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Neuroscience II > Cerebrovascular Accident > Flashcards

Cerebrovascular Accident Flashcards

1
Q

The brain constitutes ___% of total body weight.
It receives ___% of the total cardiac output.
It consumes ___% of the oxygen utilized in the body.

A

2% of body weight
15% cardiac output
20% oxygen utilized

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2
Q

Cerebral arterioles are capable of autoregulating in what two ways?

A

Dilation and constriction

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3
Q

When systemic pressure drops, or arterial CO2 concentration rises (hypercarbia), how do cerebral arterioles autoregulate?

A

Dilation

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4
Q

When systemic pressure increases, or arterial CO2 concentration decreases, how do cerebral arterioles autoregulate?

A

Constriction

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5
Q

What is ischemia?

A

Inadequate blood supply (including oxygen and glucose)

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6
Q

Prolonged ischemia results in…

A

infarction (cell death)

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7
Q

What is anoxia?

A

Inadequate oxygen supply

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8
Q

A stroke can be due to:

A
  1. ischemia
  2. hemorrhage
  3. hypotension
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9
Q

The majority of strokes are caused by…

A

ischemia

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10
Q

Ischemic strokes are caused by…

A

blood clots

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11
Q

What are the three types of blood clots involved in ischemic stroke?

A
  1. thrombotic
  2. lacunar (a kind of thrombotic)
  3. embolic (travelling)
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12
Q

Thrombotic strokes usually occur in which arteries to the brain?

A

Large arteries

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13
Q

Thrombotic blood clots form as a result of…

A

atherosclerosis

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14
Q

What is atherosclerosis?

A

A chronic inflammatory response where macrophages and neutrophils are released.

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15
Q

atherosclerosis

The immune system senses further harm and releases other factors called ___, which attract ___

A

other factors called cytokines, which attract more white blood cells (and perpetuate the cycle)

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16
Q

atherosclerosis

Injured inner walls fail to produce enough…

A

nitric oxide

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17
Q

atherosclerosis

Nitric oxide is critical for maintaining…

A

blood vessel elasticity

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18
Q

atheroscleosis

Without efficient nitric oxide, the arteries…

A

become calcified and lose elasticity

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19
Q

atherosclerosis

What does it mean if arterial walls stenose?

A

They slowly thicken, harden, and narrow until blood flow is reduced

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20
Q

atherosclerosis

If blood flow reduction leads to occlusion of blood flow in a particular artery, it will cause…

A

a thrombotic stroke

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21
Q

Where do lacunar strokes originate?

A

Small branches of the large vessels that supply the brain

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22
Q

Lacunar strokes may cause…

A

clumsiness, weakness, and emotional variability (depending on branch affected)

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23
Q

An embolic stroke is usually caused by…

A

a dislodged blood clot that has traveled through the blood vessels (an embolus)

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24
Q

Embolic strokes may be due to:

A
  1. atrial fibrillation
  2. artificial heart valves or valve disorders
  3. after a heart attack or in association with heart failure
  4. rarely from fat particles, tumor cells, or air bubbles in the blood stream
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25
Q

Describe atrial fibrillation emboli

A

Some blood may pool in the atria where it forms clots which can then break off and travel to the brain as emboli

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26
Q

What is hemorrhage?

A

Sudden bleeding

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27
Q

In a healthy brain, neurons are protected from exposure to blood by the…

A

blood-brain barrier

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28
Q

What is broken during a hemorrhagic stroke?

A

The blood-brain barrier

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29
Q

Most brain hemorrhages are accompanied by a…

A

catastrophic headache

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30
Q

What are the categories of hemorrhagic strokes based on their location?

A
  • Intracerebral or parenchymal (within the cerebrum)
  • Subarachnoid (subarachnoid space)
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31
Q

Hemorrhagic strokes occur when arteries weaken and break open because of:

A
  • aneurysms
  • arteriovenous malformations
  • hypertension
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32
Q

What is an aneurysm and how does it cause a hemorrhagic stroke?

A

Balloon like dilatations of arteries. The dome of the dilatation is fragile and may rupture and cause bleeding.

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33
Q

What are arteriovenous malformations and how do they cause a hemorrhagic stroke?

A

An abnormal connection between arteries and veins. If it occurs in the brain and ruptures, it can cause a hemorrhagic stroke.

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34
Q

Hypertensive hemorrhages tend to be…

A

intracerebral

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35
Q

Extreme hypotension can reduce ___ and cause a stroke.

A

can reduce oxygen supply to the brain and cause a stroke

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36
Q

Hypotensive hemorrhages can be caused by…

A
  • heart attack
  • major bleeding episode
  • overwhelming infection
  • surgical anesthesia
  • overtreatment of high blood pressure
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37
Q

risk factors

Most stroke victims are ___ 65.

A

over

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38
Q

risk factors

How do strokes in younger people differ between men and women?

A

Strokes in younger people affect men and women equally

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39
Q

risk factors

Major studies have reported that ischemic strokes have a higher mortality rate in…

A

women than in men

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40
Q

risk factors

How does ethnicity affect risk of a stroke?

A

All minority groups are at a significantly higher risk for stroke and stroke death than American Caucasians

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41
Q

risk factors

Where in the US do people have the highest risk for stroke?

A

Southeastern US, especially in NC, SC, and GA, as well as lower Mississippi valley and Southern California

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42
Q

risk factors

Hypertension contributes to __% of all strokes.

A

70%

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43
Q

risk factors

A wider spread between systolic and diastolic measurements means…

A

greater risk/danger

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44
Q

risk factors

About ___ strokes is due to atrial fibrillation.

A

1 in 6

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45
Q

risk factors

Smoking ___ hemorrhagic and ischemic stroke risk.

A

increases

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46
Q

risk factors

Diabetes and insulin resistance are a risk for ___

A

stroke

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47
Q

risk factors

Weight centered around the abdomen has a high association with…

A

stroke and heart disease

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48
Q

risk factors

HDL seems to be important for…

A

preventing strokes

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49
Q

risk factors

Hypertensive patients with overall cholesterol levels below ___ mg/dl, may be at risk for hemorrhagic stroke.

A

180 mg/dl

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50
Q

risk factors

Heavy alcohol use is associated with a ___ risk of both ischemic and hemorrhagic stroke.

A

higher

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51
Q

risk factors

Mild to moderate alcohol use (one to seven drinks/week) is associated with ___ risk for ischemic stroke, but not hemorrhagic stroke.

A

significantly lower

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52
Q

risk factors

Studies suggest that drinking three or more cups of coffee a day could ___ the risk of stroke in ___

A

increase the risk of stroke in older men with hypertension

53
Q

risk factors

Coffee does not appear to pose a danger for men with…

A

normal blood pressure

54
Q

risk factors

What drugs are major factors in incidence of stroke in young adults?

A

Cocaine, methamphetamine, and steroids for body-building

55
Q

risk factors

What mental and emotional factors increase the risk for having a stroke?

A

Stress and depression

56
Q

risk factors

Migraines are associated with…

A

stroke risk

57
Q

risk factors

High blood levels of homocysteine, which occur with deficiencies of vitamin B6, B12, and folic acid, are linked to an ___ risk of stroke.

A

increased

58
Q

risk factors

Certain bacteria and viruses may play a role in ___, ___, and ___.

A

atherosclerosis, heart disease, and stroke

59
Q

risk factors

Name three diseases that are associated with increased risk for stroke.

A
  1. lung infections such as chronic chlamydia pneumoniae
  2. periodontal disease
  3. varicella zoster virus
60
Q

What is a transient ischemic attack?

A

A focal loss of neurological function that usually resolves within 24 hours

61
Q

Transient ischemic attacks are a warning signal of…

A

ischemic stroke

62
Q

What are silent brain infarctions?

A

Small strokes that cause no apparent symptoms but are major contributors to mental impairment in the elderly.

63
Q

What is syncope?

A

A sudden reversible loss of consciousness and postural tone that results from temporary global cerebral ischemia

64
Q

What can syncope be due to?

A
  • hypotension
  • decreased cardiac output
  • blood and metabolic disorders
  • CNS disorders
65
Q

What is quadriplegia/paresis?

A

All four extremities are paralyzed or weak

66
Q

What is hemiplegia/paresis?

A

The upper and lower extremities on one side are paralyzed or weak (half the body)

67
Q

What is paraplegia/paresis?

A

Both upper or lower extremities are paralyzed or weak

68
Q

What is monoplegia/paresis?

A

One extremity is paralyzed or weak

69
Q

internal carotid infarction

The internal carotid arteries may become atherosclerotic and eventually…

A

get occluded

70
Q

internal carotid infarction

The extent of infarction may include the territories of…

A

the anterior and middle cerebral arteries

71
Q

internal carotid infarction

One of the first branches of the internal carotid is the…

A

ophthalmic artery

72
Q

internal carotid infarction

Occlusion of the ophthalmic artery causes…

A

unilateral visual symptoms such as dimming, color changes, or scotomas

73
Q

What type of symptoms occur with anterior cerebral infarction?

A

Symptoms of injury to the medial cerebral hemisphere

74
Q

Contralateral spastic paralysis and sensory loss affecting mainly the distal leg and perineum (urinary incontinence) is symptomatic of which injury?

A

Anterior cerebral infarction affecting paracentral lobule

75
Q

Mental confusion, impaired judgement, and flat affect is symptomatic of which injury?

A

Anterior cerebral infarction affecting (unilateral) prefrontal lobe

76
Q

Abulia, a behavioral disturbance characterized by apathy and muteness is symptomatic of what injury?

A

Anterior cerebral infarction affecting bilateral prefrontal lobe

77
Q

What type of symptoms occur with anterior choroidal infarction?

A

Symptoms of injury to the posterior limb of the internal capsule and the optic tract/lateral geniculate body

78
Q

Contralateral spastic paralysis and sensory loss of the body and face is symptomatic of which injury?

A

Anterior choroidal infarction affecting the internal capsule

79
Q

Anterior choroidal infarction affecting lateral geniculate body causes what symptom?

A

Contralateral homonymous hemianopsia

80
Q

What type of symptoms occur with middle cerebral infarction?

A

Symptoms of injury to the lateral cerebral cortex

81
Q

Contralateral spastic paralysis and sensory loss of the face and upper extremity is symptomatic of what injury?

A

Middle cerebral infarction affecting precentral and postcentral gyrus

82
Q

Acute (1-2 days) paresis of the contralateral conjugate gaze is symptomatic of what injury?

A

Middle cerebral infarction affecting frontal eye field

83
Q

Aphasia, if dominant side is affected, is symptomatic of what injury?

A

Middle cerebral infarction affecting Broca’s, Wernicke’s, or global lateral cerebral cortex

84
Q

Astereognosis/neglect is symptomatic of what injury?

A

Middle cerebral infarction affecting right parietal lobe

85
Q

Apraxia is symptomatic of what injury?

A

Middle cerebral infarction affecting premotor cortex

86
Q

Gerstmann’s syndrome is an injury to the…

A

left angular gyrus

87
Q

Gerstmann’s syndrome includes which symptoms?

A
  • agraphia
  • acalculia
  • inability to distinguish right from left
  • finger agnosia
88
Q

Posterior cerebral infarction can include which types of symptoms?

A

Symptoms of distal occlusion, bilateral occlusion, and or proximal occlusion

89
Q

Posterior cerebral infarction of distal occlusion affecting striate cortex causes what symptom?

A

Contralateral homonymous hemianopsia

90
Q

Alexia (inability to read) without agraphia (inability to write) is symptomatic of what injury?

A

Posterior cerebral infarction symptom of distal occlusion affecting splenium

91
Q

Anton’s syndrome (failure of blind patient to recognize inability to see) is a symptom of what injury?

A

Posterior cerebral infarction symptom of bilateral occlusion of basilar junction affecting both visual cortices

92
Q

Contralateral sensory loss or thalamic syndrome is symptomatic of what injury?

A

Posterior cerebral infarction symptom of proximal occlusion affecting thalamus

93
Q

Hemiballism is symptomatic of what infarction?

A

Posterior cerebral infarction symptom of proximal occlusion affecting subthalamic nucleus

94
Q

Midbrain symptoms are related to what injury?

A

Posterior cerebral infarction symptom of proximal occlusion affecting brainstem

95
Q

brainstem vascular syndromes

A substantial hemorrhage within the brainstem (medulla reticular formation) results in…

A

instant fatality or a coma due to failure of central control of respiration

96
Q

brainstem vascular syndromes

What is locked in syndrome?

A

Large infarction of ventral pons causing paralysis of all voluntary movements except of the eyes

97
Q

medial syndromes of medulla

Contralateral spastic paralysis is a result of injury to…

A

corticospinal fibers in the basilar pons/pyramid

98
Q

medial syndromes of medulla

Contralateral loss of vibration, proprioception, two-point discrimination, etc, are symptomatic of injury to…

A

medial lemniscus

99
Q

Contralateral spastic paralysis and contralateral loss of vibration, proprioception, two-point discrimination, etc. are symptoms of what type of syndrome?

A

Medial syndromes of the medulla

100
Q

medial syndromes of medulla and pons

Medial strabismus (paralysis of ipsilateral lateral rectus) (CN VI)/ paralysis of horizontal gaze to the side of lesion (center for horizontal gaze) is symptomatic of what injury?

A

Inferior pons

101
Q

medial syndromes of medulla and pons

Internuclear ophthalmoplegia is symptomatic of what injury?

A

Paramedian pontine reticular formation, superior pons

102
Q

medial syndromes of medulla and pons

Ipsilateral tongue paralysis is symptomatic of what injury?

A

Medulla

103
Q

The pons is which paramedian?

A

Basilar paramedian

104
Q

The medulla is which paramedian?

A

Vertebral paramedian

105
Q

lateral syndrome of medulla (PICA) and pons (AICA)/ superior cerebellar

Contralateral loss of pain and temperature from the body is symptomatic of what injury?

A

Anterolateral system (spinothalamic tracts)

106
Q

lateral syndrome of medulla (PICA) and pons (AICA)/ superior cerebellar

Ipsilateral loss of pain, temperature from face is symptomatic of what injury?

A

Nucleus of spinal tract of trigeminal (medulla)

107
Q

lateral syndrome of medulla (PICA) and pons (AICA)/ superior cerebellar

Ipsilateral loss of touch from the face is symptomatic of what injury?

A

Chief sensory nucleus (pons)

108
Q

lateral syndrome of medulla (PICA) and pons (AICA)/ superior cerebellar

Nystagmus is symptomatic of what injury?

A

Vestibular nuclei

109
Q

lateral syndrome of medulla (PICA) and pons (AICA)/ superior cerebellar

Cerebellar symptoms include…

A
  • ataxia
  • intention tremor
  • dysmetria
  • dysdiadochokinesia (DDK)
  • pendular reflexes
  • hypotonia
110
Q

lateral syndrome of medulla (PICA) and pons (AICA)/ superior cerebellar

Ataxia, intention tremor, dysmetria, DDK, pendular reflexes, and hypotonia are all what type of symptoms?

A

Cerebellar symptoms

111
Q

lateral syndrome of medulla (PICA) and pons (AICA)/ superior cerebellar

Ipsilateral Horner’s syndrome includes which symptoms?

A
  • ptosis
  • miosis
  • anhidrosis
  • enophthalmos
112
Q

lateral syndrome of medulla (PICA) and pons (AICA)/ superior cerebellar

Ipsilateral Horner’s syndrome is symptomatic of what injury?

A

Reticular formation

113
Q

lateral syndrome of medulla (PICA) and pons (AICA)/ superior cerebellar

Hiccup is synpomatic of what injury?

A

Reticular formation

114
Q

lateral syndromes of medulla and pons

Dysphagia, hoarseness, uvular deviation, or absence of gag reflex is symptomatic of what injury?

A

Nucleus ambiguus, CN X vagus, Wallenberg syndrome (medulla)

115
Q

lateral syndromes of medulla and pons

Loss of taste is symptomatic of what injury?

A

Solitary tract/ nucleus in medulla

116
Q

lateral syndromes of medulla and pons

Ipsilateral facial paralysis (Bell’s palsy) is symptomatic of what injury?

A

CN VII facial in lower pons

117
Q

lateral syndromes of medulla and pons

Deafness is symptomatic of what injury?

A

Cochlear nuclei in lower pons

118
Q

lateral syndromes of medulla and pons

Inability to chew and jaw deviation is symptomatic of what injury?

A

CN V trigeminal in midpons

119
Q

What type of stroke is dorsal midbrain syndrome (Perinaud’s)?

A

Posterior cerebral stroke

120
Q

What are the symptoms of dorsal midbrain syndrome (Perinaud’s)?

A
  • paralysis of upward gaze
  • loss of pupillary/light reflex
121
Q

Loss of pupillary/light reflex is symptomatic of what injury?

A

Posterior cerebral stroke (dorsal midbrain syndrome) affecting pretectal nucleus

122
Q

What type of stroke is ventral midbrain syndrome (Weber’s)?

A

Posterior cerebral stroke

123
Q

Contralateral paralysis of the body and face is symptomatic of what injury?

A

Posterior cerebral stroke (ventral midbrain syndrome) affecting crus cerebri (corticospinal/bulbar tracts)

124
Q

Ipsilateral oculomotor palsy is symptomatic of what injury?

A

Posterior cerebral stroke (central midbrain syndrome)

125
Q

What are the symptoms of ipsilateral oculomotor palsy?

A
  • ptosis
  • mydriasis: dilated unresponsive pupil
  • lateral strabismus
126
Q

What type of stroke is central midbrain syndrome (Claude’s)?

A

Posterior cerebral stroke

127
Q

What are the symptoms of central midbrain syndrome (Claude’s)?

A
  • ipsilateral oculomotor palsy
  • hemiballism
  • contralateral loss of sensation
128
Q

Hemiballism is symptomatic of what stroke?

A

Posterior cerebral stroke (central midbrain syndrome) affecting subthalamic nucleus

129
Q

The combination of ventral and central midbrain syndromes is possible and is called…

A

Benedikt syndrome

Neuroscience II (9 decks)

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