Cerebrovascular Disease Flashcards
Cerebrovascular Disease includes..
Thrombus
Embolism
Haemorrhage
= STROKE
What is the definition of a stroke?
“An abnormality within the brain caused by a pathlogic process of blood vessels”
Broadly classified into 2 types:
- ischaemic (thrombosis, embolism)
- haemorrhagic (haemorrhage)
The brian NEEDS oxygen and interruption of blood flow can lead to cell death and permanent deficits
What is a stroke?
Clinical syndrome characterised by the rapid onset of a focal disturbance in cerebral function of a vascular origin > 24 hours duration
What are the RISK FACTORS for stroke?
- age
- gender
- smoking status
- diabetes
- pbesity
- oral contraceptive pill
- History of TIA
- Vascular Disease
- Atrial Fibrilation
Symptoms/Clinical Presentation of Stroke?
- Abrupt onset
- loss of function based on a part of the brain that has been compressed
- may have weakness/numbness of face arm legs etc
- langyage impairment
- lack of coordinated movement
- visual field deficits
- headache
- difficulty swallowing
If a stoke is on the right side of the brain - generally what side of the body is affected?
The LEFT
It switches sides “decussation of pyramids”
Haemorrhagiv vs Ischaemic
What is more common?
Haemorrhagic = 15% (Due to a rupture of a blood vessel)
Ischaemic 85% (Due to ischaemia and infarction from thrombus or embolism - atherosclorosis so may be localised in the brain (thrombos) or come from elsewhere (embolis)
Haemorrhagic vs Ischaemic
how to tell the difference?
- Look at patient history
- history of previous TIA
- pattern and progression of symptom s
- focal symptoms
- co-existing diseases
- PHYSICAL EXAM - mental status, level of consciousness, nerves and motor function
- CT SCAN IS VIP HERE TO TELL THE DIFFERENCE
ISCHAEMIC STROKE
“TIA”
What is it?
Transient Ischaemic Attack
“brief period of inadequate cerebral perfusion of focal neurological function”
Lasts MINS to HOURS
Disturbance RESSOLVES BEFORE INFARCTION
or “mini stroke” like angina - transient (resolves and can go back to normal mose time)
A warning sign 1/3 go on to have a stroke
associated with thrombotic disease
ISCHAEMIC STROKE
TIA
What causes it?
What does it mimic?
- atherosclorotic plaque (breaks off and causes vessel occlusion) or thrombus formation
- Increased blood viscosity (leading to clot formation)
- temporary vasospasm
Looks like
- migraine
- glucose abnormalities
- brain tumours
- Multiple sclorosis
ISCHAEMIC STROKE
TIA
How to prevent it?
- don’t smoke
- eat healthy
- exercise
- moderate alcohol intake
- control BO
- limit salts and cholesterol
ISCHAEMIC STROKE
LARGE VESSEL DISEASE
Thrombosis = the most common cause within atherosclorotic vessels (i.e. caused by smoking genetics, hypertension, diabetes)
OR can be embolism to distal site (from herat aorta or carotid arteries)
ISCHAEMIC STROKE: LARGE VESSEL DISEASE
What is the location?
- ICA
- MCA (middle cerebral artery)
- BA (Basillar Artery)
ISCHAEMIC STROKE: LACUNAR STROKE (SMALL VESSEL DISEASE)
What is it/where does it occur?
Symptoms?
- Small infarcts
- located in deep non-cortical structires(internal capsule, basal ganglia)
- occur in the setting of atherosclerosos
- CHRONIC HYPERTENSION, diabetes
- Process of healing leads to SMALL CAVATIES giving the name “lacunar” meaning “lake}
Symptoms?
Pure motor and sensory hemiplegia
Need MRI to determine
ISCHAEMIC STROKE:
Infarction
- Irreversibel cell death
- cell death occurs withing minutes of ischaemia onset
- biochemical changes lead to cell death and necrosis quickly
TWO TYPES
Red Infarct: Red due to reperfusion after the infarct. associated with EMBOLIS
Pale Infarcts: associated withTHROMBOSIS
ISCHAEMIC STROKE:
Infarction
Information on a REPREFUSION INJURY
- Any disruption to cerebral blood flow can result in cell death
- restoring blood flow can actually damage tissues cells may still die from the injury mechanisms (free radicals, inflammation)
HOW DO THE CELLS STILL DIE?
- ROS
- Mitochondrial permeability transition pore activation –> apoptosis
- NMDA receptor activation –> Increased Ca levels
- energy depletion –> loss of channel functions –> cerebral oedema
- increased vascular permeabiloty
- activation of deleteroius enzymes –> cellular damage/death
ISCHAEMIC STROKE
INFARCTION
“What is the penumbra”
Cells around the edge of a nectoric core that have had reduced blood supply and don’t function BUT with reprefusion could survive if not will die.
This idea of reperfusion is the basis of thrombolytic therapy
ISCHAEMIC STROKE
What are the outcomes and complications?
Outcomes
- depends on location adn size
- some recover some don’t
Complications
- cerebral oedema
- haemorrhagic transformation (bleeding into an infarct and blood has nowhere to go so moves into BRAIN PARENCHYMA)
Ischaemic Stroke
What is the TREATMENT?
= THROMBOLYSIS (dissolves CLOT therefore can’t use with haemorrahage makes WORSE)
- surgical removal of clot
- stent the artery
HAEMORRHAGIC STROKE
Generally what is it?
SPONTANEOUS INTRACRANIAL HAEMORRHAGE (ICH)
What’s this also?
Well ladies and gentleman a haemorrhagic stroke is a…
RUPTURE
ICP??
Most patients above 70
10% due to amyloid angiopathy (amyloid deposition on walls of cerebral vessels)
Intracerebral Haemorrhage
Clinical Features?
Outcome?
Complications?
SIGNS
General signs of stroke (weakness, numbness)
ALSO:
- SEVERD HEADACHE
- VOMITING
- RAPID LOSS OF CONSCIOUSNESS
OUTCOME
Death mainly
In the few that survive blood is removed by mmacrophages and there is a large yellow stained cavity
COMPLICATIONS
- Mid line shift
- brain stem compression
- deep coma
- DEATH BASICALLY
Subarachnoid Haemorrhage (SAH)
Risk Factors
Clinical Features
Risk Factors
- smoking, hypertension, genetics, alcohol and trauma
- rupture often happens when straining from stool, orgasm
Clinical Features
- nausea and vomiting
- stiff neck
- blurred vision
- headache
- sensitivity to light
Heamorrhage
Charcot-Bouchard Aneurysm
AND
Berry Aneurysm (what)
Charcot-Bochard Aneurysm
- from chronic hypertension
- minute aneurysms (arterioles)
Berry Aneurysm
- Affect 2% population
- occur at the branch points at “circle of willis”
- due from DEFECT IN ELASTIC LAMINA
- hypertension EXACERBATES DEFECT
- 30% die straight away
LOOK AT MOST COMMON PLACES TO OCCUR IN LECTURE SLIDES
Complication and Treatment of Berry A?
Treatment
- Clip the bitch
- coil the bitch
- bypass the bitch
BUT it may rupture…
= SUBARACHNOID HAEMORRHAGE -
- pushes on adjacent brain tissue.
- further ischaemia and infarction
- herniation
- death from compression on respiratory centres in brain
