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NSCI 6112: Neuroscience > Cerebrovasculature & Stroke > Flashcards

Cerebrovasculature & Stroke Flashcards

1
Q

What is a blockage of a blood vessel resulting in lack of blood flow to an area of the brain called?

A

Ischemic Stroke

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2
Q

What is bleeding into the brain caused by a ruptured blood vessel called?

A

Hemorrhagic Stroke

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3
Q

Which type of stroke occurs more often (80% of the time)?

A

Ischemic

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4
Q

Stroke is ____ and occurs in _____

A

vascular/sudden/acute/focal; seconds to minutes

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5
Q

Although the brain is only 2% of the body’s weight, it is responsible for 15% of ____, 20% of ____ and 25% of ____

A

Cardiac Output
Oxygen Consumption
Total Body Glucose Use

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6
Q

The brain has a ___ energy reserve and relies on ___ metabolism to function normally

A

low; aerobic

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7
Q

The brain requires a continuous supply of ___ and ___. If hypoperfusion (reduced blood flow) occurs, it will rapidly lead to ____ and even ____

A

oxygen and glucose

neuronal injury and death

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8
Q

If soidum/potassium ATPase function decreases, intracellular potassium ____ and intracellular sodium ____, which leads to increased _____ and resulting cytotoxic edema (cell swelling)

A

decreases
increases
water

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9
Q

Cytotoxic Edema can be visualized on what type of MRI sequences?

A

DWI/ADC

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10
Q

Cytotoxic Edema can occur within minutes of what?

A

an ischemic stroke

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11
Q

Vasogenic Edema develops after _____ and peaks after _____

A

a few hours; several days

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12
Q

Increased permeability of capillary and endothelial cells leads to movement of water into the interstitial space. This is called what?

A

Vasogenic Edema

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13
Q

Vasogenic Edema is visualized on what type of MRI sequences?

A

T2/FLAIR

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14
Q

Vasogenic Edema appears hypodense on what imaging, therefore, should be ordered if it is suspected?

A

Head CT

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15
Q

Cytotoxic Edema is NOT visible on what imaging?

A

Head CT

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16
Q

What needs to be ruled out first when determining if a patient has had a stroke?

A

Intracranial Hemorrhage

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17
Q

In a stroke code, what neuro-imaging study is most appropriate and helpful?

A

Head CT because it is quick and sensitive to acute blood

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18
Q

Does a normal head CT rule out an ischemic stroke?

A

NO because cytotoxic edema is NOT visible on a CT and vasogenic edema takes a few hours to develop

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19
Q

Acute stroke imaging shows a normal CT scan and FLAIR scan less than ____ hours from onset, but abnormal DWI/ADC/FLAIR ______ after

A

6

hours-days

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20
Q

What is irreversibly damaged brain tissue called?

A

Infarct Core

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21
Q

What is the salvageable brain tissue in stroke called?

A

Pneumbra

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22
Q

What is the area of dead tissue resulting from failure of blood supply called?

A

Infarct

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23
Q

What is inadequate blood supply called?

A

Ischemia

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24
Q

Tissue viability is maintained by what?

A

Collateral circulation blood flow

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25
Q

Brain tissue dies rapidly without ______ due to dependence on continuous supply of what 2 things?

A

blood perfusion;

oxygen and glucose

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26
Q

Pneumbra tissue at the _____ of an infarct dies more slowly due to blood supply from collateral circulation

A

periphery

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27
Q

Acute stroke interventions to remove _____ are most successful when performed as soon as possible

A

blood clots

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28
Q

Artery occlusion results in focal brain injury to the areas supplied by ____

A

that artery

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29
Q

What are the 3 main categories of ischemic stroke?

A
  1. Large Vessel
  2. Small Vessel
  3. Cardioembolic
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30
Q

What are the 2 mechanisms of large vessel strokes?

A
  1. Thromboembolic

2. In situ thrombosis

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31
Q

What is the result of blood clots associated with artherosclerosis?

A

A large blood vessel stroke

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32
Q

What is a thromboembolic stroke?

A

traveling blood clot stroke

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33
Q

What is a in situ thromboembolic stroke?

A

blood clot that forms at its origin (stays put)

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34
Q

The ____ arteries join to form the basilar branches into the ____

A

vertebral; PCAs

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35
Q

The anterior circulation consists of ___, ____ and ___

A

ICAs, MCAs, ACAs

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36
Q

The posterior circulation consists of ___ arteries, ___ arteries and ____

A

Basilar, Vertebral, PCAs

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37
Q

___ branches into MCA and ACA

A

Internal carotids (ICAs)

38
Q

The _____ artery connects the anterior and posterior circulation

A

PCOM - posterior communicating artery

39
Q

ICA = ___ + ___

A

ACA + MCA

40
Q

The lateral brain is supplied by the ____

A

MCA

41
Q

The anterior brain is supplied by the ____

A

ACA

42
Q

The posterior brain is supplied by the _____

A

PCA

43
Q

The medial motor and sensory cortex is supplied by the ____

A

ACA

44
Q

The primary visual cortex (occipital lobe) is supplied by the ____

A

PCA

45
Q

The lateral portion of the primary motor and sensory cortices, language centers (left hemisphere) and spatial awareness (right hemisphere) are supplied by the ____

A

MCA

46
Q

The ____ is the primary motor cortex and the ____ is the primary somatosensory cortex

A

precentral gyrus; postcentral gyrus

47
Q

Cerebellar lesions cause deficits on the _____ side of the body

A

ipsilateral

48
Q

Cortical signs of a large vessel stroke include aphasia (____ hemisphere) or neglect (____ hemisphere)

A

left; right

49
Q

An anterior circulation stroke could affect which vessels?

A

MCA and ACA

50
Q

MCA stroke causes _____ face/arm weakness or numbness and ____ if it includes the left hemisphere or ____ if it includes the right hemisphere

A

contralateral
aphasia
neglect

51
Q

ACA stroke causes ____ leg weakness or numbness

A

contralateral

52
Q

PCA stroke causes ____ visual field deficits

A

contralateral

53
Q

A posterior circulation stroke could affect which vessels?

A

PCA, Basilar/Vertebral

54
Q

Basilar/Vertebral strokes include ____ symptoms on the ipsilateral side such as ataxia (incoordination) or ____ symptoms such as cranial nerve deficits

A

cerebellar; brainstem

55
Q

Broca’s is to _____ as Wernicke’s is to ___

mneumonic

A

“broken speech”; “warpspeed speech”

56
Q

Aphasia is a disorder of ____ whereas Dysarthria is disorder of ____

A 
language (production/comprehension)
speech articulation (muscle movements)
57
Q

Where does aphasia often localize?

A

Left Hemisphere

Left = Language

58
Q

Where does dysarthria often localize?

A

Relatively Nonspecific

59
Q

Which subcortical structure contains corticospinal motor pathways?

A

Internal Capsule

60
Q

Broca’s area is ____ whereas Wernicke’s area is ____

A

expressive; receptive

61
Q

What is it called if a patient exhibits clinical symptoms of both brocas and wernickes aphasia?

A

Global Aphasia

62
Q

A patient exhibits non-fluent speech, but is aware of their deficits and has intact comprehension. What is this type of aphasia?

A

Broca’s aphasia

63
Q

A patient exhibits fluent speech, but it is compared to “word salad” because of its paraphrasic errors and neologisms (new use of an old word). They have impaired comprehension and are unaware of their deficits (anosognosia). What type of aphasia do they have?

A

Wernicke’s aphasia

64
Q

Neglect is localized to which lobe and subsequently affects what side of the body?

A

Right parietal lobe (localization); contralateral (left) side is ignored

65
Q

Impaired attention to and awareness of one side of space is called what?

(hint: this is often related to doing the clock test)

A

Hemispatial Neglect

66
Q

A patient exhibits right side weakness and numbness in their face and arm, and have aphasia. What type of stroke has occurred?

A

LEFT MCA stroke

67
Q

A patient exhibits left side weakness and numbness in their face and arm, and have neglect. What type of stroke has occurred?

A

RIGHT MCA stroke

68
Q

A patient exhibits weakness and numbness of the contralateral leg. What type of stroke has occurred?

A

ACA stroke

69
Q

A patient exhibits contralateral visual field deficits. What type of stroke has occurred?

A

PCA stroke

70
Q

A patient exhibits uncoordinated movements, dizziness, vertigo and other cerebellar/brainstem symptoms. What type of stroke has occurred?

A

Basilar/Vertebral

71
Q

What is the strongest risk factor for a Lacunar stroke and why?

A

HTN because it wears and tears small delicate arteries

72
Q

Small vessel stroke pathophysiology occurs when chronic ____ causes intrinsic changes to the small blood vessels, causing vessel wall ____ and lumen ____, which subsequently leads to _____

A

HTN
thickening
narrowing
occlusion

73
Q

Specific pathologic changes in small vessel stroke include what? (3)

A
  1. Lipohyalinosis (vessel wall thickening and a resultant reduction in luminal diameter)
  2. Arteriosclerosis (thickening and hardening of the walls of the arteries, occurring typically in old age)
  3. Microatheroma (plaque)
74
Q

What is Lipohyalinosis?

A

vessel wall thickening resulting in reduced lumen diameter

75
Q

Vessel wall changes (weakening) can cause an artery rupture, which may lead to what type of stroke?

A

hemorrhagic stroke (focal)

76
Q

T/F: Atherosclerosis of a large trunk vessel occluding the origin of a small vessel is quite common

A

false; LESS common

77
Q

In small vessel anterior circulation, the MCA supplies what?

A

Lenticulostriate arteries

78
Q

In small vessel posterior circulation, the PCA supplies what (perforating) arteries?

A

Thalamoperforators

79
Q

In small vessel posterior circulation, the basilar arteries supply what (perforating) arteries?

A

Pontine Perforators

80
Q

Cerebellar arteries in posterior circulation of small vessels include ___, ____ and ____

A

SCA, AICA, PICA

81
Q

PICA is supplied by what artery in the posterior circulation?

A

vertebral

82
Q

AICA and SCA are supplied by what artery in the posterior circulation?

A

basilar

83
Q

The internal capsule and basal ganglia are supplied by what anterior circulation pathway?

A

MCA –> Lenticulostriate arteries –> int capsule and bg

84
Q

The thalamus is supplied by what posterior circulation pathway?

A

PCA –> Thalamoperforators –> Thalamus

85
Q

The pons is supplied by what posterior circulation pathway?

A

Basilar Artery –> Pontine Perforators –> Pons

86
Q

The cerebellum and brainstem are supplied by what posterior circulation pathway?

A

Basilar/Vertebral –> SCA, AICA & PICA –> Cerebellum and Brainstem

87
Q

Which type of stroke is more likely to cause motor/sensory deficits in more body parts?

A

small vessel strokes

88
Q

Which type of stroke causes the entire contralateral hemibody to be affected?

A

small vessel strokes

89
Q

Which type of stroke exhibits NO cortical signs?

A

small vessel strokes

90
Q

In anterior circulation strokes (face/arm/leg weakness), fill in the blanks below:

  1. Weakness distribution:
    - Face/Arm > Leg = ___ vessel
    - Just Leg = ___ vessel
    - Face/Arm/Leg ___ vessel or ____ (if this has occurred, proceed to #2 below to narrow down the vessel)
  2. Cortical Signs? (aphasia or neglect?)
    - If yes = ___
    - If no + ____
A
  1. MCA; ACA; ICA (mca + aca) OR lenticulostriate

2. yes = ICA; no = lenticulostriate

91
Q

What is a major risk factor for large vessel stroke?

A

Atherosclerosis

92
Q

What type of stroke occurs when an embolus (blood clot) travels from the heart to the brain, where is lodges in a blood vessel and causes a stroke? (Commonly a result of A-Fib)

A

Cardioembolic Stroke

NSCI 6112: Neuroscience (10 decks)

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