataxia/vertigo/incoordination/nystagmus

Stroke is a dynamic phenomenon where time is brain

38
Q

What are important things to remeber in regards to a stroke?

A

The symptoms come on rapidly

The symptoms depend on which part of the brain is affected

Abnormal movements are unusual after stroke

Positive visual phenomena more likely to be migraine

Severe headache is unusual after stroke

39
Q

What is the OCSP Stroke Classification of different strokes?

A

Total Anterior Circulation Stroke (TACS)

Partial Anterior Circulation Stroke (PACS)

Lacunar Stroke (LACS)

Posterior Circulation Stroke (POCS)

40
Q

What kind of stroke is A?

A

LACS

41
Q

What kind of stroke is B?

A

PACS

42
Q

What kind of storke is C?

A

TACS

43
Q

What kind of storke is D?

A

POCS

44
Q

What is a TACS?

A

Main artery to one hemisphere

“Full house” of effects 3 of 3:

  • Complete hemiparesis/numbness
  • Loss of vision on one side (hemianopia)
  • Loss of awareness on one side (inattention) non-dominant

or

  • Dysphasia dominant

TACS is often due to blocked Carotid or Middle cerebral artery

45
Q

What is a PACS?

A

Branch of main artery

In-between LACS and TACS

2 of 3 TACS criteria

or

One higher cortical deficit:

Inattention

Or dysphasia

or

Monoparesis

46
Q

What is a LACS?

A

Small “perforating” artery

Movement and sensation pathways

Weakness/numbness of:

Face + arm + leg

Or Face + arm

Or Arm + leg

May have dysarthria

Ataxic hemiparesis

No affect on higher function - Will not have dysphasia, inattention or hemianopia

47
Q

What is a POCS?

A

Any posterior artery

Combination of symptoms including:

Loss of balance/coordination

Vertigo

Double vision

Dysarthria - difficult or unclear articulation of speech that is otherwise linguistically normal

Visual loss (hemianopia)

48
Q

What happens when there is a basilar artery occlusion?

A

Ischaemia in pons

Predominantly motor/oculomotor signs/symptoms

Bilateral but asymmetrical

Alteration in level of consciousness common - may progress over 12-24hours

May present as reduced responsiveness - ?cause requiring critical care

49
Q

What is the outcome at 12 months of the different types of srtokes? (mortality and recurrence rate)

A
50
Q

What are some storke mimics?

A

Seizures

Syncope (hypotension)

Sugar (hypo or hyper)

Sepsis (+previous stroke)

Severe migraine

Space occupying lesions

Si-chological (Functional)

Vestibular disorders

Demyelination

Transient global amnesia

Mononeuropathy

51
Q

What are positive symptoms of a stroke?

A

excess CNS neurone electrical discharges

visual (eg, flashing lights, zigzags, shapes, lines, objects)

somatosensory (eg, pain, paraesthesia)

motor (eg, jerking limb movements)

52
Q

What are negative symptoms of a stroke?

A

Loss or reduction of CNS neurone function

Loss of vision

Loss of sensation

Loss of limb power

53
Q

What is a migraine aura?

A

Due to cortical spreading depression

Classical spreading onset

Visual disturbances

geometric (especially zigzag) patterns

positive symptoms (like a kaleidoscope, running water etc)

Can include sensory, motor or speech disturbance

Headache onset can be >1hour after the end of the aura or no headache

>20% of patients with suspected TIA have migraine aura; this is the most common mimic

54
Q

What is acute vestibular syndrome?

A

Common, onset can be acute

Can be very disabling

‘True vertigo’ vs unsteadiness vs dizziness

Nystagmus – unidirectional, increases in intensity when patient looks in direction of fast phase

Vomiting

Even an expert taking a careful history may remain uncertain

MRI can be helpful

55
Q

Acute ischaemic stroke therapies should…

A

Restore blood supply

Prevent extension of ischemic damage

Protect vulnerable brain tissue

56
Q

Comparision of storke treatments

A

Treatment NNT*

IV TPA < 3h 10

IV TPA 3-4.5h 20

Stroke Units 15

Aspirin < 48h 111

Thrombectomy <6h 3-5

*Number needed to treat to prevent 1 death or dependent

TPA = Tissue plasminogen activator is a protein involved in the breakdown of blood clots

57
Q

How many stroke patients per year in UK* might avoid being ‘dead or dependent’ with each treatment?

A
58
Q

Are stroke units beneficial?

A

Stroke units ↑good outcomes by ~6%

59
Q

What are the components of a storke unit?

A

Clinical staff

Stroke nurses

Physiotherapists

Speech and Language therapists

Occupational therapists

Dietician

Psychologist

Orthoptist

60
Q

Which acute Stroke treatment has the biggest effect on an individual?

1) Aspirin
2) Thrombolysis
3) Thrombolysis and Thrombectomy
4) Stroke unit admission

A

3

61
Q

Which Stroke treatment has the biggest effect on all patients?

1) Aspirin
2) Thrombolysis
3) Thrombolysis and Thrombectomy
4) Stroke unit admission

A

4

62
Q

What is TPA?

A

Tissue plasminogen activator is a protein involved in the breakdown of blood clots

63
Q

What is the sttrict criteria for the use of TPA?

A

< 4.5 hours from symptom onset

Disabling neurological deficit

Symptoms present > 60 minutes

Consent obtained

64
Q

What is the exclusion criteria for IV TPA?

A

Anything that increases the possibility of hemorrhage:

- blood on CT scan

- recent surgery

- recent episodes of bleeding

- coagulation problems

BP >185 systolic or >110 diastolic

Glucose <2.8 or > 22mmol/L

65
Q

Time is brain: benefit from TPA declines with ______

A

time

66
Q

What is a thrombectomy?

A

the interventional procedure of removing a blood clot (thrombus) from a blood vessel

67
Q

TIAS to a storke is like how angina is to MI – a ___________

A

warning sign

10% stroke recurrence within first 2 weeks

68
Q

Carotid endarterectomy is effective treatment in symptomatic _________________ stenosis

A

internal carotid artery

Carotid endarterectomy is a surgical procedure to remove a build-up of fatty deposits (plaque), which cause narrowing of a carotid artery

69
Q

What are investigations done for stroke?

A

• All/most patients:

  • Routine blood tests (FBC, glucose, lipids, ESR…)
  • CT or MRI head scan (infarct vs. hemorrhage)
  • ECG + Holter (?AF, LVH)
  • Carotid doppler ultrasound (?stenosis)

• Some patients:

  • Echocardiogram (valves, ASD, VSD, PFO)
  • Cerebral angiogram/venogram (vasculitis?)
  • Hyper-coagulable blood screen
70
Q

What is the seocndary prevention for strokes?

A

Relative risk reduction % :

  1. Anti-hypertensives >25%
  2. Anti-platelets 25%
  3. Lipid lowering agents 25%
  4. Warfarin for AF 66%
  5. Carotid endarterectomy NNT of 3

year 2 neuro - Robbie (48 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions