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D&T2 Exam 1 > Cerebrovascular disease: a clinical correlate > Flashcards

Cerebrovascular disease: a clinical correlate Flashcards

1
Q

define stroke

A

abrupt onset of focal neurologic deficit caused by ischemia or hemorrhage

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2
Q

what type of stroke is more commone

A

ischemic

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3
Q

define transient aschemic attack

A

abrupt neurologic deficits but resolve within 24 hours

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4
Q

what is ischemic penumbra

A

outer rim of stroke of cerebral tissue

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5
Q

what are 2 pathways that result in cellular death from stroke

A

Necrotic

Apoptotic

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6
Q

how does necrotic cell death occur

A

result of energy failure from no blood flow

-cells swell and die

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7
Q

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

A

programmed cell death

-penumbra

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8
Q

Major clinical finding for Anterior cerebral artery

A

contralateral leg weakness

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9
Q

Major clinical finding middle cerebral artery

A 
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)
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10
Q

Major clinical finding posterior cerebral artery

A

contralateral visual field cut

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11
Q

Major clinical finding subcortical lacunar infarct

A

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

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12
Q

Major clinical finding basilar artery

A

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

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13
Q

Major clinical finding vertebral artery

A

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

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14
Q

aphasia

A

loss of ability to understand or express speech

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15
Q

apraxia

A

inability to perform particular purposive actions

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16
Q

what is neglect

A

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

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17
Q

Anosogniosia

A

unawareness of illness and its clinical manifestations

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18
Q

neglect tends to occur from what type of trauma

A

right middle cerebral artery

right parietal lobe

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19
Q

what are 2 types of apraxia

A

idealtional and dressing

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20
Q

what is ideational apraxia

A

confusion about task sequencing

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21
Q

what is apraxia dressing

A

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

22
Q

where does trauma occur for apraxia

A

non-dominant parietal lobe or premotor cortex of frontal lobe

23
Q

alexia

A

inability to read

24
Q

agraphia

A

inability to write

25
Q

aphasia syndrome

A

aphasia, alexia, agraphia

26
Q

agnosia

A

loss of ability to recognize an entity for what it is

27
Q

finger agnosia

A

cant recognize individual fingers

28
Q

anosognosia

A

can’t recognize that something is malfunctioning or is deficient

29
Q

asmoatognosia

A

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

30
Q

prosopagnoisa

A

can’t recognize faces

31
Q

color agnoisa

A

can’t recognize colors

32
Q

what is the emergent assessment of stroke

A
  • EMS evaluation
  • NIH stroke scale, in ED
  • blood tests
  • non-contrast CT
  • CT angiogram with contrast
33
Q

why is a non-contrast CT ordered in ER

A

rule out hemorrhage

34
Q

what does CT angiography of head and neck with contras asses

A

stenosis or acute arterial vessel cut off

35
Q

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

A

MRI

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

36
Q

when is a stroke well visualized in a CT

A

24 hours later

37
Q

what are thrombolytics

A

clot-busting durg

-tissue plasminogen activator given IV

38
Q

how does tissue plasminogen activator TPA work

A
  • initiating local fibrinolysis by
  • binding to fibrin in thrumbus ( clot)
  • convert entrapped plasminogen to plasmin
39
Q

when can a thrombolytic be given to a stroke patient

A

within 3-4.5 hours of onset of neurologic deficit

40
Q

what is the most important benefit about giving TPA

A

people who were given TPA

- half as likely to have debilitating deficit at 3 months post-stroke

41
Q

what if given if patient does not meet requirement for TPA

A

full dose of aspirin

42
Q

is anticoagulation with heparin been useful in acute setting of stroke

A

no

43
Q

who actually benefits from early anticoagulations

A

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

44
Q

how is stroke etiology determined

A

location of stoke and distribution of infarct

  • assessment of underlying carotid or heart disease
  • assessment of hypertension, cholesterol, hyperglycemia, thyroid, tobacco
45
Q

what medications are given to prevent 2nd stroke

A 
aspirin
clopidogrel ( plavix)
46
Q

what does an ischemic stroke look like under a microscope

A

axonal swelling and inflammation first few days

- macrophages ingesting infarct debris weeks out (3-4)

47
Q

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

A

pons
basal ganglia
cerebellum
-secondary to hypertesnions

48
Q

what is a common cause of stroke in young people

A

vertebral dissection

49
Q

what can vertebral clots lead to

A

posterior circulation stokes ( BAD)

50
Q

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

A

hemibody motor or sensory symptoms without cortical involvement
-lacunar syndrome

51
Q

what is the hallmark for brainstem strokes

A

crossed findings

D&T2 Exam 1 (22 decks)

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