Cerebral Vascular Diseases Flashcards
In stroke symptoms are usually on both sides of the body. True/false?
False. In stroke, symptoms are usually on one side of the body eg arm weakness, face drop is dichotomized due to crossing in the brain
Motor symptoms in stroke are experienced due to a crossing in which tract?
Pyramidal tract
Name 6 symptoms of stroke
Hemiparesis(motor deficit)
Dysarthia- abnormality in speech articulation
Dysphagia- difficulty in swallowing
Aphasia- inability to understand a word. Sing but not talk
Sensory deficit
Ataxia
Visual disturbance- problem in right occipital cortex-left hemianopia, CRAO-stroke of the eye
Headache
Impaired consciousness
Match the artery to the symptom Anterior cerebral artery Middle cerebral artery Posterior cerebral artery Posterior circulation
Anterior cerebral artery- hemiparesis (lower extremity), apraxia
Middle cerebral artery - hemiparesis (upper extremity)
Posterior cerebral artery-visual, thalamic, memory
Posterior circulation-brain stem syndromes eg oculomotor
What is a transient ischemic attack ie TIA?
Brief, majority less than 15 minutes, max 24 hr episodes of focal loss of brain function due to ischemia
What are the symptoms of a TIA?
No persistent deficit
abrupt onset of hemideficit(paresis, numbness), slurred speech, difficulty to understand, loss of consciousness
50% demonstrate DWI abnormalities
CT/MRI may reveal abnormalities
Every third stroke heralded by a TIA
Annual risk of stroke during first 5 years at 5%
In the case of a TIA would you administer TPA?
no, because tissue plasminogen activator is administered to reopen a blocked vessel
What are examples of cererbral vascular diseases?
Ischemic stroke 85%- atherothrombotic, cardioembolic, microangiopathic
Subarrachnoid hemorrhage 10%
Primary intracerebral hemorrhage 5%
Which treatments of acute ischemic stroke have proven efficacy?
1. Thrombolysis Stroke Unit Thrombolysis with rtPA (recombinant tissue plasminogen activator) i.v within 4.5 hours of symptom onset and exclusion of hemorrhage Endovascular treatment within 6 hours 2. Thrombectomy
Thrombolysis is the only clinically proven treatment for ischemic stroke. True or false
True
Define thrombectomy
When a stent is inserted into a blood vessel to remove a clot. Clot is caught in stent and removed
What is a stroke unit?
A specialized facility for thrombolysis, checking body temperature, blood pressure, glucose, oxygenation levels to monitor and treat complications
more men than women can expect to suffer from stroke. True/false
True. 25% men Vs 20% of women by age 85
Ischemic stroke is a syndrome and not a single disease state. True/false
True
List some common unavoidable risk factors of stroke
age, gender, race, other genetic factors
List some common modifiable risk factors of stroke
Hypertension, smoking, diabetes
What are some secondary prevention methods of stroke?
300 mg asprin, clopidrogrel/ dipyridamol + ASS cardiac embolism: anticoagulation treat hypertension quit smoking statins with CHD/hypercholesterinemia Carotid-TEA if stenosis is more than 70%
Define a Penumbra
Pene (near), umbra (shadow). Regioin of silence in electrical activity but with preserved metabolism (electrophysiological/morphological)
Name two features of a penumbra
decreased blood flow, increased oxygen extraction (misery perfusion PET)
tissue at risk
reduced prerfusion, normal diffusion MRT
What is the main principle of diffusion weighted imaging?
Diffusion of protons between Intracellular volume (low ADC) and extracellular volume (high ADC). ADC is the apparent diffusion coefficient and decreases by about 30-50% in the case of ischemia due to cells swelling hence lower proton conc in extracellular
How does ischemia lead to cell death
As a result of ischemia, cells are deprived of substrate , which causes an energy deficit due to decreased ATP in the cells, therefore leading to cell death
What is the difference between a functional and structural lesion?
For an ischemic penumbra to occur, at the core, there is a structural lesion in which cells will die. A functional lesion is the penumbra where neurons are no dead but cells are arrested
What does MR measure?
MR measures the spinning of proton molecules
What happens to neurons that are low in energy?
Neurons low in energy will depolarize, release glu into ECM, receptors in ECM sense glu that is massively released, calcium entry, sodium entry, radicals, water enters cells, cells swell, potassium released leading to spread in depol, ECM shrinks….apoptosis
