Cerebrovascular disease: a clinical correlate Flashcards
define stroke
abrupt onset of focal neurologic deficit caused by ischemia or hemorrhage
what type of stroke is more commone
ischemic
define transient aschemic attack
abrupt neurologic deficits but resolve within 24 hours
what is ischemic penumbra
outer rim of stroke of cerebral tissue
what are 2 pathways that result in cellular death from stroke
Necrotic
Apoptotic
how does necrotic cell death occur
result of energy failure from no blood flow
-cells swell and die
what is apoptotic cell death? cells in what location usually do this?
programmed cell death
-penumbra
Major clinical finding for Anterior cerebral artery
contralateral leg weakness
Major clinical finding middle cerebral artery
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)
Major clinical finding posterior cerebral artery
contralateral visual field cut
Major clinical finding subcortical lacunar infarct
contralateral motor or sensory deficit without cortical signs of aphasia, apraxia or neglect
Major clinical finding basilar artery
oculomotor deficits. “crossed” face and body findings of sensory and/or motor deficits
Major clinical finding vertebral artery
lower cranial nerve deficits. “ crossed” face and body sensory deficits
aphasia
loss of ability to understand or express speech
apraxia
inability to perform particular purposive actions
what is neglect
complete loss of contralateral side of space and contralateral side of body from the stroke
Anosogniosia
unawareness of illness and its clinical manifestations
neglect tends to occur from what type of trauma
right middle cerebral artery
right parietal lobe
what are 2 types of apraxia
idealtional and dressing
what is ideational apraxia
confusion about task sequencing
what is apraxia dressing
confusion about orientation of clothing: top-bottom, right-left, front-back
where does trauma occur for apraxia
non-dominant parietal lobe or premotor cortex of frontal lobe
alexia
inability to read
agraphia
inability to write
aphasia syndrome
aphasia, alexia, agraphia
agnosia
loss of ability to recognize an entity for what it is
finger agnosia
cant recognize individual fingers
anosognosia
can’t recognize that something is malfunctioning or is deficient
asmoatognosia
can’t recognize part of your body as part of you
prosopagnoisa
can’t recognize faces
color agnoisa
can’t recognize colors
what is the emergent assessment of stroke
- EMS evaluation
- NIH stroke scale, in ED
- blood tests
- non-contrast CT
- CT angiogram with contrast
why is a non-contrast CT ordered in ER
rule out hemorrhage
what does CT angiography of head and neck with contras asses
stenosis or acute arterial vessel cut off
what is used for non-emergent imaging? why would this ordered
MRI
-confirm presence of a stroke it its not well-visualized in CT
when is a stroke well visualized in a CT
24 hours later
what are thrombolytics
clot-busting durg
-tissue plasminogen activator given IV
how does tissue plasminogen activator TPA work
- initiating local fibrinolysis by
- binding to fibrin in thrumbus ( clot)
- convert entrapped plasminogen to plasmin
when can a thrombolytic be given to a stroke patient
within 3-4.5 hours of onset of neurologic deficit
what is the most important benefit about giving TPA
people who were given TPA
- half as likely to have debilitating deficit at 3 months post-stroke
what if given if patient does not meet requirement for TPA
full dose of aspirin
is anticoagulation with heparin been useful in acute setting of stroke
no
who actually benefits from early anticoagulations
cardiac thrombus
large artery severe stenosis
dissection of vertebral and carotid arteries
how is stroke etiology determined
location of stoke and distribution of infarct
- assessment of underlying carotid or heart disease
- assessment of hypertension, cholesterol, hyperglycemia, thyroid, tobacco
what medications are given to prevent 2nd stroke
aspirin clopidogrel ( plavix)
what does an ischemic stroke look like under a microscope
axonal swelling and inflammation first few days
- macrophages ingesting infarct debris weeks out (3-4)
what are 3 common sights of hemorrhage? these sights are usually secondary to what
pons
basal ganglia
cerebellum
-secondary to hypertesnions
what is a common cause of stroke in young people
vertebral dissection
what can vertebral clots lead to
posterior circulation stokes ( BAD)
how do you know if its a subcortical stroke? what are the syndromes called
hemibody motor or sensory symptoms without cortical involvement
-lacunar syndrome
what is the hallmark for brainstem strokes
crossed findings
