Cerebrovascular disease: a clinical correlate

Question 1

define stroke

Answer 1

abrupt onset of focal neurologic deficit caused by ischemia or hemorrhage

Question 2

what type of stroke is more commone

Answer 2

ischemic

Question 3

define transient aschemic attack

Answer 3

abrupt neurologic deficits but resolve within 24 hours

Question 4

what is ischemic penumbra

Answer 4

outer rim of stroke of cerebral tissue

Question 5

what are 2 pathways that result in cellular death from stroke

Answer 5

Necrotic

Apoptotic

Question 6

how does necrotic cell death occur

Answer 6

result of energy failure from no blood flow

-cells swell and die

Question 7

what is apoptotic cell death? cells in what location usually do this?

Answer 7

programmed cell death

-penumbra

Question 8

Major clinical finding for Anterior cerebral artery

Answer 8

contralateral leg weakness

Question 9

Major clinical finding middle cerebral artery

Answer 9

contralateral face and arm, leg weakness
contralateral sensory loss
contralateral visual field cut
aphasia in dominant hemisphere 
apraxia (often in non-dominant lobe)
Neglect of contralateral side (often in non-dominant lobe)

Question 10

Major clinical finding posterior cerebral artery

Answer 10

contralateral visual field cut

Question 11

Major clinical finding subcortical lacunar infarct

Answer 11

contralateral motor or sensory deficit without cortical signs of aphasia, apraxia or neglect

Question 12

Major clinical finding basilar artery

Answer 12

oculomotor deficits. “crossed” face and body findings of sensory and/or motor deficits

Question 13

Major clinical finding vertebral artery

Answer 13

lower cranial nerve deficits. “ crossed” face and body sensory deficits

Question 14

aphasia

Answer 14

loss of ability to understand or express speech

Question 15

apraxia

Answer 15

inability to perform particular purposive actions

Question 16

what is neglect

Answer 16

complete loss of contralateral side of space and contralateral side of body from the stroke

Question 17

Anosogniosia

Answer 17

unawareness of illness and its clinical manifestations

Question 18

neglect tends to occur from what type of trauma

Answer 18

right middle cerebral artery

right parietal lobe

Question 19

what are 2 types of apraxia

Answer 19

idealtional and dressing

Question 20

what is ideational apraxia

Answer 20

confusion about task sequencing

Question 21

what is apraxia dressing

Answer 21

confusion about orientation of clothing: top-bottom, right-left, front-back

Question 22

where does trauma occur for apraxia

Answer 22

non-dominant parietal lobe or premotor cortex of frontal lobe

Question 23

alexia

Answer 23

inability to read

Question 24

agraphia

Answer 24

inability to write

Question 25

aphasia syndrome

Answer 25

aphasia, alexia, agraphia

Question 26

agnosia

Answer 26

loss of ability to recognize an entity for what it is

Question 27

finger agnosia

Answer 27

cant recognize individual fingers

Question 28

anosognosia

Answer 28

can't recognize that something is malfunctioning or is deficient

Question 29

asmoatognosia

Answer 29

can't recognize part of your body as part of you

Question 30

prosopagnoisa

Answer 30

can't recognize faces

Question 31

color agnoisa

Answer 31

can't recognize colors

Question 32

what is the emergent assessment of stroke

Answer 32

- EMS evaluation - NIH stroke scale, in ED - blood tests - non-contrast CT - CT angiogram with contrast

Question 33

why is a non-contrast CT ordered in ER

Answer 33

rule out hemorrhage

Question 34

what does CT angiography of head and neck with contras asses

Answer 34

stenosis or acute arterial vessel cut off

Question 35

what is used for non-emergent imaging? why would this ordered

Answer 35

MRI | -confirm presence of a stroke it its not well-visualized in CT

Question 36

when is a stroke well visualized in a CT

Answer 36

24 hours later

Question 37

what are thrombolytics

Answer 37

clot-busting durg | -tissue plasminogen activator given IV

Question 38

how does tissue plasminogen activator TPA work

Answer 38

- initiating local fibrinolysis by - binding to fibrin in thrumbus ( clot) - convert entrapped plasminogen to plasmin

Question 39

when can a thrombolytic be given to a stroke patient

Answer 39

within 3-4.5 hours of onset of neurologic deficit

Question 40

what is the most important benefit about giving TPA

Answer 40

people who were given TPA | - half as likely to have debilitating deficit at 3 months post-stroke

Question 41

what if given if patient does not meet requirement for TPA

Answer 41

full dose of aspirin

Question 42

is anticoagulation with heparin been useful in acute setting of stroke

Answer 42

no

Question 43

who actually benefits from early anticoagulations

Answer 43

cardiac thrombus large artery severe stenosis dissection of vertebral and carotid arteries

Question 44

how is stroke etiology determined

Answer 44

location of stoke and distribution of infarct - assessment of underlying carotid or heart disease - assessment of hypertension, cholesterol, hyperglycemia, thyroid, tobacco

Question 45

what medications are given to prevent 2nd stroke

Answer 45

``` aspirin clopidogrel ( plavix) ```

Question 46

what does an ischemic stroke look like under a microscope

Answer 46

axonal swelling and inflammation first few days | - macrophages ingesting infarct debris weeks out (3-4)

Question 47

what are 3 common sights of hemorrhage? these sights are usually secondary to what

Answer 47

pons basal ganglia cerebellum -secondary to hypertesnions

Question 48

what is a common cause of stroke in young people

Answer 48

vertebral dissection

Question 49

what can vertebral clots lead to

Answer 49

posterior circulation stokes ( BAD)

Question 50

how do you know if its a subcortical stroke? what are the syndromes called

Answer 50

hemibody motor or sensory symptoms without cortical involvement -lacunar syndrome

Question 51

what is the hallmark for brainstem strokes

Answer 51

crossed findings