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Neurology > Cerebrovascular Disease > Flashcards

Cerebrovascular Disease Flashcards

1
Q

What is a stroke?

A

A cerebrovascular event

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2
Q

What causes a stroke?

A

Disruption of blood supply to the brain

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3
Q

What does a stroke result in?

A

Damage to and death of brain tissue when cells no longer receive oxygen and nutrients from the blood.

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4
Q

What is a stroke characterised by?

A

Rapidly developing signs of focal or global disturbance of cerebral functions
Symptoms lasting for more than 24 hours

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5
Q

What are the three types of stroke?

A

Ischemic stroke
Intracerebral haemorrhage
Subarachnoid haemorrhage

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6
Q

What does an initial Brian scan confirm?

A

if individual has had a stroke, and the nature of the stroke

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7
Q

What does CT stand for?

A

Computed Tomography

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8
Q

What is a CT scan good at detecting?

A

acute bleeding and problems in bone, such as fractures, or bone breaks.

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9
Q

How long does a ct scan take?

A

5 to 10 mins

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10
Q

What is hard to image using a CT scan?

A

Brainstem

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11
Q

What does MRI stand for?

A

Magnetic Resonance Imaging

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12
Q

When will a MRI be carried out?

A

Usually completed if more information/detail is needed and for prognosis

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13
Q

What does an MRI produce?

A

Detailed pictures of organs, soft tissues, bone and other internal body structures.

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14
Q

What is an MRI good at detecting?

A

Small or subtle lesions

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15
Q

How long does an MRI take?

A

45 minutes

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16
Q

Why does a blood glucose test get carried out?

A

Low blood sugar levels may cause symptoms similar to those of a stroke.

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17
Q

Why is a platelet count get carried out?

A

platelets are cell fragments that help blood clot. Abnormal platelet levels may be a sign of a bleeding disorder (not enough clotting) or a thrombotic disorder (too much clotting).

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18
Q

What is an ECG?

A

Electrocardiogram

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19
Q

What does an ECG do?

A

Records the heart’s electrical activity
• Shows how fast the heart is beating and its rhythm (steady or irregular)
• Records the strength and timing of electrical signals as they pass through each part of the heart.
• Can help detect heart problems that may have led to a stroke

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20
Q

What is an Echocardiography?

A

Usessoundwavestocreatepictures of your heart.
• Gives information about the size and shape of the heart and chambers and valves function.
Can detect possible blood clots inside the heart and problems with the aorta.

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21
Q

What does a carotid ultrasound do?

A

Uses sound waves to create pictures of the insides of the carotid arteries – main supply of oxygen- rich blood to the brain.

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22
Q

What does Doppler ultrasound do?

A

shows the speed and direction of blood moving through the blood vessels.

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23
Q

What can a carotid ultrasound show?

A

whether plaque has narrowed or blocked the carotid arteries.

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24
Q

What happens if a blockage isn’t treated?

A

blood flow to the brain may be affected - usually because a blood clot forms and a piece breaks off and goes to the brain.

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25
Q

What does CTA stand for?

A

Computed Tomography Arteriogram

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26
Q

What does MRA stand for?

A

Magnetic Resonance Arteiogram

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27
Q

What can a CTA or MRA show?

A

the large blood vessels in the brain.
• May give the doctor more information about the site of a blood clot and the flow of blood through the brain.

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28
Q

What can a lumbar puncture be used for?

A

to confirm/rule out diagnosis of subarachnoid haemorrhage
• Any traces of blood within the cerebrospinal fluid

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29
Q

What happens in a lumbar puncture?

A

Needle inserted into the lower part of the spine

30
Q

What is the aim of the lumbar puncture?

A

to measure pressure within the spinal canal, and take a sample of cerebrospinal fluid

31
Q

What is an ishaemic stroke?

A

A blockage

32
Q

What is a haemorrhagic stroke?

A

A bleed

33
Q

What are the 2 main types of haemorrhagic stroke?

A

Intracerebral haemorrhage • Subarachnoid haemorrhage

34
Q

What causes an Intracerebral haemorrhage?

A

Artery inside the brain bursts/ruptures
Bursting/rupturing of vessel results in blood escaping into the brain tissue
• This blood collects forming a haematoma, putting pressure on surrounding tissue
• Collecting blood has toxic effects on the surrounding tissue

35
Q

What can an ICH extend into?

A

The ventricles

36
Q

What is the ultimate result of an ICH?

A

Damage to brain cells

37
Q

What is SAH?

A

Subarachnoid Haemorrhage

38
Q

When does SAH occur?

A

• In the majority of cases, SAH occurs when an aneurysm in an artery near the surface of the brain bursts
• Under pressure, blood spills out into the subarachnoid space
• Acute rise in intracranial pressure, and decrease in cerebral perfusion pressure
• Cerebral blood flow decreases

39
Q

What does a combination of SAH factors result in?

A

ischaemia (reduction/restriction of
blood flow to brain cells/tissue)

40
Q

What may also occur with SAH?

A

Intracerebral and intraventricular extension of the haemorrhage

41
Q

What is the ultimate outcome of SAH?

A

Damage to brain cells

42
Q

What is an ischaemic Stroke?

A

Blockage of blood flow (ischaemic infarction) of part of brain

43
Q

Where can an Ishaemic Stroke develop?

A

Can develop in major blood vessels on brain surface or in smaller vessels deep within brain
• Accounts for the majority of strokes

44
Q

What are the four types of Ishaemic Strokes?

A

Embolic infarct
Thrombotic infarct
Lacunae Infarct
Infarct of unknown cause

45
Q

What is an embolic infarct?

A

• A blood clot (embolism) forms in one part of body, travels through bloodstream, and lodges in and obstructs a blood vessel in the brain.
• Cardiac embolism accounts for 20-30% ischaemic strokes

46
Q

What is a thrombotic infarct?

A

• A blood clot forms in an artery that supplies the brain, causing tissue death.
• Usually occurs as a result of plaque build-up in arteries and develops overtime
• 10-15% cases

47
Q

What is a lacunar infarct?

A

Usually occurs as a result of arterial blockage caused by high blood pressure (hypertension)
• This type of stroke has the best prognosis
• Approx 20% cases

48
Q

When does an infarct of unknown cause occur?

A

more rarely from trauma, infection, tumours

49
Q

What is a TIA?

A

Transient Ischaemic Attack

50
Q

When do symptoms resolve in a TIA?

A

24 hours

51
Q

What are the stages of management of stroke?

A
  • Initial Treatment and Management in the Acute Stage
    • Medical Management
    • Prevention of further strokes
  • Rehabilitation
    • Supports
52
Q

What will treatments of a haemorrhagic stroke depend on?

A

The type and nature of the bleed

53
Q

What is the aim when treating a haemorrhagic stroke?

A

To prevent potential complications

54
Q

How do you treat a haemorrhagic stroke?

A

Management of blood clotting levels
• Intracranial Pressure control
• Treatment to help prevent Delayed Cerebral Ischaemia (SAH)
• Craniotomy
• Repair of aneurysm (coiling and clipping)

55
Q

What is thrombolysis?

A

Thrombolysis is the act of giving medication that can break down and disperse a clot that is preventing blood from reaching the brain.

56
Q

What is the clot-dissolving, or clot-busting, medication called?

A

tPA Tissue Plasminogen Activator

57
Q

How is tPA given?

A

Injected into a vein in the arm

58
Q

Does thrombolysis always work?

A

No- 1 in 7 people benefit

59
Q

What is the risk of Thrombolysis?

A

can cause harmful bleeding in your brain - approximately 7% of cases.

60
Q

When may thrombolysis not be suitable?

A

Bleed in in the brain/ Haemorrhagic Stroke
Not known or cannot tell when symptoms began
Didn’t reach the hospital in time
Have a bleeding disorder
Recent major surgery
Stroke or head injury within the past three months
Current medication not compatible with tPA.

61
Q

What may a patient receive if thrombolysis isn’t possible?

A

May receive antiplatelet medicine that helps stop platelets from clumping together to form blood clots or anticoagulant medicine (blood thinner) that keeps existing blood clots from getting larger.
• Typically aspirin initially

62
Q

What is intra-arterial thrombolysis ?

A

A catheter is put into the groin and threaded to the tiny arteries of the brain.
• Clot busting medicine is delivered through the catheter to break up the blood clot.

63
Q

What is penumbra clot removal?

A

A catheter is threaded to the arteries of the brain.
• The clot is directly aspirated out.

64
Q

What is Mechanincal Clot Removal In Cerebral Ischema (MERCI)

A

• A device that can remove blood clots from an artery.
• A catheter is threaded through a carotid artery to the affected artery in the brain.
• The device then pulls the blood clot out through the catheter.

65
Q

What happens in maintenance of restoration of homeostasis?

A
  • Oxygen therapy
    • Blood sugar control
    • Blood pressure control
  • Temperature
    • Water Balance
    • Ion Balance (Na, K+)
66
Q

What are some early complications of stroke?

A

Expansion of the infarct/recurrent infarction •Haemorrhagic transformation of the infarcted area •Re-bleeding (SAH)
•Delayed Cerebral Ischaemia (SAH)
•Haematoma expansion, Intraventricular extension of the haemorrhage (ICH)
•Hydrocephalus (ICH, SAH)
•Cerebral oedema and herniation (within 96 hr) •Seizure
•Aspiration pneumonitis
•Deep vein thrombosis and pulmonary embolism •Myocardial infarction
•Fever
•Hyperglycaemia

67
Q

What are some late complications in stroke?

A

Seizure
• Aspiration pneumonitis
• Deep vein thrombosis and pulmonary embolism
• Decubitus ulcer (pressure sore)
• Spasticity
• Delayed Cerebral Ischaemia (SAH)
• Recurrent stroke

68
Q

What is carotid endarterectomy?

A

A surgical procedure to unblock a carotid artery - can significantly reduce the risk of a stroke.
• Around a quarter of strokes are caused by a narrowing of the carotid arteries

69
Q

What is a carotid artery stent placement?

A

Less invasive than a carotid endarterectomy - doesn’t involve a cut being made in the neck
• A catheter is inserted into an artery in your groin, threaded up into the carotid artery using x-rays to guide it into place.
• A small balloon at the end of the
catheter is inflated to around 5mm at
the site of the narrowed artery, and a small mesh cylinder called a stent is then inserted.
• The balloon is deflated and removed, leaving the stent in place to keep the artery open and allow blood to flow through it.

70
Q

What are 4 things to help prevent future strokes?

A

Antiplatelets
Anticoagulants
Antihypertensives
Statins

71
Q

Where does the slt fit in with stroke?

A

Motor Speech Disorders (dysarthria, apraxia of speech)
• Language (aphasia)
• Communication (cognitive-
communication impairments)
• Swallowing (dysphagia

Neurology (8 decks)

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