Cerebrovascular disorders

Question 1

What is a stroke?

Answer 1

• Acute onset of neurological deficits due to disturbance in blood supply
• Approx 15 million people suffer strokes each year

Question 2

What are the non-modifiable risk factors of a stroke?

Answer 2

• Age
• Atrial fibrillation
• Gender
• Ethinicity
• Family history

Question 3

What are the modifiable risk factors of a stroke?

Answer 3

• Hypertension
• Diabetes
• Hyperlipidemia
• Smoking
• Obesity
• Carotid artery disease

Question 4

What are the types of stroke?

Answer 4

• Ischemic (85%)
  1. Thrombotic (55%) - Lacunar occlusion + Large vessel occlusion
  2. Embolic (30%) - Large vessel occlusion
• Haemorrhagic (15%)
  1. Intracerebral (10%)
  2. Subarachnoid (5%)

Question 5

What are the symptoms of a stroke?

Answer 5

1. Haemorrhage
   * Thunderclap headache, seizures, nausea, unilateral weakness
2. Anterior circulation
   * Hemipegia/paresis
   * Hemisensory loss
   * Dysphasia
   * Aphasia
   * Hemianopia

3.Posterior circulation
* Unilateral limb weakness
* Ataxia
* Dysarthinia

4. Non-specific symptoms
   * Confusion, drowsiness, dizziness
   * Nausea, double vision
   * Incontinence

Question 6

What is a Lacunar infarction?

Answer 6

• Small, strategic strokes in penetrating arteries that feed sub-cortical structures
• As many as 80% are clinically silent
• Motor hemiplegia syndrome - Infarction in internal capsule, basal gangli, and/or pons

Question 7

How do you identify a stroke?

Answer 7

• Diagnosis performed on the basis of neurological exam
• Followed by urgent referral for neuroimaging

Question 8

How do you treat a Haemorrhage?

Answer 8

• Well it has a 45% mortality
• 30% vasospasm
• Treatment involves pain management and surgery to repair bleed with clipping or coiling
• May include lowering BP

Question 9

How do you treat Ischemic stroke?

Answer 9

• Thrombolysis with Alteplase within 3hrs
• Thrombectomy with retriever devices within 6hrs

Question 10

What is the penumbra?

Answer 10

• Time is brain
• Core blood flow = not enough for cells to survive
• Penumbra = Just enough for cells to potentially survive
• As time goes on penumbra tissue dies, and becomes core tissue
• So the longer the stroke goes on for, the more cells will become core tissues and die.

Question 11

What is the time course of a stroke?

Answer 11

Question 12

Describe the pathophysiological overview?

Diagram

Answer 12

Question 13

Describe the pathophysiological overview?

Words

Answer 13

• No blood flow= unable to regulate polarisation
• Therefore lots of ions flow in, so more water flows in
• K+ leaves
• BAD
• Too much Ca activates enzymes, that destroy membrane in cells
• Free radicals created whcih causes apoptosis

Question 14

Explain Vascular cognitive impairments?

Answer 14

• Same Vascular risk factors that predispose an individual to stroke, also inc risk of dev dementia
• Vascular cog impairment is umbrella term for many Cognitive disorders that are thought to share vascular origin

Question 15

What is cerbrovascular disease?

Answer 15

• Less blood flow to brain
• Brain becomes hypo-perfused
• Leads to atrophy, microbleeds, large vessel occlusion etc

Question 16

Summarise CVD

Answer 16

• Vascular risk factors are hughly associated with cerebrovascular pathology and dementia
• VCI refers to heterogeneous group of cognitive phenotypes
• Many cerebrovascular pathologies associated with VCI can be visualised with neruo-imaging:
  1. White matter hyperintensities
  2. Microbleeds
  3. Enlarged perivascular spaces
  4. Cerebral amyloid angiopathy